IVF Basics: All you need to know
World IVF Day is celebrated on July 25 each year to commemorate the birth of the first In Vitro Fertilization (IVF) baby, Louise Joy Brown, in the United Kingdom.
Since then, the treatment has turned out to be a beacon of hope for couples who could never parent a child in a normal scenario. It became the choice of treatment for men with extremely low semen count or for women who have blocked fallopian tubes. The treatment itself has grown leaps and bounds and its scope today has expanded to provide genetically healthy children even to couples troubled by genetic diseases running in their families.
Preparing for IVF
Simply explained, IVF is the process of fusing the male and female gametes outside the womb of a woman. The fertilization takes place in a petri dish in a laboratory. Many years earlier, tubes were used in IVF labs giving IVF babies the nickname ‘test tube baby’.
The embryos thus created are frozen and transferred into the womb of the woman in the next ovulation cycle, a process which is called Frozen Embryo Transfer. Once implanted in the uterus, these embryos cause a ‘normal’ pregnancy henceforth for the couple, giving them the chance to have a biological baby of their own.
The preparation process for IVF includes a thorough examination of a couple, optimising body weight to reach the normal BMI of 18-24 by adopting a healthy lifestyle. This includes incorporating exercise as a daily routine and stopping the consumption of alcohol and smoking.
All medical conditions like diabetes, hypertension, thyroid disorders have to be corrected and kept in control before embarking on the pregnancy journey. In some cases, a surgical correction of uterine defects, or removal of fibroids or cysts in the ovary may also need to be done as per the doctor’s advice.
The process itself
Once that is completed, the most crucial steps involve stimulating the ovaries by hormonal injections, which are given for approximately 10 to 12 days. At the end of this, eggs are extracted from the female partner vaginally under anaesthesia.
For the process of IVF, sperms that have been specially prepared are mixed with the eggs in the laboratory. In another type of assisted reproductive technique called Intracytoplasmic Sperm Injection (ICSI), a single sperm is injected into an egg under a microscope for fertilization. This is used in cases where there is a problem with either the quality or quantity of sperms in the semen. The sperms can be collected by ejaculation or surgically retrieved from testes for men with no sperms in the ejaculate.
The sperm-injected eggs or those left in the petri dish are then incubated for up to 5-6 days to form embryos. The best quality embryos are selected are then transferred into the uterus by a thin tube. Usually, this is a painless procedure and hence there is no need for any anaesthesia.
If there are excess embryos or if the condition was hostile for an embryo transfer the same month embryos are cryopreserved for future transfer.
After two weeks of the transfer, a pregnancy test can be done to confirm the pregnancy. During this time, the patient can be on support medication.
Success rates and risks
Even with the best technology and lab support, the success rates of IVF treatment around the world is approximately 40 percent. Over the years, various technologies have been introduced to improve the success rate per cycle and to achieve a live birth.
One of the major risks with IVF is multiple pregnancies, which can pose a serious health problem for mothers. This can be avoided by judicious use of a Single Embryo Transfer (SET) in appropriate patients.
In families with a history of genetic disorders like muscular dystrophy or bleeding disorders, a Preimplantation Genetic Diagnosis (PGD) can be used. This technique involves taking one or more cells from the developing embryo to check for a specific genetic defect in the parents and transferring only healthy embryos into the womb.
PGS can also be used to screen for abnormal chromosomes in the embryo (aneuploidy), which is the single biggest reason for pregnancy failure. This makes IVF beneficial for couples facing recurrent pregnancy losses.
Various tests to assess the optimal timing for endometrial or uterine lining receptivity have also been introduced to achieve healthy pregnancies.
Dr. Cyriac Pappachan, MD (O&G) FMAS DMAS DAGE-FRANCE is Consultant Infertility Specialist and Laparoscopic Surgeon at Lifeline Super Speciality Hospital, Kochi, Adoor, Kerala.