In Vitro Fertilization (IVF) - Procedure, Preparation, Risks and Success Rate

What is IVF?

In-vitro fertilization (IVF) is a common assisted reproductive technique that involves the fertilization of the female with male sperm in a test tube or glass dish and not inside a female body. The fertilization takes place in the controlled environment of a laboratory that is conducive to embryo formation. IVF treatment includes several complex procedures to enable couples to conceive if they are not unable to do so naturally. Since the inception of IVF, around 7-8 million or more infants have been born through IVF all across the world. They are also known as test-tube babies.

Why is IVF Treatment Required?

The need for IVF treatment arises in the following medical conditions:

• Irregular Ovulation: Many females face hormonal imbalances that cause problems in ovulating regularly. One such common condition is PCOS (polycystic ovarian syndrome), where the body does not produce optimum estrogen levels that aid in inducing ovulation. Such women face difficulty in conceiving naturally. They require advanced artificial reproductive techniques like IVF to get pregnant.

• Low Sperm Count: Some males produce very low sperm, insufficient to impregnate their female partner. In addition, sperm health matters equally, so it can survive acidic vaginal walls and swim through to fertilize a female. A healthy male must have millions of sperm in semen to conceive as a couple.

• Genetic Disorders: Some females may have inherited genetic disorders such as blood clots that can cause difficulty in conceiving and make them prone to miscarriages.

• Endometriosis is a chronic condition in which the inner uterine lining is too thick and grows outside the uterus. It creates a barrier for a fertilized egg to attach to uterine walls. Endometriosis also causes heavy and painful irregular periods, which reduces the chances of conceiving successfully.

• Insufficient Eggs in Ovaries: In some females, the follicles of the ovaries do not efficiently produce eggs. Also, the eggs produced may not be healthy enough to be fertilized by the male sperm.

• Blocked or Scarred Fallopian Tubes: In rare cases, fallopian tubes are blocked due to scarring. Sexually transmitted infections such as Chlamydia may cause severe tissue damage and cause permanent scarring. Abnormal pregnancy, where the embryo attaches in the fallopian tube, called ectopic pregnancy, also poses the risk of irreparable harm to fallopian tubes.

Pre-treatment Preparation

Discussion with the Doctor

Have a detailed conversation with your infertility specialist regarding family planning. Also, discuss your medical history with the doctor and ongoing medication, if you are taking any.

Diagnosis

Before beginning the IVF procedure, it is crucial to identify the real problem. Both partners must undergo tests to examine the root cause and decide which is the best-suited treatment.

Tests for Males

• Semen Analysis: The IVF specialist asks the male to collect their semen sample. It is contained in a clean container as the male masturbates. The doctor sends the sample for lab analysis.
• Hormone Test: Hormones are checked through a blood test to determine the testosterone and other male hormones’ level.
• Screening Tests: Imaging tests like MRI or ultrasound of the genital region are conducted to check for underlying abnormalities.
• Vasography: The test is performed to determine any blockage or scarring in the vas deferens, the tube that joins the pelvic cavity, and the epididymis. The tube facilitates the movement of sperm to the urethra.
• Testicular Biopsy: It is advised to evaluate any abnormalities in the reproductive tract that may be causing infertility problems.
• Genetic Testing: It helps identify any defect in genes that can lead to infertility issues.

Tests For Females

• Ovulation Testing: A blood test helps in determining if a female is ovulating or not
• Check ovarian Reserve: This test allows a doctor to evaluate the number of eggs available in ovaries for ovulation. The IVF specialist may also test your hormones at the beginning of the menstrual cycle to carefully determine your ovarian reserve.  
• Imaging Tests: Ultrasound and MRI of the pelvic region helps in checking for problems or abnormalities related to the uterus or ovaries.
• Hysteroscopy: In some cases, the doctor recommends hysteroscopy as a diagnostic procedure. The doctor inserts a flexible and slender instrument to visualize inside the uterus and look out for abnormalities.

Before IVF Treatment

Stay calm and relaxed, and ensure that you take proper meals and fluids throughout the day. Have a conversation with your partner regarding the treatment and also discuss any worries or concerns you may be having. It is better to clear doubts before undergoing any procedure. As there is no need for an overnight hospital stay, arrange your ride to and from the hospital and do not go alone for the procedure.

Procedure

There are different steps involved in the entire IVF treatment. IVF procedure step by step:

Beginning of the Treatment 

The doctor determines the best-suited time of your menstrual cycle to start the treatment. The IVF procedure needs many eggs to mature.

Stimulation of Ovaries

The ovaries are stimulated to expedite the follicle growth that contains eggs. FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone) are the two hormones injected during this stage.

Trigger Injections

After assessing egg follicles, doctors stop ovarian stimulation. The doctor recommends the period when the female needs to be administered trigger injections. The injections contain human chorionic gonadotropin hormone for egg maturity and aid in their release from the follicle wall.

Egg Retrieval

Also known as the egg-picking stage, it is an outpatient procedure conducted after administering general anaesthesia. The IVF specialist inserts a needle through the birth canal (with the help of an ultrasound-guided probe). The doctor retrieves around 8-15 eggs. The entire procedure is completed within 30 minutes, and the patient can return home to rest and relax. It is highly advised that they do not drive or travel alone after the procedure.

Sperm Collection

The doctor asks the male partner to collect semen. They are allowed to do so in a dedicated room at the IVF centre. The semen is stored in a controlled environment in the lab. Further, the doctor visualizes it under a microscope to clean any dirt or dead cells. Only after careful assessment, does the doctor use the sperm to fertilize the retrieved egg.

Fertilization

After washing and concentrating the specimen, the IVF specialist places it in an incubator with the retrieved eggs from the female. It is similar to natural fertilization, where sperm fertilizes the egg inside the female body.

Embryo Development

The fertilized egg transforms into an embryo. The doctor collects and keeps it in a special incubator to observe its growth for 4-6 days. Further, the embryo is mixed with amino acids to aid its development. When the embryo grows consistently, it will become a 4-8-celled embryo until the fourth day.

Embryo Transfer

The IVF specialist implants the developed embryo into the uterine wall. It is a quick procedure that completes within 20 minutes. During the procedure, the doctor uses a soft, thin and flexible catheter for embryo transfer. The patient lies down with spread legs and the doctor accesses the uterus through the cervix by using the catheter.  An abdominal ultrasound helps in ensuring the process is precisely completed. Then, the patient is asked to remain at rest for sometime so that the embryo does not drop out.

Pregnancy Check

Usually, the female is called to the IVF center after 14 days for a blood test to examine the presence of hCG in blood. In case the hormone is present, this means a successful pregnancy. Further, the doctor advises her proper pregnancy care instructions and what physical activities to avoid.

Post Procedure

Usually, most of the tips on what to do or avoid after the final stage of IVF treatment, i.e. embryo transfer, are similar to what the doctor advises at the beginning of the treatment.

Do's:

• Take it easy with physical activities and drink plenty of water as it allows easy implantation.
• Wear loose and comfortable clothes to enable the uterus to expand for implantation and receive enough blood supply.
• Indulge in relaxing activities to keep away from stress, such as a warm water bath before going to bed, reading a good book, etc.

Don'ts

• Lift heavy objects or indulge in sexual intercourse that can lead to trauma to the pelvis for 7-8 days after embryo transfer.
• Take any non-prescribed or over-the-counter medication for pain relief as it can heighten the chances of delayed implantation or bleeding.
• Smoke or consume alcohol
• Eating spicy, fried and high-fat foods and processed meat

IVF success rate increases when patients take proper rest and follow a recommended diet during and after the treatment. As per studies, pregnancy rates increase by 48% in females who rest well for 14 days after embryo transfer than those who don’t rest. 

Risks and Complications

Generally, IVF treatment is a safe medical practice under the guidance and expertise of an infertility specialist. However, there are a few general risks and complications associated with the treatment.

During and After IVF Treatment:

The probability of severe complications is almost rare when IVF treatment is performed under the supervision of a professional infertility specialist. However, the following are the potential risks and complications:

• Allergic reactions to a medication,, such as nausea and vomiting. Itching and red patches on the skin surrounding the injection site.
• Discomfort and bruising at the injection sites during the phase of ovarian stimulation
• Sore breasts, mood swings, and vaginal discharge are common reactions to hormonal imbalances.
• The risk of transferring multiple embryos into the uterus can lead to multiple births and, thus, early labour.
• There is a higher risk of miscarriage than in normal pregnancies
• Pain and swelling in ovaries due to unusual reaction to excess hormone production in the body induced by hormonal medications. An ovarian hyperstimulation syndrome (OHS) may cause blood clots in the ovaries.

During Egg Retrieval:

Many women experience pain during the egg retrieval procedure of the IVF treatment. The abdominal pain can be mild to moderate and usually lasts 1-2 days. The doctor also prescribes some medication to relieve pain. If not performed correctly, there are chances that the patient may develop pelvic infections. When performed by an unskilled or non-certified professional, there remain higher chances of damage to reproductive organs like ovaries, etc. trauma to the bladder, cuts in the blood vessels, etc.

During Embryo Transfer

While transferring the embryo into the female body, the IVF specialist carefully transfers it into a thin catheter and implants the seed into the uterus. The female may experience mild abdominal cramps or pain when the doctor inserts the catheter via the cervix. Due to this, the patient may also notice some spotting post-procedure. Rarely, a female may get a vaginal infection if proper hygiene standards are not maintained during and after embryo transfer.