Whenever one is advised an IVF, there are various questions come to one’s mind. These may vary from
How is an IVF done?
What am I going to expect?
Is it painful?
What are the side effects?
And so on.
In this Blog, we are going to answer a few of these questions
IVF is a procedure when the eggs from your ovaries are taken out and inseminated with sperms outside your body and the embryo thus formed is transferred inside your uterus to implant and result in a pregnancy. There are different IVF protocols currently utilized based on the type of medicine and dosages used.
Broadly classified into natural cycle IVF and stimulated IVF (also known as conventional IVF). Both these protocols have their pros and cons, and your doctor will decide which protocol is suited best to your case.
Natural cycle IVF is also known as “drug-free” IVF. In a natural cycle IVF the aim is to harvest a single, naturally matured egg, rather than using drugs to stimulate your ovaries to produce multiple eggs. This reduces the number of fertility drugs needed in the cycle. Often medicines are added to prevent premature ovulation. The patient needs a trigger shot for the maturation of an egg or the egg before harvesting. Progesterone supplementation is also used to support the development of the uterine lining. Hence not entirely drug-free, it is an excellent alternative to patients who want to minimize the use of hormones in their treatment. There are certain patients who due to personal or religious beliefs do not want to freeze or discard their embryos for them this is also a preferred way of doing an IVF as it deals with single embryo at a time. But as natural cycle IVF relies on a woman’s natural cycle, it is not a good option for patients with irregular ovulation or anovulation.
The advantages of a natural cycle IVF
Avoidance of multiple pregnancies. As we are dealing with a single embryo for implantation, the chance of multiple pregnancies is generally eliminated.
Cost: As minimal drugs are used, it also reduces the cost of cycle. Lowering the cost of the cycle makes IVF affordable to most patients.
More importantly, with natural cycle IVF, the risk of ovarian hyper stimulation syndrome (OHSS) that occurs usually due to use of high dose of stimulation drugs is also avoided. As there are minimal injections involved, this makes IVF a pain free procedure.
Quality of eggs: there have been multiple reports that prove that the quality of eggs that are retrieved after a natural or drug-free IVF is better than stimulated IVF.
Better Implantation Rates: as there are no medicines involved, the lining of the uterus is more receptive for embryos than a stimulated IVF.
The drawbacks of natural cycle IVF
Premature LH surge: Rarely that the egg may ovulate before harvesting leading to the cancellation of the planned egg retrieval.
As there is only one egg it may sometimes not form an embryo and hence leading to cancellation of the embryo transfer.
As there is usually only one embryo and if that is transferred, there will be no embryo left for freezing. If it is not successful, you will have to go through the whole process again.
Stimulated IVF is also called conventional IVF. In this the ovaries are stimulated with the help of injections, Gonadotropins to stimulate the ovaries to produce multiple mature eggs. These eggs are then retrieved under anesthesia and used to create embryos for transfer. Usually the stimulation is started from the 2nd or 3rd day of your periods but in some instances also known as the random start protocol it may start from any day of the cycle.
Advantages of Stimulated IVF
Higher Success rates: As there is a or number of embryos hence there patients can have multiple transfers after a single attempt of Oocyte retrieval. The success rate of each cycle is around 40% and hence the cumulative pregnancy rates become much higher leading to better outcomes. Stimulated IVF has been used for a long time and has a safe track record with millions of healthy babies born.
Screening for inherited disease: When screening of embryos is needed for testing for any chromosomal disorder or any inheritable disease and preimplantation genetic screening (PGS) or diagnosis (PGD) is needed to select the healthiest embryos for transfer.
Storage of embryos: As in most cases there is a surplus of embryos after the first transfer they can be frozen for future use. To plan either the second pregnancy or use I case the first attempt may have failed which would bring down the cost of next attempt.
Diagnosing fertilization issues: In case of a stimulated IVF as there are more number of eggs therefore in patients where the natural cycle IVF has shown fertilization issues there more number of eggs may help find the problem and may help in trouble shooting.
Drawbacks of Stimulated IVF:
Risk of ovarian hyperstimulation syndrome (OHSS): Due to the high dosage of medicine used the women may sometimes over-respond to the fertility medications causing abdominal pain and bloating. In sporadic/uncommon cases, the symptoms may be severe and may require hospitalization. If your doctor thinks you are at very high risk of OHSS then they may advise you against stimulated IVF.
Multiple pregnancies: Usually 2 or rarely 3 embryos are transferred to improve success rates and that may result in multiple pregnancies. But with the advancement in technology it is possible to achieve success rates with single embryo transfers.
Cost: As there are fertility drugs involved hence it makes the IVF cycle expensive.
As you visit us, this may help you understand your treatment options and decide the best available treatment for you along with your doctor. The treatment cycles these days are tailor-made to according to your need and reserve. The doctor would see you and then decide the best protocol for you. As the clinics are shifting towards single embryo transfer stimulated IVF cycles are giving way to natural IVF cycles.
By treating each of our patients as individuals we can make treatment plans which meet your specific need. We believe that one good egg is needed to achieve pregnancy. Quality of egg is more important than the quantity. We wish you all the best for your journey to achieve motherhood.