InVitro Fertilization (IVF)

IVF is the solution on major struggles a childless couple are facing today. 

Infertility can prove to be a major struggle in the lives of couples, especially those who really want to conceive a child. Infertility is the major hurdle in the dream of parenthood and not only cause mental trauma, but can also put a strain on your relationship with your partner. The problem of infertility is very common either; around 10-15% couples in India face some issues in conceiving a child. Sometimes, these issues could be extreme and beyond the help of regular treatment. This is where IVF steps in.

In-vitro fertilization has proved to be a boon for countless infertile couples across the world. IVF can not only help in case of infertility in one or both partners but also if any of you suffers from other reproductive conditions. In India, IVF has seen great increase in popularity in the past 2 decades.

Explaining IVF

In-vitro fertilization is a combination of many steps that aim to assist couples in conceiving a child. The steps usually include processes like eggs induction, retrieval, sperm retrieval, fertilization and embryo transfer. The primary feature of IVF is that the fertilization of eggs by sperm occurs outside a woman’s body. After that, the fertilized embryo is placed inside the womb for the gestation period.

Despite its complexity, IVF can be a very flexible process with regards to its participants. Couples can give their own eggs and sperm, or look for donors for one or both of these things. Even if the first cycle fails, further cycles could be tried with different strategies.

Success Rate of IVF

One of the primary concerns of couples is “what are the chances for success?” While IVF has an ideal success rate of almost 1-in-4, there are many factors which can affect the outcome. Broadly, the factors affecting the success could be categorized as:

• Patient Factor

The question of success or failure largely depends upon the couple in question. For the woman, age is the biggest factor in IVF. Women less than 30-35years of age have a fairly high success rate. The older the woman is, the more difficult the procedure becomes. Marriage period of the couples also play a role here. Longer the period of infertility, lesser are the chances to succeed.

The cause and nature of the infertility also decides how successful IVF is going to be. Condition likes ovulatory defect (like PCOD), tubal blockage, unexplained infertility etc. all have a high success rate. But in case like poor ovarian reserve, poor egg quality or poor sperm quality, the success rate goes down.

• Clinician Factor

It must always be remembered that the IVF procedure is very different from regular gynaecological treatment. Here, the expertise of the clinician can make a huge difference – in fact, it can even bring success in the first cycle itself. Furthermore, IVF can be a very intimate experience for the couple. As such, the friendliness and concern of the clinician play a role in the success of the procedure.

• Lab Factor

IVF is, after all, a procedure – and all procedures depend upon their tools. A good lab can increase the success rate by up to 80%, while a poor lab can drop it by 20-25%. The lab you are looking for should possess, good embryologist, high-end equipment, good facilities, great hygiene etc. These seemingly trivial features actually play a significant role in the treatment itself.

Reasons for IVF

In-vitro fertilization is usually the last resort for couples when traditional treatments of infertility fail. IVF is prominently used among couples who face the following issues:

• Poor ovulation which leads to a smaller number of eggs.
• Damage or blockage in the fallopian tube which hinders fertilization.
• Endometriosis – the growth of uterine tissues outside of the uterus.
• Poor sperm production, including low sperm mobility or sperm count.
• Existence of uterine fibroids.
• Unexplained infertility.
• Existence of a genetic disorder. Couples might not want to pass on genetic conditions to their offspring, and hence opt for donor eggs/sperm via IVF.
• Some people opt for later IVF if they suffer from cancer. Cancer treatment can destroy fertility, so frozen eggs could be used later for IVF.

IVF Procedure

In-vitro fertilization is a complicated procedure which includes many steps. You can expect to encounter the following steps, though not all are necessary in every case:

• In case you are using your own eggs for the IVF procedure, you would need to undergo an ovarian induction process. Normally, the ovary produces a single egg per month; however, for IVF, you would need multiple eggs. For this, your doctor would put you on various medications and do routine check-ups.
• Before the eggs ovulate, they would be retrieved from your ovaries and stored for further procedure.
• In case you are using your partner’s sperms, he would need to undergo sperm extraction. Donor sperms could also be easily used for the purpose.
• Fertilization is the most important stage of the procedure, where sperm and eggs are combined. Conventional fertilization simply mixes the two samples and incubates them. However, in case of limited sperm count or failure of previous IVF attempts, the ICSI method might be used.
• The last step of the procedure is the embryo transfer. You might be given a sedative, after which a thin tube would be inserted in your uterus and the embryo transferred inside you.

Ovarian induction process begins on Day 2 of the treatment and continues for 10-12 days. On Day 14, the egg is retrieved from the ovary. In the next 5 days, the sperm is also retrieved and fertilisation occurs. On Day 19 or 20, the embryo transfer take places. In the next 9 days, pregnancy could be confirmed. Hence, the whole IVF procedure (single cycle) takes around a month.

Choosing the Clinic

As mentioned earlier, clinician and lab play a very vital role in determining the success of the IVF procedure. Thus, choosing the right clinic becomes all the more crucial. Here are few things you should be looking for:

• The success rate of the clinic. Most IVF clinics display their success rate on the forefront, backed by previous results.
• The expertise of the doctor. Experienced clinicians have a much higher chance of succeeding in the first round of IVF, compared to the amateur ones.
• The friendliness of the clinician. IVF treatment is a very intimate procedure, leading to one of the most intimate things a couple can go through – pregnancy. Hence, a friendly and caring attitude of the clinician is a very important feature.
• Transparency and discussions. IVF treatment is rather complicated, and most couples are completely clueless about it. Existence of doubts and confusion can actually harm the chances of success. Thus, couples must look for clinics that are transparent and willing to explain everything in great detail.
• State of the lab. As previously mentioned, the equipment and services at your disposal can play an important role in the outcome of the IVF treatment. Couples must be looking for clinics possessing the right equipment and all essential facility for its patients.

Preparing for IVF

Given the complexity of the IVF procedure (and the strain it can put on you if not done correctly), most experts suggest certain steps of preparation before the actual procedure starts. These might include:

• Ovarian testing is done to check the quality of eggs and the capacity of the ovaries (which would be tasked with producing multiple eggs during IVF).
• Semen analysis would be required in case your partner is opting to use his own sperm.
• The couple is checked for any infections that might complicate or obstruct the IVF process.
• Sometimes a mock embryo transfer is carried out to familiarize the women with the process as well as checking the depth of uterus.

Donations in IVF: When is it okay?

Most couples prefer using their own eggs and sperms for the IVF procedure. However, there are certain circumstances when this is not possible, and hence donations are used for the purpose. The two common types of donations you can encounter in IVF are:

• Donor Eggs

Women with very poor egg quality, low number of eggs or poor ovarian reserve can opt for donor eggs. Post-menopausal women can only use donor eggs to get pregnant. In case multiple IVF cycles have failed, the doctor might suggest using donor eggs.

• Donor Sperms

Men suffering from poor sperm motility, low number of sperm or zero sperm count can opt for donor sperm. In case multiple embryos get arrested after sperm retrieval, the doctor could suggest using donor sperm. Sometimes, the male partner is suffering from a genetic disorder which he doesn’t want to pass to the child; in such cases too donor sperm could be used.

Who to choose as a donor: Medical norms dictate that the person should be completely healthy, without any serious illness in the past or genetic disorder, in order to be eligible to become a donor. Harmful habits like drug addictions can make you ineligible to be one.

Generally, clinics routinely store eggs and sperms in their banks, which can be used by the couple. By default both parties are anonymous to each other, but they can choose to get acquainted with mutual consent.

Risks and Side-Effects

Certain risks exist with IVF, even though they are uncommon and rarely a concern. However, these risks can become more prominent among older women:

• In case multiple embryos are transferred inside you, it might lead to multiple births.
• Pregnancies in IVF might often lead to premature birth and low birth weight of the child.
• Miscarriage is a possibility in IVF, though the rate is similar as in case of normal pregnancies.
• About 2-5% of the IVF pregnancies might turn into ectopic pregnancies – where eggs is implanted outside the uterus. Some pregnancies cannot continue and have to be terminated.
• The ovarian induction step employs many drugs, which can lead to ovarian hyperstimulation syndrome. It causes the ovaries to swell and cause mild pain.
• The egg retrieval step can cause complications like bleeding and infection if not done correctly.

Aftermath

After the IVF procedure, you are immediately free to leave. For a few days, you might experience pain while doing vigorous activities as your ovaries are still enlarged. After a period of 9-12 days, the doctor checks if you are pregnant.

Your success rate depends on the factors discussed previously. If you are pregnant, the procedure is considered successful. If not, the doctor would stop the medications blocking your menstrual cycle. You and your doctor would also discuss future rounds and how to increase your chances.

In case there are any left-over embryos, you have to decide what to do with them. You can freeze them for later IVF rounds, donate them to other infertile couples, or ask the lab to destroy them.

Cost of IVF

Cost is often one of the primary concerns of patients when they choose a treatment. However, the cost of IVF really depends on many factors. Cases with relatively straightforward causes of infertility are easier to treat and hence cost lower. The treatment in such cases does not usually exceed 1.5-1.7 lacs. Couples suffering from multiple causes of infertility would obviously increase the cost, as would the requirement for donor eggs/donor sperm. The number of cycles also play a significant role in determining the cost.

However, despite all of this, IVF is still easily affordable by most couples. The treatment of IVF is especially cheap in India, almost 5x lower compared to the western nations. In case couples from economically backward classes need some financial help, many clinics offer discount/loans to aid them.

Conclusion

In-vitro fertilization has emerged as a major solution to the woes of many couples struggling to conceive a child. It must be kept in mind that IVF is not an easy procedure, and so it should be opted for only when all other treatments have failed. But its high success rate, especially in case of elder women, has really made it a boon for couples.