In-vitro fertilization, commonly known as IVF is the most common form of assisted reproductive technology (ART) that literally means fertilization in tube (test-tube baby). IVF treatment is the most effective option to conceive when the fallopian tubes are damaged; sperm is of poor quality or any other type of infertility faced by couple. During the IVF process, eggs are taken from the female’s ovaries; sperms are also collected from the male partner at the same time. Then both collected eggs and sperms are made to fertilize in the lab and this fertilized egg called embryo is then implanted in the women’s womb via catheter through the cervix to achieve pregnancy. Extra embryos will be frozen and saved for a future pregnancy.
This IVF technique is used when patient have been diagnosed with:
· Endometriosis (uterine lining developed outside the uterus)
· Low or borderline sperm count
· Defect in uterus or blocked fallopian tubes
· Ovulation problems
· Failed traditional treatments like timed intercourse, follicular monitoring, IUI etc.
· Unexplained fertility problem
· Inability of sperm to penetrate or survive in the cervical mucus.
IVF treatment process:
1. Ovary stimulation – fertility medications like gonadotropin are prescribed to stimulate egg production for 8- 14 days near the beginning of menstrual cycle. The ovaries are stimulated to develop multiple mature eggs for fertilization as some eggs may not develop or fertilize after retrieval. Ovaries are examined through transvaginal ultrasound and hormone levels are checked through blood samples. This will also help the doctor to monitor the development of the follicles (the fluid filled sacs where eggs are matured). Patient will get a trigger shot to mature eggs fully and are ready to be retrieved about 36 hours after the trigger shot is given.
2. Egg retrieval – eggs are retrieved through a minor surgical procedures done under the influence of anesthesia. A thin needle is inserted through the vaginal wall to remove the eggs from the follicles with the guidance of ultrasound probe that helps to see inside the ovaries and identify the follicles. Woman may feel some discomfort, cramping or spotting for few days after the egg retrieval.
3. Fertilization – retrieved eggs are examined by an embryologist before combining them with the partner’s sperm and incubating them overnight. In some cases, when a sperm quality is poor or there is low probability of fertilization then doctor may use additional technique called Intracytoplasmic sperm injection or ICSI in which single sperm is injected directly into each mature egg. Once the eggs are fertilized and cell division has taken place, they are considered as embryos.
4. Planting the embryos - the embryos are usually transferred into the woman’s uterus three to five days after egg retrieval and fertilization and doctor will decide how many embryos should be inserted depending on the age and diagnosis. These embryos are inserted with a thin tube called catheter through the cervix and may not require anesthesia to undergo this process. Patient may feel some mild cramping for a day or two.
If the treatment is successful, then an embryo will be implanted in the uterine wall and will continue to grow into a baby. The whole IVF cycle takes about 4 to 6 weeks to complete. The success rate may vary depending on the infertility conditions of the each couple and their ages. Younger women have healthier eggs and have higher success rates than women in their older years.
There are some side effects of the IVF process that may include:
· Expensive treatment
· Time consuming
· Multiple pregnancies
· Ectopic pregnancy
· Ovarian hyperstimulation syndrome (OHSS)
· Failed cycle
Intracytoplasmic Sperm Injection (ICSI)
ICSI is done as an additional procedure of an IVF treatment cycle in which a single sperm is injected directly into each egg to fertilize it with the help of very fine micro-manipulation instrument. Then the fertilized egg known as embryo is transferred to the woman’s womb. This method has good success rate and is cost effective especially for men with low or zero sperm count. When there is no sperm count or if male partner is unable to ejaculate on the day of egg collection for IVF, then sperms are extracted either from testicles (using TESA) or epididymis (using PESA).
ICSI is done with the help of sharp and delicate needle to immobilize and pick up a sperm to inject it into the cytoplasm of the egg. This needle is removed after injecting the sperm.
Significantly, ICSI has higher success rate than IVF. Couple often opts for ICSI technique along with IVF to get the desired results for them. The success rate of ICSI is also depending on age: younger patients have higher chances of conceiving.
Some of the potential ICSI may involve:
· More expensive then IVF treatment
· Higher risk of neonatal abnormalities
· Eggs may become damaged
· Failed cycle
Intrauterine insemination or IUI is fertility treatment for couple who cannot conceive through natural process. In this procedure, high quality sperms are separated from sluggish or immobile sperm. This high quality sperm is then injected directly into the womb. People may need donated sperm when there are no problems with female fertility, or may be for single women and same sex couples. Couple who have unexplained infertility, who have difficulties having vaginal intercourse due to physical disability or psychosexual problem, cervical scarring or cervical mucus abnormalities, severe pain during sex, erectile dysfunction or ejaculation problem, semen allergy etc can opt for IUI treatment.
IUI treatment is sometimes combined with the fertility drugs to increase the chances of conception that is called stimulated cycle. In unstimulated cycles, IUI is timed to take place when there is natural ovulation.
IUI process –
1. Production of eggs – eggs produced by ovaries for fertilization can be done through unstimulated or natural cycle or stimulated cycle in which fertility drugs are given in the beginning of the cycle. These eggs then can be tracked with the help of ovulation detection kit which is important for timing insemination. Women may ovulate naturally, or may require hormone injection called human chorionic gonadotrophin (hcg) to bring it on. When an egg bursts from its follicle, insemination usually happens the next day. Ovulation can be figured out by doing ultrasound also.
2. Sperm washing – once the ovulation takes place, male partner produce s a sperm sample to be washed in laboratory to concentrate the hardiest sperm into a small amount of fluid.
3. Insemination - this concentrated sperm is then placed directly into the uterus through the cervix with the help of thin long tube called catheter. Insemination takes only few minutes. This procedure is painless but may cause mild cramping for a day or two. Doctor will recommend pregnancy test to be done about two weeks after the insemination.
The success rate of IUI treatment depends on type of fertility problem, age etc. Non-stimulated or natural cycle has 4% to 5% success rate while in stimulated cycle it can be 7% to 16%.