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The concept of egg quality of a woman is derived from the belief that the embryo implantation probability is powerfully related to the age and ovarian reserve of the woman. Thus, it is regarded that the quality of the egg is almost synonymous with the chances of embryo implantation. Its quality cannot be assessed merely by looking at the egg or measuring its ability to receive the fertilization by sperm or simply observing the initial embryo division.
There are a few important factors that contribute to the success or failure of the embryo implantation and some of them are:
- Diminished ovarian reserve: A woman with an increased FSH level on the third day of the menses is regarded as having diminished reserve of ovary. This implies that her ovary is not competent in sending feedback signals to the pituitary gland and the body responds by producing an increased amount of FSH for stimulating the ovary. For more than 10 years, it has been found that in over thousands of fertility treatment cycles, women with an increased FSH level have a lower egg quality.
- Advanced age of maternity: Even though the FSH level is normal, the age of the mother who provides the eggs plays an important role to determine the quality of the egg. Quite like women with increased FSH levels, eggs obtained from women aged more than 40 years can have some problems at a later stage of fertilization. Normal FSH levels are not considered a reassuring factor, owing to the lower implantation rate in females aged over 45 years.
- Diminished quality of egg: With an increase in age, the capacity of the mitochondria in producing energy slowly decreases. The egg is linked to the circulation before ovulation, and it is linked again after the embryo implantation. But during the one week time ranging from ovulation to implantation, the egg and the resulting embryo are contained in the zona pellucida and function on the basis of mitochondrial energy supply. The older age of the woman doesn’t cause any problem at the initial stage of ovulation. Its fertilization and embryonic development are also normal. But soon, it runs out of energy and stops dividing before reaching the stage of implantation.
Therefore, it is important to have the eggs tested to find out any sort of chromosomal abnormality. In case the mother is deficient of producing high quality eggs, the best option is to have donor eggs.
In case you have a diseased uterus, which makes you infertile, you can undergo a procedure known as uterus transplant or uterine transplant to get pregnant. In the process of sexual reproduction, a diseased uterus does not allow embryonic implantation. This factor is referred to as uterine factor infertility or UFI. As a result, you will not be able to get pregnant.
Who requires a uterus transplant?
This procedure involves women who have UFI and women who had their uterus removed by hysterectomy. Women who have a damaged uterus on account of an injury or infection, which does not function anymore, can also undergo a uterus transplant procedure. Women from the age of 21 to 45 are eligible for this procedure. Many women are born without having a uterus. This condition is called Mayer-Rokitansky-Küster-Hauser syndrome.
Uterus transplantation begins with undertaking a uterus retrieval surgery on the uterus donor. The uterus, which is recovered has to be stored and transported to the location of the patient undergoing the transplant. An ischemic tolerance may last over 24 hours. Three major surgeries have to be carried out with the recipient. Firstly, a transplantation surgery is required in which the donor’s uterus gets transplanted. In case pregnancy develops, a caesarean section surgery has to be performed. The patient is given immune suppressive therapy. After childbirth, a hysterectomy is done in order to terminate the immune suppressive therapy.
Will the women be able to get pregnant after having sex?
Women receiving a uterus transplant will not be capable of becoming pregnant without undergoing fertility treatments. The transplanted uterus is not connected with the fallopian tubes, which is the location of the normal fertilisation process. The women will require to carry out IVF or in vitro fertilisation to become pregnant after a uterus transplant. IVF is a process in which the eggs are removed from the ovaries and get fertilised in a laboratory. Then, they are implanted in the uterus. After undergoing the uterus transplant procedure, a woman has to wait for a period of one year. The uterus requires time for healing and after recovery, the embryo may be implanted for pregnancy. After giving birth successfully, a woman will be able to keep the transplanted uterus.
She has the option to get pregnant again. However, after giving birth twice, a hysterectomy must be carried out for the removal of the uterus. This is done so that the woman can stop using the immune suppressant drugs, which are associated with major risks. Uterus transplant is a relatively new technology. In October 2014, the first healthy baby was born to a woman who had undergone a uterus transplant. This surgery is kind of experimental in nature and is usually the last option for getting pregnant.
How does the ICSI method in IVF treatment help manage severe male infertility?
Male infertility is a growing problem in India. According to survey, almost 40 percent of all infertility cases have been attributed to male infertility. Severe male infertility is often dealt with IVF, using the ICSI method. Here is a look at all you need to know about IVF with ICSI.
What is ICSI?
ICSI or intracytoplasmic sperm injection is a specialized method of IVF, where the sperm from the male partner is not allowed to fertilize the female egg normally. Instead, a single sperm is isolated and inserted into a mature egg, to get it fertilized. A hollow needle is used to extract the sperm from the male. Primary features of the ICSI-IVF include-
- The egg is fertilized inside a petri dish, as the sperm is not introduced inside the female’s body.
- Only one healthy sperm is selected from the sample and is injected into a single mature egg for the fertilization
- The fertilized eggs are monitored under laboratory conditions.
- Once the egg is fertilized, it can be introduced inside the woman’s body, similar to the ordinary IVF procedure.
Reasons why ICSI is used
Here is a look at some instances, when your doctor may advise you and your partner to undergo ICSI-IVF-
- Very low sperm count
- Sperm with abnormal shape
- Poor sperm motility
- Other IVF treatment has not yielded desired results
- If the sperm being used is frozen, the ICSI-IVF procedure may be required.
Risks involved in the IVF-ICSI method of fertilization
The ICSI procedure comes with all the risks involved in the normal IVF procedure. However, it does not introduce any new risk factors into the mix. This method of fertilization carries a slightly higher chance of the baby being born with defects when compared to a normal conception. However, it is still quite rare.
With the IVF-ICSI method , couples suffering from infertility have 50 to 80 percent chance of a successful conception.
Infertility is known to usher a lot of emotional stress in the lives of those who go through it. Often, an overwhelming sense of grief descends upon the couple who try to grapple with the sense of loss. The social and psychological ambience plays a very important role in reconciling one with the harsh reality and prepping one up for a fresh start.
While IVF has proven to be a boon in the lives of many couples, many still take to IVF as the last resort. Another factor that makes the responses about IVF rather ambiguous is the uncertainty of the results. There are numerous factors like failure in embryo attachment or uterine incompatibility that often results in a failed IVF. Therefore, before opting for this surgery, one must be mindful of the consequences.
Some of the ways, one can prepare oneself for IVF have been enlisted below:
- Informed choice - Considering IVF is a rather stressful surgery, one needs to be well aware of the stakes. Reading up about the potential risks and the details about the process, helps one to be prepared for the consequences and deal better with the trauma.
- Take good care of your intimate relationships - Since IVF tends to take a toll on not just the mother, but also the close family, it is important to maintain a strong bond of trust and compassion in the course of the surgery. Hostility and discordance adds on the stress and sometimes inflict grave health implications upon the mother. It is important to support your partner through the entire journey. You may consider professional counselling too.
- Prepare yourself for all possible situations - While the advanced technology aims to minimize any hazard, the results can often be unpredictable. You might want to adequately monitor your cycle in order to anticipate the potential problem areas and the results thereof. You should discuss these with your loved ones to avert excessive stress. It is a good idea to keep oneself productively busy in the due course to avoid anxiety.
In case the fertility odds are against your favour, you can undergo a procedure called IVF or in vitro fertilisation. It is a form of fertility treatment in which the sperms and eggs are combined in a laboratory. IVF is a very common fertility treatment procedure, involving modern technology. It is carried out by many women and couples worldwide. When you are facing ovulation problems and issues with the quality of eggs, have blocked fallopian tubes or if your male partner has a low sperm count, a sperm donor’s eggs are used via IVF to become pregnant.
The overall process of IVF involves several methods and steps :
- Ovarian stimulation - You will have to take a fertility drug called gonadotrophin eight to fourteen days before the beginning of your menstrual cycle. This will help to stimulate your ovaries for the development of multiple, mature eggs for fertilisation. You will also be given synthetic hormones like cetrorelix and leuprolide.
- Development of follicle - You should be visiting your doctor frequently while having the medicines for a check-up of your blood hormone levels. Your ovaries will also be measured using ultrasound. This will allow the doctor to monitor the follicle development.
- Trigger shot - You will be given a trigger shot injection when the follicles are prepared. This injection leads to full maturation of the eggs, making them ready for fertilisation. The eggs require a period of 36 hours for retrieval after receiving the trigger shot.
- Gathering of the eggs - An anesthetic will be given to you and an ultrasound probe will be inserted via your vagina for observation of the ovaries and follicles. A thin needle will be inserted through the vaginal wall with which the eggs are removed from the follicles.
- Fertilisation - The eggs will be observed one final time before being combined with your partner’s sperm. Then they will be incubated overnight. Fertilisation occurs during this period and the abnormal eggs do not get fertilised. Three days after the egg retrieval, some of the successfully fertilised eggs transform into embryos composed of six to ten cells. Within five days, some of these embryos turn into blastocysts composed of fluid-filled cavities and tissue. This separates into the baby and the placenta. The most viable embryos are placed in your uterus. One to five embryos are placed in your uterus by the insertion of a catheter through the cervix. The embryo implants itself to the uterus walls. Gradually, it develops into the baby. The chances of pregnancy are higher when there are multiple embryos.
Before thinking of undergoing IVF, you must consult a doctor to know about the entire process. You also need to know whether you are fit to undergo IVF as there are several criteria you should satisfy for IVF.
Giving birth to a baby is one of the happiest experiences for a mother. However, there are times when a woman runs into problems while trying to conceive. This is where the technique of IVF is very useful.
What is IVF?
In vitro-fertilisation, a type of assertive reproductive technique or ART involves retrieving eggs from the ovaries of a woman and then fertilizing them with sperms taken from a man. The fertilized egg also called an embryo is frozen for a long time in an incubator and then put into a woman’s uterus so that she gets pregnant.
The embryos can also be implanted inside a surrogate mother. IVF has been a proven and effective method to treat infertility among both men and women. The Society for Assisted Reproductive Technology (SART) states that the average women who fall under the reproductive age develop a 20% to 35% chance of getting pregnant via IVF.
Reasons why couples opt for In Vitro Fertilisation-
1. Blocked or damaged fallopian tubes
One of the major causes of infertility, fallopian tubes can block due to a number of reasons like Pelvic infection, Appendix burst, Gonorrhea or other sexually transmitted diseases, Abdominal surgery, Hydrosalpinx or swelling at the end of the fallopian tube and others.
Both the ovaries inside the female body is linked to the uterus by a fallopian tube. If one of the tubes is blocked, there are low chances of producing a fertilized egg. But if both the tubes are blocked, the chances of conceiving are nil.
IVF doesn’t involve fallopian tubes for pregnancy.
Sometimes the egg does not mature during the menstrual cycle. As a result, the woman does not ovulate. This is called anovulation. It either develops as a chronic problem where they experience an anovulatory cycle at one time and a regular cycle in the next or they experience no periods at all. It mainly prompts from the disruption of the hormone levels in the body, which further interferes with the pregnancy.
IVF method is used when the woman cannot conceive even after the intake of ovulation-inducing pills.
A type of pregnancy loss, miscarriage usually occurs when the pregnancy ends after the first 20 weeks of gestation due to certain complications.
In the first trimester, a miscarriage can occur due to the chromosomal abnormality of the baby inside the mother’s womb. Other possible causes include hormonal problems, the age of conceiving, maternal trauma, an unhealthy lifestyle like smoking, doing drugs or exposure to toxins etc.
With IVF, the number of candidate embryos increases and creates chances of a successful pregnancy.
4. Infertility among men
Male infertility lowers the possibilities for a woman to get pregnant. It contributes to about 45-50% in all cases of infertility.
The doctors suggest IVF with intracytoplasmic sperm ejection, a laboratory procedure where a single sperm is injected directly into the cytoplasm of a woman’s egg taken from her ovary.
5. Low Ovarian Reserve
A woman can also have a lower count of eggs in her ovaries. Also called Diminished Ovarian Reserve or DOR, the woman’s ovaries lose their potential for reproduction and result in infertility.
IVF stimulates in the development of healthier eggs. With reproductive endocrinologist, the matured eggs are collected directly from the ovaries. However, younger woman has more chances of success with the IVF technique.
This is the condition when the tissues lining your uterus or endometrium grows outside the uterus or the fallopian tubes and is largely associated with fertility problems. About 40% of unexplained infertility results from endometriosis through anatomical distortion or inflammation.
Although it can be successfully treated with surgeries and medication, IVF is a favoured option among many couples. Since it fertilizes the eggs and the sperm outside the body and later transplants it into the uterus, it bypasses the toxic pelvic environment and helps overcome endometriosis-related infertility.
7. Unexplained infertility
Most of the causes behind unexplained infertility are said to be epigenome or genetic. However, with IVF, the chances of getting pregnant are higher.
IVF can also determine the causes of your infertility. For example, if the fertilization of the sperm and the egg fails to result in pregnancy, it is a direct sign than embryonic development or implantation is the root cause.
PCOS is the condition where small cysts form inside your ovaries triggers irregular periods, excessive stomach cramps and hormonal imbalance. Immature ovaries do not assist in ovulation and produce complications infertility. Women with PCOS also develop high levels of ‘androgen’ or male hormones in their body, which is converted to estrogen and in turn, impairs the conception process.
Assisted reproduction or in vitro fertilization (IVF) sharply improves the chances of pregnancy despite PCOS.
The uterine cavity has a tissue base that is known as the endometrium. When this endometrium spills over or spreads to the other parts of the reproductive organ, it begins to punch through the uterine lining. Such a condition creates complications and even infertility, and is known as endometriosis.
Read on to know more about endometriosis and how it can cause infertility.
When the endometrium tissue spreads to areas like the ovaries, and the abdominal cavity, it can lead to numerous complications. Apart from pain, this may also cause infertility. 5 to 10% of the women worldwide suffer from this condition and have trouble conceiving. Additionally, about 30 to 40% of the infertility cases are due to endometriosis, not all cases. These figures are all confirmed by various medical studies.
How does it cause infertility?
Endometriosis can prevent ovulation, which is the process that occurs every month. During the ovulation process, the ovaries release eggs that may be fertilised in order for the woman to conceive. In this condition, the fimbria of the fallopian tubes also has trouble in capturing the egg, which prevents conception from taking place. This leads to infertility in the long run. Endometriosis also interferes with the proper production of the hormones that are required for normal ovulation and fertilisation of the egg.
Diagnosis: The diagnosis of the condition can be done with the help of lab tests and ultrasounds as well as imaging tests that can create the image of the womb and the endometrium lining. This will help in showing the severity and damage caused by the tissue. A surgical procedure called a laparoscopy may be carried out by the doctor to ascertain whether the patient is suffering from this condition. In this procedure, a small incision will be made and a camera will be inserted to view the insides on a screen, to learn more about the tissue’s spread and the kind of treatment that will be required. The doctor will also diagnose the condition on the basis of various symptoms like irregular and heavy bleeding.
Treatment for endometriosis associated with infertility needs to be individualized for each woman. There are no easy answers, and treatment decisions depend on factors such as the age of the woman, the severity of the disease and its location in the pelvis, the length of infertility, and the presence of pain or other symptoms. Some general issues regarding treatment are discussed below.
Treatment for Mild Endometriosis
Medical (drug) treatment can suppress endometriosis and relieve the associated pain in many women. Surgical removal of lesions by laparoscopy might also reduce the pain temporarily.
However, several well-controlled studies have shown that neither medical or surgical treatment for mild endometriosis improving the pregnancy rates for infertile women as compared to expectant management (no treatment).
For treatment of infertility associated with mild to moderate endometriosis, controlled ovarian hyperstimulation with intrauterine insemination - IUI is often attempted and has a reasonable chance to result in pregnancy if other infertility factors are not present.
Details about IUI success rates with endometriosis
IUI and endometriosis
Success rates with IUI for endometriosis have been variable in studies, showing:
- A pregnancy rate of 6.5% for women with endometriosis vs. 15.3% per cycle for unexplained infertility
- A pregnancy rate of 5.6% for women with advanced endometriosis vs. 22.7% per cycle for mild endometriosis vs. 25.7% for no endometriosis
- Pregnancy chances with insemination for natural cycle IUIs (no drugs) with endometriosis are about 2% per cycle vs. 11% with injectables plus IUI for endometriosis
Several studies have shown that medical treatment for severe endometriosis does not improve pregnancy rates for infertile women.
Unfortunately, infertility in women with severe endometriosis is usually resistant to treatment with ovarian stimulation plus intrauterine insemination. If the pelvic anatomy is very distorted, artificial insemination is unlikely to be successful. These women often require in vitro fertilization in order to conceive.
Although the studies of in vitro fertilization for women with severe endometriosis do not all show similar results, pregnancy success rates are usually good if the woman is relatively young (under 40) and if she produces enough eggs during the ovarian stimulation.
There are many reasons leading to infertility, but one of the main causes is the inability of the sperm to travel all the way up to the uterus to fertilize an egg. This is caused by defective sperms and could be due to poor sperm quality, poor motility, etc. There are multiple reasons for this, and even smoking, obesity, diabetes, hypertension, etc. could be reasons.
Many technical advancements in fertility treatments are being done, and they try to keep the natural process of fertilization intact, at the same time improving the chances of success. Intracytoplasmic sperm injection (ICSI, often used as a standalone term iksee) improves the rate of fertilization in that the sperm is directly injected into the egg. The environment of this artificial fertilization is completely controlled, and the fertilized egg is then placed into the womb for further growth. It is one of the recent methods of improving fertility, a part of ART (assisted reproductive technology).
- Poor sperm perms motility
- Semen where sperm concentration is low
- Male infertility with unidentifiable cause
- Poor sperm quality, with sluggish sperms
- Ejaculation issues, such as retrograde ejaculation (semen is ejected into the bladder)
- Useful in couples who have failed IVF.
The following outlines some of the steps for both male and female before and during the procedure.
Before the procedure - males:
- First step is the sperm collection; a screening is first done
- Sperms collection happens through either masturbation or directly from the testicles via a small incision
- Sperms could be collected fresh or collected and frozen for later use
Before the procedure – women:
- In the normal menstrual cycle, only a single egg is released. However, prior to ICSI, the woman is given ovulation drugs, which are high-dose hormone injections prior to ovulation. This ensures multiple eggs are released, which are then retrieved for fertilization in the external environment.
- Blood and urine are monitored regularly to identify the ovulation time, and eggs are collected within 24 to 36 hours of release
During the procedure - How ICSI happens:
- A healthy egg is chosen and placed in a glass tube, and a sperm is introduced to ensure fertilization
- This could be repeated in multiple tubes, and the most healthy one could be chosen to be implanted into the uterus
- Some of the fertilized ones could be frozen for later use, in case the implanted embryo fails to grow as expected
- The success rate for this procedure is quite high as the fertilization rate is almost 80 - 85 %
There is every possibility that even after going through more than three rounds of IVF, the treatment might not turn out to be successful, wherein it might not result in pregnancy. Naturally this kind of situation makes women frustrated and thus leads them to consider other alternative options.
One other option which is sometimes offered by IVF clinics present abroad after few unsuccessful attempts or miscarriages, which cannot be explained by the specialists, is using corticosteroids. Corticosteroids are steroid hormones that can either be made in the body or even in a lab.
Generally, corticosteroids are used to treat certain life threatening autoimmune diseases like lupus, severe kinds of allergies and for preventing the organ transplants from getting rejected. Certain serious side-effects are associated with corticosteroids, which include insomnia, infections, mood changes, heart problems, gain in weight and also headache.
At IVF Clinics, corticosteroids are given in order to meet the demands of people having fertility problems along with other doses to suppress immunity. All these are mainly driven by misunderstanding both on the part of a consumer as well as that of medical, on how the immune response actually works.
Immune system in case of pregnancy
- Most of the doctors carry a view, which is completely outdated. They believe that immunity gets naturally reduced, when a woman is pregnant. As a result of this belief, they feel that it is completely acceptable to get the immune system suppressed by way of medication.
- The argument which the doctors put forward in case of suppressing the immune system during pregnancy completely ignores clear proof of the fact that an immune response in a controlled manner is actually an essential part of normal embryo implantation. This is necessary for healthy growth of the fetal. Though the uterus might look to be unwilling to allow implantation of the embryo, if the immune system is suppressed through the use of drugs, then that will not solve the problem.
- The immune system plays an important role as it acts as a defence for the body against all kinds of infections and cancer. During pregnancy, cells of immune system assist the uterus to tolerate and properly nurture the embryo even when it carries the foreign genes from the father.
Use of corticosteroids is not so safe or effective
The records put forward by the IVF clinics through those women, who have been pregnant by way of IVF, have created the false perception about the fact that corticosteroid drugs are safe and effective. The patient group had low chance of adverse effects from the use of this drug has ensured wide-scale use of corticosteroids, as they come up with no kind of immune disorder.
Still, there always remains a high chance of problems in pregnancy and a higher rate of foetal malformations for women, who take these drugs. Data suggests that among 311 women, who had used corticosteroid drugs for more than the first 3 months of IVF cycle, had gone on to show 64% increase in miscarriage.
In certain case of autoimmunity, some women might benefit from these drugs but in majority of women, these steroids cause more than any good.
In vitro fertilization (IVF) includes empowering the woman with medicines, taking various eggs from her ovaries, fertilizing them with her partner’s sperm, and inserting a portion of the subsequent embryos into her uterus with the trust that one will form into a fetus.
Tubal ligation reversal, on the other hand, requires a laparotomy, which needs a much bigger entry point on the abdomen, usually around four to six fingers long. Since the skin, each of the muscles, and different tissues of the stomach must be sliced through, there is extensively more uneasiness and a longer recovery time required after the surgery, when compared with a laparoscopic surgery, for example, with a tubal ligation.
- Sperm quality: The male partner needs a sperm test before basic procedures of either of the two. In case that the sperm quality is great, then the couple could consider proceeding. In case that the sperm quality is poor, in vitro treatment is the better alternative. With IVF, poor sperm quality is effectively overcome.
- Tubal status: The length of the remaining tubal stumps after tubal ligation is an important aspect. The more extended the two remaining stumps are on each side, the better and more effective is the pregnancy. The shorter the stumps, the lower are the odds for pregnancy.
- Status of other pelvic conditions: Pelvic endometriosis or any scar tissue in the range of the tubes or ovaries would diminish the chance for accomplishment after tubal ligation reversal. Although, IVF pregnancy achievement rates are usually not influenced by these conditions. Along these lines, in vitro fertilization is most likely a superior alternative in women with noteworthy endometriosis or pelvic scar tissue.
- Female age: Chances for pregnancy with either tubal ligation or IVF decrease in the mid to late thirties and significantly reduce at the age of thirty-eight. By age forty-three or forty-four, not many women will have the capacity to have a baby using either approach.
- Egg amount and quality: A few women have a decrease in either egg amount or quality prior in life than anticipated. In this manner, the woman’s ovarian capacity needs to be tested before a choice is made in regards to whether to continue with either tubal ligation or in-vitro fertilization. AMH levels, ovarian antral follicle number, and day 3 FSH levels are generally done to evaluate ovarian capacity or hold.
- Doctor intervention: The greatest favorable position of tubal ligation reversal over IVF is that once the woman has experienced the surgery she ideally will not require any medication through the doctor, for example, medications or systems, keeping in mind the end goal to get pregnant.