What is IVF?
IVF that stands for In Vitro Fertilisation, is an advanced reproduction technique in which fertilization takes place in a lab. IVF is a boon that helps infertile couples to fulfil their dreams of becoming parents. It is an infertility treatment that helps a woman to conceive and experience motherhood.
In the normal reproduction process, fertilization takes place inside the body of a woman. But because of some infertility issue in a man or a woman, natural fertilization can not happen. This is where the need for an IVF procedure comes in. During an IVF procedure, sperms and eggs are left in a petri dish so that the fertilisation can take place. Once the embryo is formed, it is then transferred to the women’s uterus.
IVF is not a single step procedure or treatment. It involves various steps and stages that give the result. There are major five steps involved in an IVF procedure:
1. Stimulation of Ovaries or Ovulation Induction:
This is the foremost step of an IVF procedure in which your doctor will give you certain medications in order to increase egg production in your body. In a normal menstrual cycle, ovaries produce only one or two eggs. But, for increasing pregnancy chances by IVF, you need a good amount of eggs.
During this time, the doctor will do regular ultrasounds and blood tests to check your hormones levels and also the production of eggs in the ovaries.
2. Retrieval of eggs:
Once there is enough production of eggs, the next step includes the retrieval of those eggs after their maturation. This egg retrieval during an IVF is done by a minor surgery your doctor will perform that at the clinic itself. With the help of a suction tube, multiple eggs can be removed in 25 minutes.
You may feel slight cramping after this process, which is normal. If you face serious discomfort, consult with your doctor at the earliest.
3. Retrieval of sperm:
The next step of an IVF procedure includes the retrieval of sperm, in which the male partner is asked to collect his semen sample through masturbation. If the collected sample doesn’t have enough number of sperms, then another method of sperm retrieval is used like a testicular aspiration. In this method, sperms are directly retrieved from the testicle with the help of a surgical needle.
4. Fertilization in the lab:
Once the retrieval of eggs and the sperms has been done, the next important step of an IVF procedure is Fertilization. Now, in the lab. If the sperms are healthy, conventional fertilization is done. In this, we store sperms and eggs in an incubator for a night. The sperms fertilize the eggs during the night.
In another case, where sperms are not motile, ICSI, Intracytoplasmic sperm injection, is performed as a part of IVF. In ICSI, one best sperm is selected and is directly injected into a mature egg.
5. Transferring an Embryo:
The last step of the IVF procedure includes the transfer of the embryo. After the fertilization is done, the fertilized egg is called an embryo. The growth of this embryo is monitored for at least 2-3 days, and when it grows properly, it is then transferred into the uterus of the lady.
After the transfer, the embryo implants itself on the lining of the uterus. If the implantation is done properly, it results in pregnancy.
IVF vs ICSI vs IUI
As we have already discussed, IVF is an advanced fertilization procedure that is done manually by doctors in the lab. In this process, eggs and sperms are retrieved and then they are fused in the lab in order to form an embryo. Once the embryo grows for 2-3 days and there is enough growth monitoring, the embryologists transfer the embryo into the uterus.
in IVF, if sperms are healthy, they will fuse the egg on their own. But in IVF cases, where sperms are not enough motile, which means sperms can not move properly, we do ICSI as a part of IVF. ICSI or Intracytoplasmic sperm injection is a refinement of IVF in which a healthy sperm is selected from the semen sample and is directly inseminated or injected into the mature eggs. ICSI-IVF is used in cases with male infertility issues.
The third option is IUI stands for Intrauterine Insemination. It is a fast insemination process that skips the whole lab procedure. In IUI, a single healthy sperm is selected from the sample and is directly injected or inseminated into the women’s uterus at the time she is ovulating.
IVF, ICSI or IUI: How doctors decide which treatment to choose?
When you first visit a fertility clinic a lot of tests are done as part of the workup of male and female infertility. These test results help your doctor to understand the exact problem and then decide and choose the best fertility treatment for your case. This is based on various factors like your medical history, the result of various physical examinations and investigations.
No matter what treatment option your doctor will choose, he will do it properly after consulting it with you. He will discuss everything and will choose a treatment best for you and your wife.
Cost of IVF
IVF is an advanced infertility treatment that is considered as one cycle per treatment. One cycle of IVF can cost up to 80,000 to 3,50000 in India. IVF also includes various tests, medications and additional procedures that have their own cost.
The cost of IVF also depends upon the fertility clinic you choose, the experience of the doctors, method of doing a procedure, technologies and techniques used.
The success rate of IVF
The success rate of IVF is around 35-40% in young women worldwide. In India, this figure is around 30-35%. Overall, the success rate of having a baby in the first IVF cycle is around 33% which increases to 50-70% till the eight cycles. This success rate is measured according to the number of live birth rate.
The Health of IVF babies
The vast majority of babies that are born through IVF are healthy as just normal babies. But in the rare case, the babies will have some problems. The biggest risk of IVF is multiple pregnancies that too comes with a lot of complications. Other than this, the percentage of birth defects in IVF infants is 9 whereas it is just 6.5% in natural-born infants.
It is also seen that IVF babies are born prematurely or with a low birth rate, some have birth defects, and some face neonatal deaths. But, it is to note that all these abnormalities are caused by the factors behind male or female infertility and their age as well. The process has nothing to do with the health of the baby.
When to go for IVF?
Your doctor may recommend you to go for IVF if there can’t conceive naturally and have some fertility issues like:
- Problem with ovulation due to PCOS/PCOD
- Low sperm count
- Blocked Fallopian tubes
- Female partner having endometriosis
- Or in the case where someone doesn’t wish to pass on some inherited genetic disorder to the baby.
Why does IVF fail?
Along with successful IVF cycles, there are some IVF cycles that fail. There are various reasons behind the failure of IVF like:
1. Embryo Quality:
Some embryos don’t implant after their transfer into the uterus. This happens because the embryo has defects and which is why it didn’t implant.
2. Female age
The women with older age will have less number of eggs and that too of low quality. Women above 40 have a lower success rate of IVF as compared to that of women under 30-35.
The success rate of IVF decrease for women who smoke, are overweight or underweight, etc. Just like a normal pregnancy, lifestyle has a major impact on IVF pregnancies as well.
4. Ovarian response:
: In the initial steps of IVF, women are given certain medications to increase the production of eggs. Now, a woman who is above 40 will automatically have low AMH and which is why her ovaries will not respond to such medication. No response means not having enough number of eggs for the IVF cycle which in turn means that an IVF cycle can fail.
5. Chromosomes problems:
An IVF cycle may also fail in cases where an embryo will have some chromosome abnormality and the body will reject it. These abnormalities can either pass on from a parent or can be newly developed in the stages of embryo division.
Miscarriages in IVF
Some researches have shown that IVF pregnancies have a slightly increases risk of miscarriages than natural pregnancy. Now, the process of IVF doesn’t elevate the risk of miscarriages. The reasons for miscarriage depend a lot on the factors that cause infertility in the female or the male partner.
Similarly, women of older age have a higher risk of miscarriages as compared to women below 40. Women above 45 have 50% chances of miscarriages. Also, women that have some underlying health condition also have a risk of miscarriages.
Repeated IVF failures: What to do next?
The next step after failed IVF cycles depends upon the reason why the IVF cycle failed. The next step could be trying for another IVF cycle. In most cases, going for another cycle will give desired result. If the cycle fails again, other options one could take will be the of third part assistance or atlast adoption.
It’s not always that IVF cycle fails. There could be some reasons behind it. There no problem in trying for another cycles as many couples were blessed with a baby in the future.
IVF Age Limit
Different Fertility clinics have different age limit for qualifying IVF. On a average, the IVF age limit is around 42 to 45 years of age. It is believed that after this age, women has a very low number of eggs in her ovaries which is why it is difficult to perform this procedure as expected.