INVITRO FERTILISATION ( IVF )

IVF is the process by which eggs are removed from ovaries and mixed with sperms in a laboratory culture dish. Fertilisation takes place in this dish,in vitro means in glass . Successful IVF procedure is combined with a procedure known as embryo transfer, which involves physically placing the embryo in the uterus. ( IVF-ET) . The first successful birth of a "test tube baby", Louise Brown, occurred in 1978. Thousands of IVF babies have been born since the first in 1978.

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Indications :
  • blocked or damaged fallopian tubes.
  • male partner has a minor problem with his sperm.
  • Failed treatment cycles with fertility drugs like clomiphene or IUI
  • trying to conceive for at least two years
  • you are 40 years or more.
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Five Basic Steps:

  • Monitor and stimulate the development of healthy egg(s).
  • Collection of eggs.
  • Preparation of sperms.
  • Combining the eggs and sperm together in the laboratory under appropriate environment for fertilization and early embryo growth.
  • Transfer embryos into the uterus.

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    Male Partner Requirements :
    A qualitative semen analysis is done prior to IVF to reveal normal functioning in terms of:
  • Sperm count
  • Mobility (movement of sperm)
  • Sperm morphology (shape of sperm)
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    Female Partner Requirements :

    Because fertilisation and conception are still expected to take place as normal, the female partner will be tested to assessensure :

  • Ovariann function
  • Female reproductive hormone status
  • A normal uterine cavity
  • IVF Step 1 :

    Fertility medications are prescribed to control the timing of the egg ripening and to increase the chance of collecting multiple eggs.Then daily hormone injections are given for 12 days .The hormones used are follicle stimulating hormone (FSH) and luteinising hormone (LH). Egg development is monitored using ultrasound ,urine or blood tests .

    IVF Step 2:

    When eggs are mature , an injection of human chorionic gonadotrophin (hCG) is given to trigger the release of eggs between 34 hours and 38 hours after injection . Eggs are retrieved by a procedure called follicular aspiration or ovum pick up(OVU) which involves ultrasound guidance .Sedation and local anesthesia may be provided to reduce discomfort .

    IVF Step 3:

    Sperms usually obtained by ejaculation ( ideally inside the clinic )and is prepared for combining with the eggs.

    IVF Step 4:

    In a process called insemination , the sperms and eggs are placed in incubators located in the laboratory. The incubators enable fertilization and the fertilized eggs are considered embryos.

    IVF Step 5:

    The number of embryos that are transferred will depend on  age & particular  fertility problem.The embryos (one or two , maximum three) are usually transferred into the woman's uterus  between two to three days following egg retrieval. At this stage, the fertilized egg has developed into a two-to-four cell embryo.  

    Following embryo transfer , you will  be given luteal phase support for 10-14 days in the form of Progesterone gel/pessary/tablets/injections which help in the process of conception .

    These steps are followed by rest and watching for early pregnancy symptoms. A blood test and potentially an ultrasound will be used to determine if successful implantation and pregnancy have occurred.

    IVF FACTS

    Duration of IVF Treatment

    One cycle of IVF takes between four weeks and six weeks . You and your partner can expect to spend about half a day at your clinic for the egg retrieval and fertilisation procedures . You’ve to attend the clinic two to three days later for the embryos transfer or five to six days later for blastocyst transfer.

    Advantages

    There are no long-term problems for most children conceived by IVF .Only it offers you a chance of having a baby if you are unable to conceive naturally .

    Disadvantages

    IVF increases risk of certain complications , such twins ,triplets,premature baby,low birth weight baby , ectopic pregnanacy.Side-effects from fertility drugs & are usually mild , and include hot flushes , headaches ,nausea , ovarian hyperstimulation syndrome.

    IVF - Success Rate

    The success rate of IVF depends on a number of factors including patient characteristics and treatment protocols .
  • 30-35% for women under age 35
  • 25% for women ages 35 to 37
  • 15-20% for women ages 38 to 40
  • 6-10% for women ages over 40
  • Repeated cycles : Extra embryos (if any) are usually  frozen for future use when a cycle doesn't succeed or a couple wants a baby after your successful treatment.

    INTRAUTERINE INSEMINATION ( IUI )

    IntraUterine Insemination ( IUI ) : involves preparing a semen sample in a simple way, so that higher concentrations of the most motile sperms are selected and injected through the cervix around the time of ovulation in order to achieve high rates of pregnancy. It is a simple OPD procedure , not a surgery . There is no need of any sedation or anaesthesia or painful injections . It is less expensive and less invasive than IVF and ICSI .

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    Indications :
      In general, artificial insemination is used when:
    • Cervical mucus is scanty or hostile to sperm . In IUI, sperm directly reaches the uterus, bypassing the cervix and the cervical mucus.
    • Husband having a low sperm count
    • Male infertility due to antibodies to his own sperm.
    • Ejaculation difficulties due to vaginal muscle contractions or psychological problems.
    • Retrograde ejaculation( where the semen goes back into the bladder rather than being expelled outside )
    • When natural intercourse not feasible due to disability, injury or premature ejaculation.
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    SPERM WASHING :

    Once ovulation is achieved, male partner needs to produce a semen sample . A thorough washing procedure is done in andrology laboratory which helps to concentrate the good sperms into a smaller amount of fluid. The physician draws the washed semen into a syringe with a flexible catheter attached to it (IUI Catheter ) , the washed semen is slowly injected into the uterine cavity The woman rests for half an hour .
    You should undergo a pregnancy test two weeks after the procedure if there is no bleeding or else you may contact your consultant on the 2nd day of your period.

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    Male Partner Requirements :
    A qualitative semen analysis is done prior to IUI to reveal normal functioning in terms of:
  • Sperm count
  • Mobility (movement of sperm)
  • Sperm morphology (shape of sperm)
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    Female Partner Requirements :

    Because fertilisation and conception are still expected to take place as normal, the female partner will be tested to ensure that she has:

  • A normal ovulation cycle
  • Open fallopian tubes
  • A normal uterine cavity
  • IUI FACTS

    Double IUI in a month

    Double/Second IUI in a month is done between 12 to 48 hours after the first IUI as time of ovulation is difficult to pinpoint . Intercourse at home is also recommended in between inseminations to increase the chances of conception

    Success rate of IUI

    Women under the age of 35 usually have higher success rates than women over age 35, but the average success rate for IUI ranges from 10-20% in one cycle. This success rate depends primarily on the health of both the sperm and the woman.

    Complications

    The risk for complications is very low with IUI .The main risks are some discomfort such as cramping, minor injury to the cervix that leads to bleeding or spotting, or introduction of infection. There are also risks of hyperstimulation associated with the use of ovulation induction medications . Proper technique and adequate monitoring reduce risks.

    AID (Artificial Insemination by Donor)

    AID (Artificial Insemination by Donor) or TDI (Therapeutic Donor Insemination):
    Some male partners don't have a single sperm in their semen (Azoospermia) . In these cases, the treatment may also be done using donor sperms. This procedure is called AID (Artificial Insemination by Donor) or TDI (Therapeutic Donor Insemination).If no pregnancy is achieved after three to six IUI's, your fertility consultant may recommend more advanced treatments such as IVF or ICSI .