Dr. Gokhle

In vitro fertilisation, commonly known as IVF, is the process of fertilising single or multiple eggs outside the body. This treatment can be performed by either using your own egg and sperm or using donated egg or sperm or sometimes both. The resulting sperms and eggs are evaluated for quality and then one or more of them are positioned properly in the uterus through the cervix. IVF is regarded as one of the most commonly opted treatment plans, and it accounts for more than 99% of assisted reproductive technology processes.

Who are suitable for IVF?
IVF can be helpful for you in case you have some issues with the egg quality or ovulation, fallopian tubes that are blocked in some way or endometriosis. It can also help you get pregnant if your partner has problems with mortality and reduced sperm count and when you have opted for donor eggs. About 1.5% of babies in the United States are conceived through the IVF process.

How does IVF work?
There are several steps through which IVF process works and the timeline follows the following steps:

1. Stimulation for ovary: You will have to take a special kind of fertility drug for 8 to 14 days near the start of your menstruation cycle. This drug aids in the stimulation of your ovaries for developing multiple mature eggs to fertilise instead of a single one. You may also need to take an artificial hormone-like cetrofelix and leuprolide for keeping your body from releasing eggs very early.
2. Development of follicle: When you are under all these medications, you will have to visit your doctor’s office often for checking the hormone levels as well as ultrasound measurements for the ovaries.
3. Getting the trigger shot: Once the follicles are ready, you are likely to receive a trigger shot, which is an injection causing the eggs for maturing fully and becoming capable of being fertilised. Your eggs are ready for being retrieved after about 36 hours of receiving this shot.
4. Gathering the eggs: At this stage, you are likely to receive an aesthetic or ultrasound probe that is inserted through the vagina for checking the ovaries and identifying the follicles. Normally, about 8 to 15 eggs are retrieved through the insertion of a thin needle.
5. Fertlisation: This is the most vital step, where an embryologist is going to examine the eggs before they are combined with the sperm and incubated overnight. Fertilisation happens at this particular time, but abnormal eggs are not fertilised.

Then the embryos slowly develop and are planted on the basis of your age and clinical condition. When the treatment is working, an embryo is implanted in the uterine walls and starts developing. 

Disabilities can occur due to injuries, infections, or old age. Whatever the reason, the person has limited movement and suffers from pain and stiffness during this period. In addition to surgery and antibiotics, occupational therapy (OT) helps the patient immensely by providing complete rehabilitation and to help recover completely. Many who do not respond well to medications have benefited from occupational therapy and have had complete functional recovery. The occupational therapist helps patients to improve and maintain skills so they can perform their daily chores on their own.

The benefits of occupational therapy are too many and would depend on the setting in which it is used:

1. In the elderly: With age, general movement is reduced and OT can help improve overall movement and quality of life, thereby enabling them to lead more independent lives.
2. In mentally disabled: Occupational therapists work with people with emotional and mental limitations and teach them the necessary skills to be able to perform their functions in society. This can even enable them to take up a job and lead healthy, positive relationships.
3. In physically disabled: OT can help them teach to perform their chores and socialize at school and home. There is a great deal of facilitating age-appropriate social interactions, thereby improving the chances of social acceptance of the affected individual.

No matter what setting Occupational Therapy is used in, the following are definitely some benefits:

1. Improves range of motion: The person undergoing OT will see better movement of the affected parts, especially in old age where some joints are more involved than others.
2. Increases mobility in injured or disabled patients: Disability or injury can lead to reduced mobility and OT can significantly improve this.
3. Helps the body heal naturally: The body is not being subjected to any external chemical, and only natural movements and exercises are done, which is beneficial for the person.
4. May reduce or eliminate muscle spasms: Pain and disability can lead to reduced mobility, which can cause muscle spasm. OT can help reduce and in some cases completely reverse the muscles spasms that may have set in. Can be supplemented with thermal modalities and treatment to reduce pain: Adding heat packs and moist heat to the regimen will produce better results.
5. Treatment is customized for the individual: Each person is different with the cause and the effect of disability. The therapist will customize the program based on the person's needs and therefore will benefit the patient.
6. Can boost self-esteem and promote feeling of well-being: The mere thought of being independent gives a big moral boost to the affected person, thereby improving quality of life.

Occupational therapy forms a part of the holistic regimen and can, therefore be integrated along with physical therapy to reap benefits.

Vitamin D is present in the skin and is considered to be a steroid hormone that is found in fortified foods and sun exposure. For years, it has been associated with bone health, but recent studies have revealed that it plays a major hand in mammal fertility as well. Research conducted by the Journal of Clinical Endocrinology & Metabolism has shown that Vitamin D plays a pivotal role in IVF procedures. It not only helps to produce good quality embryos, but also increases the success rate of implantation dramatically.

Study 1: Researchers followed 154 women who were vitamin D deficient and 181 women who had sufficient levels of vitamin D in their blood. The women who had sufficient vitamin D were nearly twice as likely to conceive through their IVF cycle as their deficient counterparts. Women who had vitamin D levels of at least 20 ng/ml in their blood were considered to have sufficient levels of the hormone. Levels of 30 ng/ml are recommended for general health.

Could Vitamin D also contribute to IVF success?

While the role of vitamin D infertility is less certain, an Italian study published in 2014 found that women undergoing IVF treatment with sufficient levels of vitamin D were more likely to produce high quality embryos, and nearly twice as likely to become pregnant. Although the researchers stated further studies were needed, the results indicated that low levels of vitamin D could contribute to infertility. 

More recently, 11,500 women were evaluated in a European study examining the effect of the environment (temperature, rain and sunshine) on the outcomes of IVF treatment. The study found the birth rate improved for women exposed to more sunshine the month before the start of their IVF cycle, while the egg was maturing.

For the men, a link between vitamin D and sperm movement and function has also been identified.

What role does vitamin D play in pregnancy?

Vitamin D plays an important role in ensuring that the body has enough amount of calcium to conceive. For women who are pregnant or are breastfeeding, calcium ensures that the baby’s immune system and bones are strongly formed. Deficiency of vitamin D can lead to gestational diabetes in pregnant women.

Sources of vitamin D: Although the sun is the best source of vitamin D in an individual, it is recommended not to rely on it totally. Overexposure to sun rays can lead to skin cancer. Some food items from where the requisite amount of vitamin D can be obtained include eggs, dairy products, fatty fish etc. People who are critically deficient in vitamin D can go for vitamin D supplements.

Other lifestyle improvements for your fertility

While the importance of vitamin D in pregnancy and its link to IVF outcomes certainly gives couples something to think about, don’t overlook the well-established health and lifestyle improvements you can make to boost your natural fertility including quitting smoking, consuming alcohol in moderation, and maintaining a healthy weight. 

If you are undergoing fertility treatment, your fertility specialist will likely have already organised a vitamin D blood test. For all other women trying to conceive, consult your IVF specialist for more information.