In Vitro Fertilization: Cost, Procedure, Recovery, Risk & Complication

Egg Freezing, which is also known as mature oocyte cryopreservation, refers to the method through which reproductive potential is restored among women. Eggs get harvested from the ovaries, frozen and in an unfertilized manner and are stored for purpose of using them later on. The egg freezing procedure is recommended for those women, who would like to delay conceiving baby due to various kinds of reasons.

Before the freezing of eggs, it is important to first retrieve the eggs. Let us look at how the eggs are retrieved, followed by the procedure of egg freezing through two different ways.

Retrieval of Egg

Egg Retrieval takes place just like it is done in case of in vitro fertilization (IVF). Women would need to be put under medication for hormones or through injections, which shall lead to the stimulation of ovaries, leading to more eggs getting matured. After this women would receive the necessary medication to stimulate ovulation and then the extraction of eggs takes place through the use of a needle. Specialists perform this whole procedure by putting women under the effect of anesthesia and are also guided by ultrasounds. Once the extraction is completed, the freezing takes place.

There are two different techniques involved in the egg freezing process. They include:

Slow Egg Freezing Method

A substance called cryoprotectant is used in order to protect the biological tissues from getting damaged out of freezing. This slow freezing method of getting eggs freezed relies on low initial concentrations of crytoprotectant. The cryoprotectant in low concentration is introduced when the egg is at a relatively warm temperature and still continues to experience the usual functions of a living cell. Then the cryptoprotectant would spread all throughtout thus fill the egg, hence replacing most of the water inside the egg. The egg is then inserted into a small container made of plastic and ultimately get placed inside a cooling chamber. The lowering of temperature, to around -6 degree centigrade, takes place through injecting very tiny amounts of liquid nitrogen into the cooling chamber. The cooling process is controlled by a computer.

The main purpose of these techniques is to avoid ice crystals from getting formed in the egg. During the spreading of the cryoprotectant, if the ice crystals are still present, they can cause damage to the egg and hence the egg may not survive the process of thawing. Then the temperature is lowered further to around -32 degree centigrade. By this time, the egg’s metabolic rate become slow. The container where the egg was placed, is then dipped inside the liquid nitrogen, forming a solid.

Rapid Egg Freezing Method or Vitrification

At the time of rapid freezing method, there is high concentration of initial cryoprotectant whereas the cell remains at room temperature. The egg is unable to stay for long in this temperature and thus gets poured immediately onto the liquid nitrogen. Cryoprotectant spreads at a rapid rate so as to avoid ice-crystal from getting damaged. Vitrification is a very new method for freeing eggs. Recent research has shown that vitrification of eggs largely improves the possibility for survival after thawing and the rates of pregnancy.

Cryopreservation is usually performed as a component of in vitro fertilization, which also tends to include ovarian hyperstimulation, retrieval of egg and embryo transfer. With the frozen embryos available, a woman need not undergo stimulation through fertility drugs for having an embryo transfer during a cycle of an infertility treatment. When sperm gets collected during microsurgery or through other means and being frozen for a subsequent cycle of IVF, additional surgery might well be avoided.

Embryo Cryopreservation

At the time of standard manner of treatment for infertility, hormones get used to stimulate the development of multiple eggs. Then, after those eggs are retrieved and fertilized in the laboratory, more embryos might be created than those, which could be transferred quite reasonably to the uterus of a woman. Now, when such extra embryos are of sufficiently good quality, they might get cryopreserved or in simple language, frozen, so that they could get transferred at some future date. Approximately in 25% of IVF cycles, embryo cryopreservation becomes possible, which in turn provides the opportunity to have an extra embryo transferred, without going through the inconvenience and bearing the expense of a full cycle of IVF.

Embryos may get frozen on Day 2 / Day 3 / Day 5 stage. We can freeze the embryos at the age of 40yrs also. One thing should be noted that not all embryos are right candidates for cryopreservation. Unfortunate thing is that some embryos could well get damaged by cryopreservation and certain experiences have even show that high quality embryos are more likely to suvive and become capable of getting developed further after freezing, than other types of embryos. Embryos, which divide slowly or are somehow irregular in other ways, do not perform well after cryopreservation, hence do not get frozen. These problems generally tend to arise among older women, so cryopreservation is normally not a recommended option for patients around the age 40 and older.

Once the embryos are placed in a cryoprotectant solution, they are made to freeze in a computer-controlled device, which is specifically designed for embryo cryopreservation. Embryo storage for a long-term basis takes place in liquid nitrogen at a temperature of -320 degree Fahrenheit.

Embryos that are cryopressed, get replaced either during a natural menstrual cycle or in case of a hormonally controlled cycle. Reasonable amount of care is taken to minimize the possibility of damage caused as a result of cryopreservation. Now, depending upon the stage of embryo during the time of freezing, around 60 and 90% survive this process of freezing. The rate of pregnancy after those embryos get transferred is quite similar to that of those, when embryos are fresh.

Extended amount of storage in liquid nitrogen does not have any effect on an apparent basis on their viability. The embryos which get frozen after numerous years of cryostorage perform equally well as those which are frozen for only a couple of months.

Since the year of 1983, the procedure of cryopreservation has lead to the birth of thousands of babies on a worldwide basis. Though this has been used on an extensive basis, yet there have not been any report of any kinds of increase in birth defects due to cryopreservation.

Have you and your partner decided to complete your family by having a baby? Are you unable to conceive even after trying really hard? You are not alone. There are many couples who are facing this problem. But there is nothing to worry about at all. Latest and advanced science is offering solutions for this problem. When none of them are working for you, you should try In Vitro Fertilization or IVF. During IVF treatment, men have as vital a role to play as women. A man needs to really support and care for his partner during this period.

Here is a guide for men for IVF treatment:

1. Keep a check on your weight: If you are overweight, then your sperm will be affected. Also, some studies have shown that the mobility of the sperm is affected by obesity. It will also affect the sperm count when your BMI value is too high. So, it is always good to maintain the BMI levels required, based on your height, age and gender.
2. Temperature of the sperm: If you are a cyclist or use a laptop for extended time periods by keeping it on your lap, then the production of sperm could be affected because it is going to increase the temperature of the testicles. Make sure that you take care of this.
3. Make changes to your lifestyle: If you smoke or drink, then you will have to make sure that you cut down or stop because this is going to affect not just the quality of the sperm but also the quantity of the sperm. Smoking decreases the mobility of the sperm.
4. Healthy diet: A healthy diet means healthy sperm quality and quantity. So, you should always keep a check on what you are eating. You will have high fertility levels if you consume green vegetables, fresh fruits and pulses as part of your daily diet. You should cut down on processed food and make sure that you are eating fresh and healthy food.
5. Regular Exercise: You will have to maintain good health and for that, you need regular exercise. You do not need to join the gym and lift weights. You can do a few exercises at home. Exercising can also help to get rid of anxiety and stress and help you to stay healthy.

Get advice from experts as they can help you with tips to follow during the IVF treatment or when you are preparing yourself for the IVF treatment. You and your partner can do these things together and achieve better results.

IVF or In-vitro fertilization is an assisted reproductive technology, whereby the eggs of a woman who is unable to conceive naturally is collected and mixed with sperms for fertilization to take place. The resulting healthy embryo is then transferred into the female uterus to facilitate the implantation process followed by the pregnancy.

Before undergoing an IVF procedure, both the partners have to undergo few vital screenings and health check-ups, which would assist the doctor in having a better understanding of the fertility problem.

The Screening process before an IVF
The success of an IVF depends on many factors including the quality and quantity of the egg and sperm, or any defects in the female reproductive organs.

1. For males, doctors perform a semen analysis to evaluate and examine the sperm (quality, quantity, morphology, mortality).
2. In case the analysis shows any abnormality (such as low sperm count, sperm unable to penetrate the egg or an unsuccessful fertilization in the previous IVF attempts) doctors opt for Intracytoplasmic Sperm Injection or ICSI. ICSI is an advanced procedure whereby a specialist (embryologist) collects a single active sperm and injects it directly into the egg to bring about the fertilization of the egg.

In extreme cases of no sperms, a doctor may opt for Testicular Sperm Extraction (TESE) or Percutaneous Epididymal Sperm Aspiration (PESA) to retrieve the sperm.

1. In females, the fertility problems can be brought about by a myriad of triggers, especially hormonal imbalance, the medical conditions that affect the hormonal balance and the reproductive organs (such as PCOS, endometriosis, cancer of the reproductive organs, obesity). Thus, for a female, a blood test to analyze the levels of the reproductive hormones- prolactin (PRL), luteinizing hormone (LH), thyroid stimulating hormone (TSH), and follicle-stimulating hormone (FSH) are crucial.
2. Imbalance in the Prolactin, TSH or an elevated FSH: LH level (indicative of PCOS or an unhealthy ovarian reserve) once treated, enhances the effectiveness of IVF by several folds.
3. To understand the condition of the fallopian tubes and the uterine cavity, a hysterosalpingogram (HSG) is performed on the 8th day of the cycle.
4. The doctor may even perform an ultrasound scan of the vagina to examine the uterus (morphology), AFC (antral follicle count), the thickness of the endometrium and ovarian volume. In most cases, a woman is also tested for HIV, TB, VDRL, Hepatitis-B.

Some vital questions that every individual should ask before an IVF
Every individual or couple undergoing an IVF should be aware of the procedure:

1. If the physician is specialized and qualified enough to perform the IVF.
2. How expensive is the procedure and if they are a suitable candidate for IVF?
3. Are there any life-threatening side-effects or complications associated with IVF?
4. What are the chances of the IVF being a success?

Once a couple decides to go through IVF, they prepare themselves and go through various steps to reach the final stage of embryo transfer into the uterus. Read on to know more about the journey of IVF culminating in embryo transfer. From there it is another journey through to pregnancy.

• Step 1: The nurse will help identify day 1 of your menstrual cycle, and this is important. 
• Step 2: The ovaries usually produce an egg between the 12th and 16th day of the menstrual cycle. After identifying day 1, ovary-stimulating medicines (higher doses of hormones) are given to support the release of more eggs. The ovaries may be subjected to ultrasound imaging to monitor the development of eggs.
• Step 3: About 8 to 15 eggs are then retrieved under anaesthesia, these are carefully picked to ensure higher success rate of IVF. The process takes about 30 to 40 minutes in the clinic and the woman can go home and rest after this process. 1 or 2 embryos can be transferred at day 2, 3 or 5 stage of embryos.

Factors you need to consider while making a decision

• Sperm selection: Either fresh sperm or frozen sperm can be used by the couple. Fresh sperm is collected the same day as egg retrieval. Frozen sperms are thawed before use. Sperms of good quality are chosen after careful examination under a microscope to improve success rates of fertilization.
• Fertilization: This is where the name IVF is derived from. In-vitro (meaning in the glass, from the glass dish used) is where the fertilization occurs.
• Embryo development: Once fertilized, the embryo is kept in a conducive environment so that it can continue to grow optimally. The couple of kept updated on the progress here, as they would be wanting to know the status. After 5 to 6 days of fertilization, it can be implanted into the uterus.
• Embryo transfer: Once the medical team confirms that you are ready for an embryo transfer, you will be called into the doctor’s office. This is usually painless, but some women may have a slight abdominal discomfort. You will be advised to drink water and come with a full bladder. The uterus is scanned to see whether the embryo is getting placed, and having a full bladder helps clearly outline the uterus. The embryo is placed inside you via a catheter through the cervix into the uterus, under ultrasound guidance. The doctor has about 1 mm area within which it should be placed correctly for good implantation. Therefore, this placement is very critical. One embryo is placed, and the others are frozen and may be used in case of failure.
• Confirmation: After a two-week wait (2WW), a blood test is done to test for HCG levels and confirm pregnancy.