KISHORI IVF
In-Vitro Fertilisation (IVF)
IVF (in vitro fertilization) is a fertility treatment where eggs and sperm are combined in a laboratory outside of the body. This method is utilized by individuals who require assistance in becoming pregnant. IVF consists of multiple intricate steps and is a successful form of assisted reproductive technology (ART).
Overview
What is IVF?
In vitro fertilization (IVF) is a form of assisted reproductive technology (ART) in which an egg and sperm are fertilized outside the body. IVF is a complex procedure that includes extracting eggs from the ovaries and manually combining them with sperm in a laboratory for fertilization. After several days of fertilization, the resulting embryo is transferred into the uterus. Pregnancy occurs when the embryo implants itself into the uterine wall.
Why is IVF done?
IVF is chosen for various reasons, such as infertility problems or when one partner has a pre-existing health issue. Some individuals opt for IVF after unsuccessful attempts with other fertility methods or if they are older. Additionally, IVF is a viable option for same-sex couples or individuals who want to conceive without a partner.
IVF may be considered if you or your partner have:
- Blocked or damaged fallopian tubes.
- Endometriosis.
- Low sperm count or other sperm issues.
- Polycystic ovary syndrome (PCOS) or other ovarian conditions.
- Uterine fibroids.
- Uterine problems.
- A risk of passing on a genetic disease.
- Unexplained infertility.
- Are using an egg donor or a gestational surrogate?
How long does the IVF process take from start to finish?
The IVF process is intricate and involves several stages. Typically, it lasts for about four to six weeks. This duration encompasses the period from before egg retrieval, when fertility medications are taken, to the time of pregnancy testing.
Is IVF common?
Around 5% of couples experiencing infertility opt for IVF. Since 1978, over 8 million babies have been born through IVF. It remains one of the most successful assisted reproductive technologies (ARTs) accessible.
What is the difference between IVF and IUI (intrauterine insemination)?
Intrauterine insemination (IUI) and in vitro fertilization (IVF) differ in how fertilization occurs. During an IUI procedure, sperm is placed directly into a person’s uterus, where fertilization can take place naturally. The sperm sample is prepared to ensure only high-quality sperm are used. This is done using a catheter (a thin tube) during ovulation, facilitating the sperm’s journey to the egg, increasing the chances of fertilization.
On the other hand, with IVF, fertilization occurs outside the uterus, typically in a laboratory. The sperm and egg are combined in a dish to create embryos, which are then transferred into the uterus.
IUI is generally less expensive and less invasive compared to IVF. However, the success rate per cycle for IUI is typically lower than that of IVF.
Procedure Details
What are the steps of IVF treatment?
The steps of IVF treatment are as follows:
Birth control pills or estrogen:
Before starting IVF, your healthcare provider may prescribe birth control pills or estrogen. This helps to prevent ovarian cysts from developing and regulates the timing of your menstrual cycle. It allows your healthcare provider to manage your treatment effectively and increase the number of mature eggs during egg retrieval. Some individuals are given combination birth control pills (containing estrogen and progesterone), while others receive estrogen alone.
Ovarian stimulation:
During a natural menstrual cycle, a group of eggs begins to mature each month, but typically only one egg becomes mature enough to ovulate. In IVF, you’ll take injectable hormone medications to stimulate the entire group of eggs in that cycle to mature simultaneously. This increases the chances of obtaining multiple mature eggs for retrieval. The type, dosage, and frequency of medications are personalized based on factors such as medical history, age, and response to previous IVF cycles.
The ovarian stimulation process involves:
- Monitoring: Ultrasounds and blood hormone levels are used to monitor your ovaries’ response to the medications. Monitoring occurs regularly over a period of about two weeks to assess follicle growth and egg maturation. Follicles containing mature eggs are typically larger than 14 millimeters.
- Trigger shot: Once your eggs are mature, a “trigger shot” is administered to finalize their maturation in preparation for egg retrieval. This shot is given precisely 36 hours before the scheduled retrieval.
Egg retrieval:
- Using ultrasound guidance, a thin needle is inserted through the vagina into each ovary to retrieve the eggs from the follicles.
- The retrieved eggs are placed in a dish with a special solution and incubated in a controlled environment.
- Medication and mild sedation are provided to minimize discomfort during the procedure.
- Egg retrieval typically takes place 36 hours after the trigger shot.
Fertilization:
The day after your egg retrieval procedure, the embryologist will attempt to fertilize all mature eggs using a technique called intracytoplasmic sperm injection (ICSI). This involves injecting sperm into each mature egg. It’s important to note that immature eggs cannot undergo ICSI. Instead, they are placed in a dish with sperm and nutrients. However, immature eggs rarely complete their maturation process in the dish. If by chance an immature egg matures, the sperm in the dish can then attempt to fertilize it.
On average, about 70% of mature eggs successfully fertilize. For instance, if 10 mature eggs are retrieved, approximately seven will fertilize. If fertilization is successful, the fertilized egg will develop into an embryo.
In cases where there is an exceptionally large number of eggs or if you prefer not to fertilize all eggs at once, some eggs may be frozen before fertilization for future use.
Embryo Development:
Over the next five to six days, the progress of your embryos will be closely monitored.
For an embryo to reach a suitable stage for transfer to your uterus, it must overcome significant obstacles. On average, about 50% of fertilized embryos advance to the blastocyst stage, which is ideal for transfer. For example, if seven eggs were fertilized, approximately three or four of them might develop into blastocysts. The remaining 50% typically do not progress and are discarded.
All embryos deemed suitable for transfer will be frozen on either the fifth or sixth day after fertilization for future use in embryo transfers.
Embryo Transfer:
There are two types of embryo transfers: fresh and frozen. Your healthcare provider will discuss with you which option is best based on your individual circumstances. Both types of transfers follow the same procedure, with the main distinction being whether the embryos are fresh or frozen.
During a fresh embryo transfer, the embryo is inserted into your uterus between three and seven days after the egg retrieval procedure. It is not previously frozen and is considered “fresh.”
In a frozen embryo transfer, embryos that have been previously frozen (from a previous IVF cycle or donor eggs) are thawed and then inserted into your uterus. This method is more commonly used for logistical reasons and has a higher likelihood of resulting in a live birth. Frozen embryo transfers can be performed years after egg retrieval and fertilization.
In preparation for a frozen embryo transfer, you will take hormones orally, via injection, vaginally, or transdermally to prepare your uterus for embryo implantation. This typically involves 14 to 21 days of oral medication followed by six days of injections. You will have several appointments during this time to monitor your uterus readiness with ultrasound and hormone level tests. Once your uterus is prepared, the embryo transfer procedure will be scheduled.
The process for fresh embryo transfer is similar, except the transfer occurs within three to five days of egg retrieval.
The embryo transfer procedure is simple and does not require anesthesia. It feels similar to a pelvic exam or Pap smear. A speculum is inserted into the vagina, and a thin catheter is passed through the cervix into the uterus. The embryos, contained in a syringe attached to the catheter, are then injected into the uterus. The procedure usually takes less than 10 minutes.
Pregnancy:
Pregnancy occurs when the embryo successfully implants into the lining of your uterus. Your healthcare provider will conduct a blood test approximately nine to 14 days after the embryo transfer to determine if pregnancy has been achieved.
If donor eggs are used, the same steps are followed. The egg donor undergoes ovarian stimulation and egg retrieval, and after fertilization, the resulting embryo is transferred to the intended parent(s), with or without additional fertility medications.
Before embarking on IVF treatment, it’s essential to consider various factors. To gain a comprehensive understanding of the IVF process and what to expect, consulting with your healthcare provider is crucial.
Preparing for IVF Treatment:
Before beginning IVF treatment, you will undergo a comprehensive medical examination and fertility tests, as will your partner if applicable. Some of the preparatory steps include:
- IVF consultation: Meeting with healthcare providers to discuss the details of the IVF process.
- Uterine exam, Pap test, and mammogram (if over 40).
- Semen analysis for your partner.
- Screening for sexually transmitted infections (STIs) and other infectious diseases.
- Ovarian reserve testing, along with blood and urine tests.
- Instructions on how to administer fertility medications.
- Genetic carrier screening.
- Signing consent forms.
- Uterine cavity evaluation through hysteroscopy or saline-infused sonography (SIS).
Your healthcare provider may also recommend starting folic acid supplementation at least three months before embryo transfer.
Post-IVF Treatment Expectations:
After undergoing IVF treatment, you may experience some mild symptoms following embryo transfer, such as:
- Mild bloating and cramping.
- Breast tenderness due to increased estrogen levels.
- Spotting.
- Constipation.
While many individuals resume normal activities immediately after egg retrieval, it’s important to refrain from driving for 24 hours after anesthesia. Approximately nine to 14 days after embryo transfer, you will return to the clinic for a pregnancy test using a blood sample.
How do IVF Injections Work?
During an IVF cycle, injectable hormone medications are used to stimulate the ovaries, encouraging the maturation of multiple eggs simultaneously. Your healthcare provider will prescribe specific drugs, dosages, and frequencies based on factors such as age, medical history, and response to previous cycles. Typically, fertility medications are administered for about eight to 14 days.
Medications Used for IVF:
Several medications may be used during an IVF cycle, including:
- Follicle stimulating hormone (FSH): Stimulates egg production in the ovaries.
- Human chorionic gonadotropin (hCG): Triggers egg maturation and ovulation.
- Leuprolide acetate: Controls the stimulation process or acts as a trigger shot.
Additionally, birth control pills or injections may be prescribed before IVF to synchronize your cycle, while estrogen and progesterone supplements are often used to prepare the uterus for embryo transfer.
Assisted Hatching in IVF:
Assisted hatching is a technique where a hole is made in the embryo’s outer shell before transfer to facilitate implantation in the uterus. This procedure is typically reserved for individuals who have had multiple failed IVF cycles.
Cost of IVF:
The average cost of an IVF cycle in the United States is $15,000, excluding medication expenses which can amount to around $5,000 per cycle. Costs vary based on individual health factors, insurance coverage, and the chosen treatment center.
Risks / Benefits
IVF carries certain risks, including multiple births, premature delivery, miscarriage, ectopic pregnancy, and ovarian hyperstimulation syndrome (OHSS). Common side effects of IVF medications include nausea, hot flashes, headaches, and abdominal discomfort.
IVF Pregnancy:
The success of IVF depends on factors such as age, with higher success rates in younger individuals. Pregnancy tests are typically conducted nine to 14 days after embryo transfer, with a recommended break of one menstrual cycle between IVF cycles.
IVF Recovery and Outlook:
Recovery from IVF is relatively quick, with normal activities resuming after embryo transfer. Emotional support is essential during IVF treatment, as it can be physically and emotionally demanding. While IVF pregnancies are not inherently high-risk, certain medical conditions may increase the risk.
Additional Details:
Can You Select the Gender During IVF?
Yes, gender selection is possible during IVF. Before embryo implantation, the embryo’s cells can be analyzed to determine its sex. Couples can opt to implant embryos of the desired sex and discard others. However, this practice is illegal in many countries outside the United States, and not all U.S. practices offer this service.
Increasing Chances of Pregnancy with IVF:
Several factors influence IVF success, including age, weight, previous births, and health conditions. Your healthcare provider will assess your situation and history to recommend strategies for improving your chances of pregnancy.
Reasons for IVF Treatment Failure:
IVF failure can occur due to various factors at different stages of the process, such as premature ovulation, fertilization issues, embryo viability, or problems with retrieval or transfer. Your healthcare provider will assess each step and guide you on future treatments.
"A note from Kishori IVF Clinic"
IVF treatment is a deeply personal and intricate journey. It’s essential to have open conversations with your healthcare provider to fully grasp all the involved steps. Your healthcare team is dedicated to supporting both you and your partner every step of the way during your treatment.
