In Vitro Fertilization (IVF): Procedure, Risk, Cost and Success rate

IVF stands for In-Vitro Fertilization. It consists of a series of procedures that are used for the treatment of genetic or fertility problems while assisting the conception of a child. One of the most effective forms of assisted reproductive technology, IVF procedures can be conducted using a woman’s own eggs and her partner’s sperm. It can also be done by taking the eggs, sperm or embryos from a known or unknown donor.

There are some cases where a gestational carrier (a woman with an embryo implanted in the uterus) can be used. During IVF, mature eggs are retrieved from a woman’s ovaries and fertilized with the sperms in the lab. Once it has been fertilised, the egg or eggs are implanted back in the uterus. A cycle of IVF can take about 2 weeks.

One may have to undergo an IVF treatment in the following conditions:

• If a woman’s fallopian tubes are blocked or damaged
• If ovulation is infrequent/absent, or there are few eggs available for fertilization
• Loss of normal functions of the ovary before reaching the age of 40
• Previous treatment of tubal ligation, where the fallopian pipes have been cut/blocked permanently. In this case, one can opt for IVF instead of tubal ligation reversal.
• Poor mobility, abnormality in sperm size/shape, or below an average concentration of sperm of the male partner
• If you have the conditions of endometriosis (uterine tissue will implant and grow outside the uterus) or uterine fibroids
• Unexplained fertility or a genetic disorder

Pre IVF Procedure:

Before beginning the process of IVF, both the partners may have to go through certain pre-procedure screenings such as:

• Ovarian reserve testing, for determining the quality and the quantity of the eggs. The concentration of estrogen, follicle stimulating hormone, as well as the antimullerian hormone in your blood, is checked by your doctor in the initial days of the menstrual cycle. These test results may help in predicting the response of your ovaries to fertility medications.
• Analysis of the semen of the male partner
• Screening for any infectious disease like HIV
• A mock transfer of the embryo for determining the depth of the uterine cavity and the technique that may work best for you
• An examination of the uterine cavity that may involve sonohysterography (fluid is injected in the uterus through the cervix and an ultrasound creates images of the uterine cavity) or hysteroscopy
• Some serious question like the numbers of embryos that will be transferred, what needs to be done with the extra embryos, how to handle multiple pregnancies, and the complications that may occur with donor eggs and sperms or a gestational carrier have to be discussed.

During IVF Procedure:

IVF treatment involves the following steps:

• Ovulation induction, where synthetic hormones stimulate the ovaries for producing multiple eggs. You have to be under several medications for a week or two before the eggs are ready for retrieval. Vaginal ultrasound or blood tests are examined by the doctor to determine it.
• Egg retrieval, through a transvaginal ultrasound. In this process, an ultrasound probe is inserted in the vagina for the identification of follicles. A thin needle is guided through the ultrasound guide to reach the vagina for collecting the eggs. The laparoscopy method can also be used for the same.
• Sperm retrieval through masturbation or testicular aspiration in case the partner’s sperm is being used.
• The next step is fertilization either by insemination (sperm and eggs are incubated overnight) or Intracytoplasmic sperm injection (ICSI), where a single sperm is injected directly in a mature egg.
• Embryo transfer is next step performed at the doctor’s clinic. It takes place two to six days after the retrieval of the eggs.

Post IVF Procedure:

Once the embryo has been transferred, you can go back to your regular schedule. However, your ovaries may be enlarged for a few days, so it is advisable to avoid any vigorous activity that may cause discomfort.

• Passing of a small amount of clear/bloody fluid after the procedure, which is caused because the cervix is swabbed before the transfer of the embryo
• Mild bloating
• Cramping
• Constipation
• Breast tenderness because of the high levels of estrogen

In case you have a moderate or severe pain after the transferring of the embryo, consult your doctor who will evaluate your condition. Any indication of a complication like an infection pr ovarian torsion can be examined and treated.

An IVF procedure may bring along with it certain risks and complications like:

• Multiple births if more than one embryo has been implanted in the uterus. Multiple foetuses can often lead to premature delivery or a low birth weight of the newborn.
• The frequent injection of fertility drugs to induce ovulation may lead to ovarian hyperstimulation syndrome, a condition where the ovaries become painful and swollen.
• Using an aspirating needle for collecting eggs may lead to bleeding, damage or infection in the bowel, bladder or a blood vessel.
• In some cases, there may be chances of an ectopic pregnancy. This is a condition where the fertilised egg will implant outside your uterus, generally in the fallopian tube. The egg would not be able to survive outside the uterus and the pregnancy will not be possible to be continued.
• Miscarriage or birth defects
• There may be a possible connection between some medications used in IVF and a specific type of ovarian tumor, though there have not been enough cases to support it.
• The procedure of IVF can be physically, emotionally as well as financially draining, leading to stress.

The average cost of an IVF treatment may vary from Rs. 10,000 – Rs. 70,000, depending on your condition.

Make sure that you continue having the medications after the embryo transfer has been successfully completed. It is better to avoid travelling during this period. It is generally after 2 weeks after the embryo transfer that you have to go for a pregnancy test. It is important not to be stressed during this phase, but be optimistic and occupied. Also, the pregnancy test must be conducted by a doctor at the clinic and not by yourself at home. After the test results will be declared whether the procedure is successful or not.

Success rate depends on multiple factors like age, time, and remaining factors comes into play. The success rate of IVF in India is in the range of 30-35% per embryo transfer.(Third party ref)