In Vitro Fertilisation (IVF)
IVF refers to a procedure where the woman’s eggs are removed from her ovaries and fertilised with the man’s sperm in a laboratory. The embryos formed are then put back into the uterus to achieve a pregnancy.
Who does IVF Treatment help?
IVF was initially offered to patients with bilateral tubal block. Today, its indications include mild to moderate male factor infertility, couples who are unable to conceive after first and second line procedures like ovulation induction (OI) and Intra Uterine Insemination, patients with endometriosis, Polycystic Ovarian Syndrome (PCOS) who have not conceived with routine treatments and those with Unexplained Infertility . IVF is also the treatment option for couples requiring donor oocytes.
What are the Chances of IVF Success?
This depends on various factors like; age of the patient, type and duration of infertility, ovarian response, type of procedure (fresh or vitrified embryo transfer, self or donor eggs). Your consultant will be able to give you a prognosis after proper evaluation. While there is no guarantee, we do our best to ensure you find happiness.
These depend on you and your partner’s age and medical history. These include basic evaluation. In addition, we will also advise routine blood reports to check your physical fitness. Extra tests to check hormone levels or determine ovarian reserve maybe advised as required.
a. Commencement of the treatment
You must come for a check up on the specified day of your menstrual cycle.
b. Ovarian stimulation
Medications will be administered to stimulate the ovaries to produce several eggs in order to increase the chances of pregnancy. You could undergo one of the two protocols available, based on your case history and reports. Your doctor will discuss this with you.
In the Long Protocol, you will be given injections from the 21st day of the previous menstrual cycle. You will need to come back on the 2nd or 3rd day of your next menstrual cycle to start the actual ovarian stimulation.
The Antagonist Protocol requires fewer injections and the entire treatment begins on the 2nd day of the menstrual cycle.
In both protocols, injections have to be taken approximately at the same time every day. It is advisable to come to the hospital for your injections, but if you can’t, our medical staff will teach you how to self-administer the injections or you can have them taken locally by a doctor. These medications can cause mild side effects like acidity and some discomfort.
c. Ultrasound examination
A vaginal ultrasound examination is conducted at regular intervals to assess the response of the injections on your ovaries. If the response is poor, there is a possibility that your doctor might advise you to cancel the IVF cycle. This will be a joint decision between you and your doctor.
d. hCG injection/GnRH injection
This is given to trigger the final maturation of the eggs and make them ready for collection, which happens about 34 to 36 hours later.
e. Ovum pick-up (egg collection)
Eggs are removed from the ovaries under general anaesthesia, with the help of transvaginal sonography. The procedure takes 15-30 minutes and the number of eggs collected will depend on your response to the injections. You can go home approximately 2-3 hours after the procedure. Occasionally one could have some vaginal spotting and some abdominal discomfort, but this settles in a day or two.
f. Sperm collection
Usually, a fresh semen sample is collected on the day of ovum pick-up (egg collection). Some men find it difficult to produce a semen sample on request, so it may be collected elsewhere and brought to the centre within 30 minutes of collection. Generally, to produce the best sample, abstinence of 3-5 days is recommended and lubricants should not be used. However, if a fresh sample cannot be produced on the same day or if the husband is not available on the day of egg collection, a previously frozen sample can also be used. In fact we encourage you to have a semen sample frozen for this eventuality.
g. After ovum pick-up
Following ovum pick-up, the eggs will be fertilised in the lab either by standard IVF or by ICSI. The next day, the embryologist will examine the eggs for fertilisation and later on for further development of embryos. If there are more than three well developed embryos, it is possible to freeze them for a later transfer, if necessary.
h. Embryo transfer
This is performed 2,3 or 5 days after egg collection. The day of the embryo transfer and the number of embryos to be transferred will be discussed with you. In this procedure the embryo is transferred through the cervix into the uterus via a thin, soft plastic tube guided by sonography. After the transfer, you will be given a course of medication to support the luteal phase.
If there are excess good quality embryos, it is possible to freeze them for a later use.
i. Pregnancy test
About two weeks after the embryo transfer, you will be given a beta-hCG test to check if gestation has been achieved. If the test is positive, a vaginal ultrasound scan will be performed 1 week later to confirm the pregnancy and view the gestational sac.
If the beta-hCG test is negative, further treatment will depend on whether you have frozen embryos or not.
Precautions after an IVF treatment
- Any vigorous exercise, heavy lifting and other activities that involve jarring or potentially jarring movements (cycling, jogging, skiing, tennis etc.) are generally discouraged. All routine day to day activities are allowed.
- Take medications as prescribed by the treating doctor as these have been prescribed to improve your chances of achieving pregnancy. If you become pregnant you might be asked to continue some of these medications until the 12th week of pregnancy when the body usually starts producing enough.
- Avoid smoking, exposure to cigarettes, alcohol and exposure to X-rays.
- Please consult your doctor before taking any medication.