IVF ( VITRO FERTILIZATION )
It’s one of the more widely known types of assisted reproductive technology. In this procedure, the eggs are retrieved from the ovaries of a female, and by mixing it with the sperm of the husband in a high-tech laboratory the fertilization is achieved. These fertilized eggs are called embryos. To make multiple eggs one needs to administer injections every day for 9 to 10 days these are very mild injections given subcutaneously nowadays. To know the maturity of the eggs serial Ultrasounds are done.
A very mild anesthesia is given for 10 minutes to retrieve these eggs with the help of an ultrasound machine. Once these eggs are retrieved they are mixed with the husband’s semen to fertilize them. After the fertilization process is complete embryos are formed. These embryos are deposited back into the uterus of the female after three or five days post retrieval. The pregnancy test is performed after 12 days to know if the female is pregnant or not.
The indications of IVF are many but the most important indications are listed below:
- Bilateral blockage of tubes.
- Three IUI cycles done with no results.
- Unexplained infertility that means no major abnormality found in husband or wife.
- Moderate to severe endometriosis.
- The poor ovarian reserve which means less number of eggs in the ovaries.
- The premature ovarian failure you may need a donor at this time.
- No sperms found in semen. In these cases, sperms are taken out from the testes directly and IVF/ICSI is performed.
- In cases of repeated abortions.
- Any history of the abnormal baby in the family PGD and PGS are done for such cases for a healthy baby next time. This is done through IVF/ICSI.
- In cases of surrogacy, the embryos are formed outside the body and placed inside the surrogate mother, For this also one has to undertake IVF.
Entire IVF procedure is divided into six stages:
A thorough investigation of the male and female is done to rule out any hormonal imbalance or deficiencies, like thyroid, Vit D, Hemoglobin, urine and blood sugar, etc.
The following tests are done before starting the IVF cycle:
- AMH to know the ovarian reserve
- FSH/LH /prolactin, TSH and E2
- Vitamin D
- Random blood sugar
- Viral markers like HIV, Australia antigen, Hepatitis C and VDRL
- Rubella and HPLC
- Urine Routine and Culture
- Husband Semen Analysis
After the investigations are done and any abnormal finding is corrected the IVF is started from the second day.
of her menstrual cycle. In the IVF our goal is to make many eggs so that to increase the chances of success.
2. OVARIAN STIMULATION
So the second stage is ovarian stimulation and follicular monitoring.
For this small subcutaneous injections are prescribed to be taken every day for the next 9-10 days. At the same time, follicular monitoring and hormone tests are done 2 to 3 times during these 10 days period.
The follicular monitoring is done with the help of ultrasound and daily progress is noted simultaneously the lining of the endometrium which is called endometrial thickness is measured.
The egg maturation and thickness of the endometrium is the sign of good progress while one takes injections every day the hormone level should also rise. The stimulation is completed around 9-10 days.
After a strict monitoring one fine day, the trigger injection is given which provides final maturation to the eggs, and eggs are retrieved after 34 to 36 hours of trigger injection.
3. EGG RETRIEVAL
The timing of egg retrieval is very crucial as otherwise eggs can be released in the abdomen if delayed.
The egg retrieval is done in IVF OT under strict is aseptic precautions. General anesthesia is given for 10 to 15 minutes and the follicular fluid is sucked with the help of a machine. Eggs are retrieved from the ovaries with the help of vaginal ultrasound machine.
The eggs are identified from the follicular fluid and kept in the culture media so the egg retrieval process
In the Fertilization process, the selected eggs are mixed with washed semen samples provided by the husband. This is done by an experienced embryologist team in a high-tech embryology lab.
Once the fertilization process is completed the prepared dish in which eggs and sperms were fertilized is kept
in the incubator for 2 to 3 days.
A regular check of these embryos their quality and numbers is done by Embryologist team Once the good quality of embryos is identified the next process starts, which is embryo transfer.
5. EMBRYO TRANSFER
Embryo transfer is a simple procedure, it is absolutely painless and is done under ultrasound guidance which takes 5 to 10 minutes only. Before the embryo transfer is performed the quality and quantity of the embryos obtained are discussed with the couple. The consent of the couple is obtained regarding the number of Embryo to replaced.
The remaining embryos can be frozen for subsequent use.
6. PREGNANCY TEST
Last and the final stage is to find out about the pregnancy. The beta HCG test is done on day 9th to 12th depending on which day embryos were transferred. If BHCG is more than five it is called positive but repeat test is done after 48 hours to see if pregnancy is growing or not. BHCG should be double up in 48 hrs.
If the beta HCG value is above 50 it is called definite positive pregnancy. The IVF process is complete once the beta HCG report is obtained.