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In Vitro Fertilization (IVF): What is IVF & Step by Step IVF Process

In Vitro Fertilization (IVF): What is IVF & Step by Step IVF Process

In Vitro Fertilization (IVF): What is IVF & Step by Step IVF Process

What Is IVF?

History of IVF

How to prepare for IVF

IVF Myths and Facts

Who can opt for IVF?

Why Consider IVF?

Types of IVF Treatment

FAQs

Latest developments in IVF treatments

What Is IVF?

Dreaming of having a little you and yours and getting ill of years and years of trying to conceive? Fertility pills causing nothing but sadness, anger, and fear? Here’s to a big-time solution to fulfill your desire to have a family, IN-VITRO FERTILIZATION. In Vitro Fertilization (IVF) is a technique where fertilization happens outside the human body. In this technique, man’s sperm and women’s eggs are united to create an embryo(s) in a laboratory. Often, women consume stimulating medicines to produce several eggs before fusing them with the sperm. After the fertilized egg develops into an embryo, it is embedded in the woman’s uterus to establish a successful pregnancy. IVF process is a very successful and most commonly used “Assisted Reproductive Technology (ART)” among the people with fertility issues.

History of IVF

In 1973, The first IVF pregnancy (human) was reported by the Monash research team of Professors Carl Wood and John Leeton in Melbourne, Australia. Though it ended in early miscarriage.

It was then in 1978, Louise Brown became the first baby ever to be born through IVF in Oldham, England. The collaboration of Patrick Steptoe and Robert Edwards pioneered this successful birth. Just 67 days after the birth of Louise Brown, the Indian scientist and physician “Subhash Mukhopadhyay” created the world’s second and India’s first In Vitro Fertilization (IVF) baby named Kanupriya Agarwal (Durga). 

How to prepare for IVF

Preparing yourself before experiencing anything improve the chances of success. It is quite similar in the case of IVF. Though being a highly successful treatment, IVF not necessarily always work. So, it is crucial to prepare both physically and mentally beforehand. 

It is advisable to be open to your doctor and follow all the instructions wholeheartedly. 3 to 6 months is considered ideal for the preparation of IVF. Give your best shot in preparation even if you have lesser time. You got no reason to not try your best. 

A customized regime may be directed by your fertility specialist. Still, here are 5 general recommendations for better preparation:

Avoid drinking and smoking

Nicotine is proven to age ovaries and make the eggs resistant to fertilization. Also, according to a report in the American Journal of Epidemiology, nicotine is more concentrated in the uterine fluid than in the rest of the mother’s body. On the other hand, Alcohol consumption is found to be highly correlated with the lesser chances of success in the IVF cycle. Therefore, it is advised to completely cut off the intake of alcohol before and during the IVF cycle.

Take high-quality vitamins

Quality of the egg is vital in IVF. It can be the decider between the success and failure of the treatment round. Thus, a high-quality prenatal supplement is beneficial to improve the egg quality and fertility of the body. As said before that it is best to start 3 to 6 months before but supplementing 1 to 2 months prior to the IVF is also advantageous. Moreover, high-quality vitamin supplements are worth investing in.

Have a fertility-enhancing diet

It is always advisable to maintain your health and an ideal BMI. An unideal BMI could lower the chances of IVF success.  Try to incorporate fertility-enhancing foods into your diet. Some are avocados, eggs, nuts, beans, seeds, and whole grains. Low fat and high protein diet is better. Iron, magnesium, calcium, and potassium are also vital. Moreover, fresh, seasonal, and organic food, hormone-free whole foods are good to go. It is advisable to avoid consuming processed and sugary items.

Ensure better sleep

A better sleep not only promotes rest to the body. But the quality and quantity of sleep also affect the sexual hormones both in males and females. Hence, a sound sleep schedule is desirable for you as well as your partner, particularly, pre IVF cycle period. 

Some ways to improve sleep are:

o Avoid the intake of unnecessary stimulants like alcohol and caffeine. 

o Abstain from the digital screens at least 1 hour before bedtime.

o Follow a sleep routine. Same time to bed and wake up every day.

o Spend time with nature. It helps regulate sleep cycles.

Reduce stress

Stressful levels may affect the chance of success. An IVF cycle is considered stressful and demanding process. So, it is favorable to keep the stress at bay for the desired outcome.

To reduce stress level:

  • Get proper rest
  • Practice meditation
  • Experience silence
  • Slower the pace of life
  • Practice breathing exercises

Breathing exercises help reduce the stress hormones instantly especially deep breathing. Deep breathing can be practised anywhere and anytime. It can be useful during your doctor visits or sudden times of intense situations.

Now, you know how to prepare your body for IVF. But it is equally valuable to get mentally prepared. 

Mental Preparation for IVF

A detailed discussion is necessary between you and your partner before going for IVF. As mentioned earlier, keep in mind, IVF is not always successful despite the high chances. The process can be challenging both for body and mind. The costs and regular injections can prove frustrating. Consider the possibilities like multiple pregnancies, using donor egg or sperm, what to do with extra embryos etc. Also, be ready to support each other emotionally during the journey.

IVF Myths and Facts

 

Myth: IVF is only for the rich

Fact: IVF may be a little expensive but it is still affordable than other surgical treatments. Couples are advised to save and invest. After all, if it is successful the result will be precious and priceless (isn’t it?). You may get EMI options to pay (discussed below in the article).

Myth: IVF is helpful only for young aged women

Fact: Though the age is a factor in deciding fertility, IVF is considered beneficial for women of all ages. In the higher age group in the post-menopausal set, donor eggs from young women are employed. But, yes, the rate of success the older age group is much lesser than the young ones.

Myth: Pregnancy for old women is harmful

Fact: The medical problems in older age are high during pregnancy. The complications with pregnancy in the older woman can be worrisome. According to a study, nearly 80% of pregnant women over 45 years of age had no major medical problems and more than 80% gave birth at full term. It is advised to be aware of any risks and consider them while making decisions about whether or not to become pregnant through IVF.

Myth: IVF has a 100% success rate

Fact: IVF is undoubtedly a highly useful treatment. But, the success rate of IVF is around 40% in couples below 35 years of age. The success rate depends upon several factors like age group, hormonal issues, the reason for infertility and other health issues.

Myth: IVF babies are different from normal babies

Fact: The IVF babies are as “different” as normal babies. The only difference is the way they are conceived.  The risk of an IVF baby being abnormal is very low. IVF babies are similar to the normal population.

Myth: IVF is unsafe

Fact: IVF is a safe technique. Also, as mentioned above, it does not carry any harm for the child. Moreover, the risk of being unwell from ovarian hyperstimulation disorder is just around 2%.

Myth: Admission to the hospital is required in IVF

Fact: IVF does not require you to get admitted to the hospital. Just the process of egg collection in IVF demands the patient to be in the hospital for a few hours.

Myth: IVF is for women only

Fact: This is a big false myth. There are special techniques in IVF such as ICSI, IMSI and PICSI for the situations where a woman is fine and fertile but a man is not. They are invented specially for men with infertility issues like low sperm count or poor sperm motility.

Myth: Donating eggs will decrease them

Fact: A female has over four hundred thousand eggs at the time of menarche. During the lifetime, only 400 are required out of these 400,000 eggs. Every month about 20 of these eggs are mobilized and just one or two eggs grow to the point of being released during ovulation. About 18 or 19 of the leftover eggs die. IVF helps to maintain the growth of these eggs. Hence, the chance of eggs depleting through donation for In Vitro Fertilization is negligible.

Myth: Pregnancy via IVF result in Cesarean birth

Fact: A standard vaginal delivery is possible for succeeding IVF. IVF pregnancies are similar to usually conceived ones but not a sign for cesarean section. Couples who may have several attempts to have a baby over the years or even those that have higher chances of a multiple pregnancy may go for elective cesarean birth.

Who can opt for IVF?

For treating fertility issues, there are many forms of treatments available. IVF is just one of them.

You can consider IVF:

  1. If you have a blockage in the fallopian tubes.
  2. If there is any tubal damage.
  3. In case when the male partner has a poor or low sperm count.
  4. If sperm motility is low in the male partner.
  5. If there is no cause for infertility and other forms of treatment have not worked.
  6. If you have suffered from endometriosis. It is where the uterine lining grows outside the uterus and affects the fallopian tubes.
  7. If your does not function normally before you turned 40.
  8. If you do not have eggs for regular release.
  9. If you suffer ovulation problems or absence of ovulation.
  10. If genetic problems could pass on to your future offspring.
  11. If you have been under chemotherapy or radiation.

* Though, IVF is recommended in all the above-mentioned scenarios. Always seek the guidance of a specialist doctor or an IVF specialist before deciding to opt for IVF.

Why Consider IVF?

 

IVF can use donated eggs/sperms

In a few infertility cases, the donated eggs/sperm can be utilized. During such cases, the eggs and sperm are fused manually in a laboratory and the resulting feasible embryo can be used for IVF.

IVF can work where other treatments fail

Doctor recommend IVF during particular infertility diagnoses directly. Because in these cases like blocked fallopian tubes, mature age, severe male infertility factor, reduced ovarian reserves, other treatments do not work well. So, it is beneficial to directly invest in the IVF rather than wasting time and money in other treatments.

IVF decreases the incidence of multiple pregnancies in younger women

Spontaneous identical twinning occurs in 2% of IVF pregnancies – compared to 8% for Clomid pregnancies. Women less than 35 years of age normally should only have a single blastocyst placed back into their uterus as part of an IVF cycle.

IVF is useful in other cases too

Same-sex couples, single parent, mothers who are physically unable to carry a baby full-term can also use IVF. It can be used by surrogate or gestational carriers so they can become parents and participate in the pregnancy and labor experience too.

IVF Process Step by Step (detailed)

One round of the IVF treatment from start to end is called the “IVF Cycle”. Given below are the steps of an IVF cycle:

Step 1: Ovaries Stimulation

Stimulation phase start from the very first day. As naturally ovaries produce just one egg. So, women are given fertility drugs/medication for 8-14 days to stimulate the follicles in your ovaries to produce more eggs. The medication is prescribed individually according to the body and treatment plan. On average, 10-20 eggs are retrieved for IVF though all are not used in the process as only two-third are about viable. 

Your doctor will monitor you using blood testing, hormonal testing and ultrasounds. At the time, you have a sufficient number of large enough follicles and the right level of estrogen, you’ll be given a trigger shot of hCG or other medication. It makes the eggs are capable of being fertilized.

Step 2: Retrieval of Eggs

Egg retrieval is the procedure of removing eggs from the follicles in the ovaries before the eggs ovulate. During this procedure, the doctor will use an ultrasound to guide a thin needle into each of your ovaries one after another through the top of the vagina to remove the eggs. Though, before this procedure, you are suitably medicated to vanish any feeling of pain or discomfort. You may experience some cramping afterward, but this usually disappears in a day. 

Step 3: Sperm Collection

When the eggs are removed, it is the time to look at sperm collection. The male partner will produce the sample of sperm or you may choose to opt for donor sperm. The sperm is then washed in a special mixture and do through the spin cycle in order to find the healthiest ones. A perfect, healthy sperm is not too fat or thin, with a tail that’s not too long or short.

Step 4: Fertilization

Once the maturity and quality of eggs is determined, eggs and sperm are transferred in a dish. They have the chance to find each other and fertilize naturally. This procedure of fusion of eggs and sperm is called conventional insemination. The other is intra-cytoplasmic sperm injection (ICSI) where the doctor injects the sperm directly into the egg. Both methods have approximately the same success rate. 

Step 5: Embryo Transfer

An expert prepares the embryo by placing it in a small tube called a catheter. After about three to five days of fertilization, the fertility specialist places the catheter through your cervix and into your uterus. This part of the procedure is done while you are awake with no anesthetic. 

Multiple embryos are transferred back so that at least one sets itself in the lining of your uterus. A few times, more than one embryo gets implanted resulting in multiples.

Step 6: The Final test

Approximately 12 days after the embryo transfer, you’ll have a pregnancy test. If the test results positive, blood tests and eventually, ultrasounds are conducted, to confirm viability and if there’s a multiple pregnancy.

Types of IVF Treatment

 

Natural & Injection free IVF and Conventional IVF

Natural and Injection free IVF process is a treatment without the use of medications to stimulate the ovaries to produce multiple eggs but similar to conventional or stimulated IVF. It may sound interesting to the ones who are reluctant to medications. As the natural IVF technique does not use medications to stimulate the ovaries, the cycle produces up to one mature egg at a time naturally. Patients are monitored to track the development of the single ovarian follicle so that it is not ovulated before it can be removed. Notably, this treatment has evidently exhibited a lower rate of pregnancy than conventional IVF. 

IVF with Egg donor

The women who cannot use their eggs due to infertility issues or any other reasons can opt for IVF with donor egg. The couples who use screened donor eggs have a higher success rate on average than the couples who do not. Egg donor IVF simply means that to be a father will be genetically related to the baby while the mother will not.

IVF with Donor Sperm

IVF with donor sperm is just opposite to the IVF with egg donor. This is opted in cases where the male partner has fertility issues. IVF with donor sperm is also useful for a single mother or lesbian women. The sperm donor may be known or anonymous.

What happens to your harvest eggs during IVF Treatment?

When the eggs are retrieved, the doctor informs about the oocyte count. About 80% of eggs harvested are healthy, mature, and normal

In the fresh IVF cycle, the sperm droplets are placed in the proximity of the eggs, the lab then assesses whether the eggs have fertilised the next day. In the case of ICSI, the cumulus covering of the oocyte is removed and the sperm is injected. The embryos (fertilised eggs) are then placed in special incubators for about 5 days, they have a similar environment as that of the uterus. Afterward, the healthy embryo is inserted into the vagina through a catheter. 

If the pregnancy does not happen in 2 weeks, the second round of IVF starts after a week, in this round frozen embryos are thawed and used. The eggs that were retrieved and fertilised in the first cycle and frozen.

How is the embryo placed in your womb?

After the retrieval of the eggs, they are made to undergo fertilisation under a controlled laboratory environment, in a petri-dish. After 3-5 days of fertilisation embryos are implanted. A thin tube(catheter) containing the embryos is inserted into the woman’s vagina by the doctor when the woman’s wake. If the implantation occurs and the embryo sticks to the inner lining of the uterus, pregnancy occurs. Multiple embryos are placed inside the womb, depending on various factors like age, which can result in twins or more. Unused embryos can be frozen and saved for later or sometimes donated.

What to expect from the IVF doctor/ clinic?

Fertility clinics waiting room is filled with hope, and futuristic dreams as they have banners including testimonies of parents who have had children in the most non-viable conditions through IVF treatments. 

Before meeting the doctor, one must start filling up the forms asking about all the genetic history, overall health, and pregnancy history, including the paperwork related to insurance and various consent forms regarding the procedures.

When the first-timers meet the doctor, a lot of questions are asked about the overall health, which would help them figure out what procedure is best for the expectant. One must be thorough with their family history while explaining to the doctor and prepared with their medical reports and hormonal level reports like AMH level plays an important role in the conception. 

Then the couples are thoroughly explained the fertilisation process and how IUI AND IVF are different from it. They are given full support and asked to keep their emotional self in check, as the next few months can be exhausting with the medications and procedures.

What should you know: Risks and safety?

Medical procedures come up with certain risks. In IVF, it can cause Ovarian hyperstimulation syndrome that includes the following symptoms:

  • Nausea or vomiting
  • Decreased urinary frequency
  • Breathlessness
  • Dizziness and faintness
  • Severe stomach pains and bloating
  • Sudden weight gain

 

Other risks of IVF include:

Bleeding or damage to bladder or bowel could be caused in the retrieval process.

As there are chances of multiple pregnancies in IVF, multiple pregnancies come up with additional risks and concerns like low birth weight and premature delivery.

There can be a chance of miscarriage due to unnatural conception.

2-5% expectant have ectopic pregnancies, i.e. pregnancies outside the uterus which is not viable.

A healthy lifestyle must be followed during the IVF cycle, having a proper diet would be good for the female health and sperm health and viability in men. Light exercising or light jogging is necessary. Other medications must be avoided as they interfere with fertility drugs. 

Chances of pregnancy in IVF: IVF success rate

Success rates mainly depend on the woman’s demography particularly age, the viability reduces with age, clinical management, and embryo transfer techniques.

For the women under 35, the success rate is 54.4%, whereas for the women up to 40 the success rate is 26.6%.

Above 40, the success rate declines to 13%, so many women go for donor eggs. 

The number of cycles also impacts the success rate. According to studies, an average of 2.7 cycles leads to conception. Although subsequent trying can be stressful, still it is proven to be more successful.

Several other factors that impact the success rate are:

  • Height and weight
  • Number of full-term pregnancies
  • Total number of pregnancies before IVF
  • Oocyte count 
  • Cause of infertility

Another factor to consider is the clinic rates, which can be easily looked up at the CDC site, and a comparison can be done to check up on live birth rates.

Cost of IVF in India

IVF is cost-effective in India to reach out to maximum couples in need of it and have been planning for a long time. The cost is divided into 2 parts, the basic and advanced IVF. Basic IVF cost up to 1,75,000, it is used when both partners have healthy eggs and sperm. Advanced IVF costs up to 4,00,000, it is performed when any of the two have issues with sperm or ovum.

FAQs

 

What are the stages of IVF?

As discussed above, the stages of IVF are:

Stage 1: Ovaries Stimulation

Stage 2: Retrieval of Eggs

Stage 3: Sperm Collection

Stage 4: Fertilization

Stage 5: Embryo Transfer

Stage 6: The Final test

Are IVF babies Normal?

The IVF babies are as “different” as normal babies. The only difference is the way they are conceived.  The risk of an IVF baby being abnormal is very low. IVF babies are similar to the normal population. So, yes, IVF babies are normal.

Can I get pregnant in the first attempt of IVF?

Although no one can guarantee first-time success, to increase the probability several measures are kept in place at different levels. During fertilisation of the egg, standard insemination procedure i.e. placing the sperm in the proximity of the ovum can have a 5-15% of failure rate, so to have a higher first-time success rate ICSI is performed, which involved injecting sperm directly into the ovum.

After fertilisation, the embryos are transferred into the womb. To ensure a higher success rate, it is best to watch the growth until the blastocyst stage, as some embryos degenerate instantly while some embryos do not undergo growth. Therefore, it’s better to observe for a longer period. 

To have a viable pregnancy, embryo testing is a must to keep in check the chromosomal abnormalities. 

I have no eggs, is IVF treatment possible?

In the case of low embryo count mini-IVF procedure that involves cleanroom grade, a system of embryo freezing and a mild ovarian stimulation that is more natural than providing fertility drugs. Women with no egg count would have to consider a donor egg for IVF treatment.

What is the age limit for IVF treatment?

Women above 40 years age have reduced fertility potential than younger women relatively. Also, the success rates with fertility treatments including in vitro fertilization (IVF) is significantly low.

When couples try to conceive on their own the factor responsible for success potential is egg quality. But In IVF, the factors are both egg quality and egg quantity.

Mostly the upper age limit for allowing IVF treatment using “own eggs” is between 42 and 45 years of age. Donor eggs are commonly used until about age 49.

Is IVF treatment painful?

Every individual can have a different sensation when it comes to IVF, physical discomfort is common in such kind of medical procedure. It could be painful to some and for others, they might face no pain at all. 

During the first process, fertility drug injections are self-administered by patients through a thin needle, which only causes a slight sting. 

During the egg retrieval process, the expectant woman is sedated, so the procedure isn’t painful but afterward can cause slight discomfort or cramps similar to period cramps which can be easily dealt with paracetamol or hot water bottle.

In the embryo transfer stage, a small catheter is used, which can be intimidating but is not painful, only a slight discomfort can be seen, similar to any other medical procedure.

For a procedure like IVF, it isn’t just about the physical pain but emotional pain is also involved with it. One has to be strong enough to handle the stress, as it can take more subsequent cycles than the next person. Or if the procedure is successful in one go, there won’t be any pain at all, in the end, it all comes to the fact, ‘how well does your body respond!’

What is a good AMH level for IVF?

AMH is a hormone released by the ovaries, and its levels are indicative of the oocyte count. A typical oocyte count for a fertile woman is 1.0-4.0ng/ml, under 1.0ng/ml is considered low and considered as a diminished ovarian reserve. Women with a very low AMH level (0.5ng/ml) can have a chance of getting pregnant, although there is a risk of cycle cancellation but should not exclude a couple from IVF. 

How long does it take to get pregnant with IVF?

After 2 weeks of egg retrieval, blood is tested for the detection of pregnancy. Several factors matter like maternal age, hormonal factors and lifestyle impact the chances of pregnancy. If the pregnancy does not occur, you may get your period within a week and can go for another round of IVF.

Are there any EMI options?

Many clinics have tie-ups with certain companies that offer loans for IVF, that comes up with their risks and benefits. Indira IVF offers interest-free IVF loan options at affordable rates.

LetsMD provides the IVF loan at 0% interest rate, online application is also available for the same, and you can pay the EMIs from home, with minimal paperwork requirements.

Bajaj Finserv has a tie-up with various clinics and hospitals and provides loans up to 4.5 lakhs, with instant approval and flexible EMI tenor.

Latest developments in IVF treatments

Today, IVF babies account for around 1.5% of all births in the US. This portrays the long journey since a few last decades after “Louise Brown”, the first IVF baby was born in 1978. There have been many developments across all aspects of fertility treatments across these years.

Gonadotropins are now readily available and safe for use. Transvaginal Ultrasound has replaced laparoscopic retrievals and Fallopian Tube transfers. Intracytoplasmic sperm injection has helped a lot of infertile males intended to become fathers. Preimplantation genetic screening has helped newborns being unaffected by diseases. In addition to this, IVF studies are now larger and able to look at pregnancy outcomes instead of intermediate outcomes.

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