In vitro fertilization & Embryo transfer (IVF - ET)
IVF is the technique of mixing the women's eggs (ova) with sperm from her partner in a small dish or test-tube in the laboratory to allow fertilisation to occur. Once the ova are fertilised, one or more fertilized eggs (pre-embryos) or developing embryos are replaced into the woman's womb through the cervix.
Do you really need IVF? Why?
Many cases of infertility can be helped with IVF. However, the chances of pregnancy are very variable and depend on the cause of infertility. When you are seen at the clinic we will discuss the most suitable type of treatment for you and give you an estimate of your chances of becoming pregnant For most couples, IVF treatment involves using your own sperm and eggs. Rarely one may recommend using donated eggs or sperm but of course this would never be done without your consent.
IVF treatment is beneficial in
Tubal Factor-: IVF was developed specifically for women whose fallopian tubes had been injured by prior surgery or infection. For women with significant damage to the ends (fimbria) of their tubes, one IVF attempt offers a better chance of a viable pregnancy than surgery ever will and at a lower overall cost.
ICSI, where a single sperm, obtained either from semen or from needle aspiration of the testicular sperm ducts (PESA - Percutaneous epididymal sperm aspiration) is placed inside each mature egg is clearly the best treatment modality ever developed for low sperm count problems.
While not usually the first line of treatment for this problem, IVF works well for endometriosis. It is the therapy of choice for severe cases or when lesser treatments have failed or for women at or approaching age 40.
Anovulation The majority of patients with anovulation will conceive using simpler treatments. However, those patients requiring IVF are typically "high responders" to gonadotropin therapy and have a good prognosis.
Unexplained Infertility Approximately 20% of couples will have no identifiable cause of infertility after completing a comprehensive evaluation. IVF is often successful when all conservative treatments have failed, especially since some of these couples actually have some block to fertilization. Majority of these pateints have either poor egg quality or failure of the egg to escape or may have implantation proble.
The Process :-Once the procedure of IVF-ET is recommended to you, the actual procedure involves induction of ovulation followed by egg retrieval. The eggs are then inseminated in lab with semen & the resulting embryos are transferred to uterus after 48-72 hours.
Induction of Ovulation:- A woman is born with millions of egg follicles each of which contain an immature egg at its centre. Each month, multiple follicles begin to develop, but only one dominates & matures & finally release into the peritoneal cavity. In order for IVF to be most effective, more than just one mature egg needs to be retrieved. There are special medications that help stimulate the development of multiple follicles together. The most common stimulation protocol we use is gonadotropin with GnRH analogues either GnRH antagonists or GnRH agonists. GnRH agonists are started few days prior to the periods & continued afterwards (Long Protocol). Gonodotropins are started from D2 or D3 of periods & on an average nine to ten days stimulation is required. Repeated ultra sonography & estradiol levels are done tosee the follicular maturation and when it is judged to be adequate, hCG injection is given for final maturation.
Oocyte retrieval:- hCG would lead to ovulation about 36 to 42 hours after injection, but just before that time retrieval procedure is done to recover the egg cells from the ovary. The eggs are retrieved using a transvaginal ultrasound-guided needle piercing the vaginal wall to reach the ovaries. Through this needle follicles can be aspirated, and the follicular fluid is handed to the IVF laboratory to identify ova. The retrieval procedure takes about 15-20 minutes and is usually done under general anaesthesia.
Insemination:-The embryologist looks for eggs in fluid aspirated from the follicles. The eggs are assessed for maturity and incubated. The male partner is asked to collect a semen sample if fresh sperm is used. A semen analysis is performed and the sample is washed with a special solution of nutrients to isolate the more motile sperm. Fertilization is done in the lab. In standard IVF, the sperm is placed into the dish containing the eggs. In ICSI one sperm is drawn up in a needle and then injected into the egg. The actual injection process takes less than 60 seconds.
The sperm and eggs (oocytes) are placed in growth media containing special nutrients that allow them to live outside the body. The egg when fertilized by sperm becomes an embryo that is allowed to grow and divide in the laboratory for two to five days in the special culture media.
Embryo quality is a critical factor affecting the success of IVF. You will be given the detailed information about your egg quality, sperm quality as well as embryo quality. After thorough discussion with you, the best embryos are transferred to the uterus based on grade and cell number. The rest of the embryos can be either discarded or frozen, depending on the embryo quality and your wish.
Embryos are transferred into the uterus through a small tube or catheter. This procedure does not require anaesthesia, as it is usually painless. The embryos are placed in a small amount of fluid inside the catheter, which is threaded through the cervix during a speculum examination. The embryos are implanted so that they reach the top part of the uterus. Abdominal ultrasound is used to confirm the correct placement. Depending on your wish, one to four embryos may be transferred in one treatment cycle.
You will have to wait for two weeks for the pregnancy test. During this time you may receive progesterone - a hormone that keeps the uterus lining thickened and suitable for implantation.