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In Vitro Fertilization (IVF) Tips

Low Ovarian Reserves - Knowing The IVF Protocol!

Dr. Richa Singh 91% (112 ratings)
MBBS, DNB - Obs & Gynae, Diploma In Reproductive Medicine (Germany), Fellowship In Laparoscopy, Fellowship in Reproductive Medicine & ART, Hysteroscopy advanced traraining training
IVF Specialist, Delhi
Low Ovarian Reserves - Knowing The IVF Protocol!

The available eggs in the ovaries at a time are collectively called an ovarian reserve. Low reserve happens when the production of eggs reduces. This affects the chances of pregnancy. The general cause of low reserves can be aging ovaries. In such cases, the ovary may be healthy and functioning even if the reserve is low. Production of eggs lower as a woman ages.

A woman starts with 25,000 to 5,00,000 eggs at puberty and ends up with 1000 eggs at menopause.

Causes:
Low reserves are caused by

  1. Production of eggs decreasesChromosomal abnormalities like Turner syndrome (lack of two X chromosomes) and genetic anomalies like Fragile X can decrease egg production.
  2. Ovarian tissue damage: Rough torsion, endometriosis triggered ovarian cysts, malignant or benign tumours, surgical removal of ovary or any other part of it, chemotherapy or radiation, pelvic adhesions, immunological problems or high BMI (Body Mass Index) can destroy the ovarian tissues.

IVF Protocols:
If a woman has low ovarian reserves, then she will be put on the either of the following protocols:

  1. Short GnRHa Flare: Gonadotrophin releasing-hormone-agonist (GnRHa) like Lupron, Nafarelin, Synarel or Buserelin is administered. This therapy is initiated at the onset of menstruation. The goal of the treatment is to stimulate the release of the follicular stimulating hormone (FSH) which augments the ovarian follicular growth.
  2. Combined Clomiphene or Gonadotrophin/Letrozole Stimulation: Older women are mostly administered this protocol. But it is strongly advised not to, as this protocol can potentially harm the egg or the embryo.
  3. Mid-follicular GnRH-antagonist protocol: Once the GnRHa-agonist protocol is commenced, the GnRH-antagonist is given several days later. Once the follicles reach the size of 12mm, GnRHa antagonists like Ganirelix, Orgalutran, Cetrotide and Cetrorelix are added. These drugs stop the pituitary from secreting the luteinizing hormone (FSH leads to secretion of this hormone).
  4. Long GnRHa Pituitary Down Regulation Protocol: This is the usual approach to deal with low ovarian reserves.
  5. Agonist/Antagonist Conversion Protocol: This protocol inhibits FSH production. This protocol generally yields good results.
1310 people found this helpful

IVF - Are You Ready For It?

Dr. Shashi Agarwal 85% (78 ratings)
MBBS, DNB
Gynaecologist, Bangalore
IVF - Are You Ready For It?

One of the major milestones in a woman’s life is the entry into motherhood. For most women, when this does not happen in the natural logical sequence of things, there is anxiety and lot of pressure from family and friends. However, with advancements now, there are options like intrauterine insemination and in vitro fertilisation (IUI and IVF) available, which can help increase the chance of conception and pregnancy.

IVF is where the egg is retrieved from the woman’s womb, fertilised externally and then transplanted back into the uterus where it grows to full term. However, there are always unanswered questions like how long to wait before going for IVF, is it the right procedure for me, etc.

Read on to find answers to some of these questions.

  1. Maternal age: As a woman reaches 35 and a man reaches 40, the fertility rates drop significantly. The chances that a woman at 35 will conceive is about 20%, which goes down to 5% if the woman is 40. However, this rate can be significantly increased by using IVF, moving it up to about 80%. The quality of the egg would gradually deteriorate, and so if a woman is nearing 40, it is better to consider IVF as the ovarian reserve would be optimal with IVF.
  2. Failed intrauterine insemination: In couples who have problems with the sperm reaching the uterus, intrauterine insemination (IUI) is first attempted. However, if 3 or more attempts of fail, it is time to consider IVF.
  3. Duration of inability to conceive: While some couples conceive quite promptly in a month or two, most take about 6 to 8 months of unprotected sex to conceive. Therefore, IVF can be an option if you are failing to conceive even after a year. Less than a year, don’t fret. Take it easy and it might just do the trick.
  4. Medical health: Both the partner’s medical health should be taken into account. Lifestyle changes like smoking, alcohol abuse, drug abuse should be considered, which can account for poor sexual performance and therefore lead to an inability to conceive. Health conditions like diabetes and heart disease can also lead to infertility. Hypothyroidism in women is another thing that must be ruled out, as it often leads to an inability to conceive.
  5. Sexual problems with the partner: One of the first things to do before going for IVF is to check that the male does not have any issues. Be it erection issues or ejaculation issues or sperm issues, they need to be ruled out. Sperm quality, quantity, and motility have to be analysed, and if they are optimal, IVF can be considered.

Hypothyroidism - Can It Hamper Your IVF Chances?

Dr. Arun Muthuvel 85% (10 ratings)
MCH - Reproductive Medicine & Surgery, MS - Obstetrics & Gynaecology
IVF Specialist, Chennai
Hypothyroidism - Can It Hamper Your IVF Chances?

The thyroid gland is a small butterfly-shaped gland located at the base of the neck. This is responsible for producing the thyroid hormone that in turn helps regulate metabolism and other bodily functions. The production of less than normal amounts of thyroid hormone is termed as hypothyroidism. Stress, food intolerance, an unhealthy lifestyle and immune system disorders are some of the factors that could contribute to hypothyroidism.

Symptoms of hypothyroidism include

  1. Fatigue
  2. Weight gain
  3. Eczema
  4. Cramps and menstrual irregularities

In mild cases, there may be no visible effects on the person but in severe cases, it can reduce ovulation or cause the ovulation to stop completely. This can result in infertility. Hypothyroidism can also put a woman at a high risk of having a miscarriage.

Infertility can be treated in a number of ways. One of the most common amongst them is IVF or In Vitro Fertilization. This procedure involves stimulating the woman’s ovaries to produce eggs, harvesting them and combining them with sperm cells from the male partner in a laboratory. This increases the chances of forming an embryo. 2 or 3 of the healthiest embryos formed are then reinserted into the woman’s womb. When the embryo is successfully implanted, the woman may then carry the pregnancy to full term.

Many women who undergo IVF treatment give birth to twins or triplets. IVF typically has a very high success rate but when it comes to women suffering from hypothyroidism, this may not be the best course of treatment. This is because hypothyroidism can also prevent the embryos from being successfully implanted in the uterus.

For this reason, a thyroid test is essential before inserting the embryos into the uterus. This can be done with a simple blood test to measure the level of thyroid hormone in the blood. This test is known as a TSH test. Normal TSH levels range from 0.3 to 3.0 mIU/L. If the levels are unacceptable, medication will be prescribed to help regulate them. Dietary changes may also be required. Once the levels are within the normal range, the embryos can be inserted.

Women suffering from hypothyroidism must have regular checkups for the entire duration of their pregnancy. This will help doctors identify potential problems early and deal with them before they can affect the growing fetus. Even after giving birth, the woman should get her thyroid levels checked regularly while she is nursing the baby.

IVF - What Is The Prognosis For It?

Indira Ivf 87% (46 ratings)
MBBS Bachelor of Medicine and Bachelor of Surgery
IVF Specialist, Udaipur
IVF - What Is The Prognosis For It?

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 :

  1. 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.
  2. Development of follicleYou 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.
  3. 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.
  4. 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.
  5. 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.

4369 people found this helpful

IVF And Tubal Ligation Reversal - Know The Difference!

Aarush Ivf & Endoscopy Centre 90% (135 ratings)
IVF Specialist, Mumbai
IVF And Tubal Ligation Reversal - Know The Difference!

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. 

Here are a few common differences: 

  1. 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. 
  2. 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. 
  3. 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. 
  4. 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. 
  5. 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. 
  6. 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.

IVF Vs Tubal Ligation Reversal - Know The Differences!

Milann : The Fertility Centre 90% (1377 ratings)
ABC
IVF Specialist, Bangalore
IVF Vs Tubal Ligation Reversal - Know The Differences!

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. 

Here are a few common differences: 

  1. 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. 
  2. 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. 
  3. 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. 
  4. 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. 
  5. 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. 
  6. 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.
3609 people found this helpful

Can Endometrial Scratching And IVF Help You Get Pregnant?

Aarush Ivf & Endoscopy Centre 90% (135 ratings)
IVF Specialist, Mumbai
Can Endometrial Scratching And IVF Help You Get Pregnant?

In vitro fertilisation (IVF) is a medical procedure followed for those women or couples suffering from infertility or for certain specific genetic problem. In the normal course, women or couples experience positive results within a few IVF cycles. However, in spite of reasonable pregnancy rates, some women may require few more cycles to achieve pregnancy. In such cases, in order to ensure a healthy pregnancy, the gynecologist may suggest the women undergo Endometrial Scratching before IVF. 

Endometrium explained in brief: 

The uterus is located in the pelvic region and it is in the size and shape of a pear. The inner cavity of the womb or uterus is protected by the tissue lining called endometrium, also called endometrial. The endometrium plays a significant role in supporting the pregnancy. 

The enhanced success of achieving pregnancy: 

The endometrial scratching procedure is a very simple one, which is resorted, so as to improve the results of IVF procedure. In this procedure, the gynecologist uses a very fine catheter and makes a small scratch on the endometrial lining. In fact, the scratch causes a kind of inflammatory reaction in the uterus. This inflammatory reaction induces the endometrium to be highly receptive to embryos during the successive menstrual cycle. This added receptivity enhances the success of pregnancy during the next menstrual cycle. 

Considering the higher level of success in achieving pregnancy, the endometrial scratching procedure has gained popularity in the IVF procedure. However, some of the other issues related to endometrial scratching may be as follows: 

  1. Endometrial scratching optimises the uterine lining and thereby, makes it easier to continue the embryo implanting procedure. Normally, before the endometrial scratching procedure, the gynecologist may suggest endometrial biopsy. 
  2. The endometrial procedure is usually suggested for those women who had two or more unsuccessful IVF procedures, despite having good quality embryos. However, in some cases, depending on the health of the patient and various other factors, the gynecologist may suggest this endometrial scratching at the very first IVF procedure. This procedure can be availed either for fresh embryos of the couple or frozen embryos or for the donor egg. 
  3. Although this is a part of a surgical procedure; endometrial scratching is very simple and painless and it is done without administering anesthesia. The procedure does not require any hospitalisation. In fact, the patient can go home soon after the procedure. Except for a few pain killers, this procedure does not require any extensive medication. 

This is a safe and easy procedure. Neither does it lead to any side effects, nor is the procedure burdensome for your wallet. Many couples have been benefited by this endometrial scratching procedure.

3193 people found this helpful

IUI Versus IVF - Key Differences!

Dr. Ritu Prabhakar 89% (23 ratings)
MD - Obstetrtics & Gynaecology
IVF Specialist, Sonipat
IUI Versus IVF - Key Differences!

Many couples find it difficult to conceive a child. There are many factors that could cause infertility. Infertility affects both men and women and in some cases, there is no clear reason for it. In such cases, intrauterine insemination (IUI) and in vitro fertilization (IVF) are the most common forms of treatment offered. Since their acronyms are usually used to describe them, many patients may be confused into thinking that the terms are synonymous. However, there is one major difference between the two processes. To understand this difference one must first understand the process of IVF and IUI.

IVF Procedure
This process is usually recommended for couples who have had recent miscarriages or are infertile because of blocked fallopian tubes or poor quality semen.

  • IVF is a process wherein the ovaries are first stimulated to produce a number of fertile eggs.
  • This is done with the help of ovary-stimulating medication.
  • Once the eggs have been produced, they are then harvested and removed from the woman’s body.
  • At the same time, sperm is also collected from the male partner. This is then used to fertilize the eggs in a laboratory.
  • Once fertilized, healthy embryos are transferred to the woman’s uterus where she can carry the pregnancy to full term.

IUI Process

  • IUI is recommended in cases where the couple face hormonal imbalances or have unexplained infertility.
  • To undergo IUI treatment, the woman’s eggs do not need to be harvested.
  • However, medication may be needed tostimulate the ovaries into releasing an egg. Instead, only semen is collected from the male partner.
  • This is then ‘washed’ in a laboratory so as to separate the healthy sperm cells from the plasma.
  • It also removes any toxins that may be present. In this way, the sperm is concentrated.
  • The doctor will then wait for the woman to ovulate. After the egg has been released, the sperm cells are then directly inserted into the woman’s uterus with the help of a catheter. This increases the sperm’s chances of fertilizing the egg.

Difference in Costs
IUI is typically considered less invasive and cheaper of the two forms of treatment. However, success rate of IUI is 15% as compared to 50% in IVF. This is because more than one egg is fertilized in an IVF cycle. Hence, if a second and third cycle of treatment is required, the costs may even out. However, it is not possible to say that one is better than the other.

3868 people found this helpful

IVF or IUI - Which One Should You Opt for?

W Pratiksha Hospital 93% (3394 ratings)
IVF Specialist, Gurgaon
IVF or IUI - Which One Should You Opt for?

Intrauterine insemination (IUI) and in vitro fertilization (IVF) are two commonly used methods of fertility treatment, which increase a couple’s chance of becoming pregnant.

The Procedure

IUI - IUI is a procedure during which processed and concentrated motile sperm are inserted directly into a woman’s uterus. This procedure is timed according to a woman’s ovulation, and may be performed single/double IUI in the days immediately following the detection of ovulation. After ovulation a woman’s egg is picked up by the fallopian tube and waits there for the sperm. Since the IUI procedure deposits higher concentrations of good quality sperm close to where the egg is waiting, the chances that the egg and sperm will find one another are increased.

IVF - IVF is the most successful method of fertility treatment utilized today to help couples to conceive. The basic components of the IVF process include stimulation of the ovaries to produce multiple eggs at a time, removal of the eggs from the ovary (egg retrieval), fertilization of the eggs in the laboratory, and subsequent placement of the resulting embryos into the uterus (embryo transfer). The chance of pregnancy from IVF depends primarily on the age of the woman, the cause of infertility, and factors related to the quality of the IVF laboratory.

Success Rates

IUI Treatment - There is a marked difference between IVF and IUI pregnancy rates. IUI has a success rate between 5% and 20%, but it can even be as low as 1-2 %, depending on the woman’s age and fertility levels. The chances of conceiving through IUI is higher if fertility drugs are administered along with the treatment.

IVF Treatment - IVF has a high success rate – between 20% and 35% and it can even go as high as 40%. This may not seem like a lot, but it is very high, considering that an average young and fertile couple has only a 15-20% chance to conceive in a month. It is important to understand what IVF and IUI success rates mean and the factors that affect it before deciding on a fertility treatment. You can also use any reliable online IUI vs IVF comparison tool to determine your approximate success rates with each of these treatments, depending on your age, lifestyle, and medical history.

You should use online sources of information to understand more about fertility problems, how age affects fertility levels, and whether freezing your eggs is a good option for you. However, discuss all these issues with your doctor to ensure that you have the right information and that you have understood it correctly. Fertility specialists provide you with personalized fertility plans based on your health which is why you should always talk to them before you make any decision.

1 person found this helpful

IVF Treatment - Does Quality Of Eggs Have Any Impact On It?

IVF Specialist, Jaipur
IVF Treatment - Does Quality Of Eggs Have Any Impact On It?

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:

  1. 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.
  2. 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.
  3. 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.
 

2916 people found this helpful
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