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In Vitro Fertilization (IVF)

The Concept

In vitro fertilization refers to a procedure where the woman's eggs are removed from her ovaries and fertilized with the man's sperm outside the body, in a laboratory. The embryos formed are then put back into the uterus to achieve a pregnancy.

Whom does it help

IVF was initially offered to patients with bilateral tubal block. Today, its indications include mild to moderate male factor, couples who are unable to conceive after first and second line procedures like ovulation induction (OI) and intra-uterine insemination (IUI), patients with endometriosis, Poly Cystic Ovarian Syndrome who have not conceived with routine treatment and those with unexplained infertility.

IVF is also the treatment option for couples requiring donor oocytes and / or surrogacy.

What are the chances of success

This depends on various factors like: age of the patient, type and duration of infertility, ovarian response, type of procedure [ fresh or vitrified embryo transfer, self or donor eggs ]. Your consultant will be able to give you a prognosis after proper evaluation. While there is no guarantee, we do our best to ensure you find happiness.

The Process

Preparatory Tests
These depend on your and your partner's age and history. These include : basic evaluation mentioned in Infertility Assessment above. In addition, we will also advise routine blood reports to check your physical fitness. Extra tests, to check hormone levels or determine ovarian reserve maybe advised as required.

Treatment
a. Commencement of the Treatment

You must come for a check up on the specified day of your menstrual cycle between 9 am to 12 pm at a Nova IVI Fertility centre.

b. Ovarian Stimulation

Medications will be administered to stimulate the ovaries to produce several eggs in order to increase the chances of pregnancy. You could undergo one of two protocols based on your case history and reports. Your doctor will discuss this with you.

In the Long Protocol - You will given injections from the 21st day of the previous menstrual cycle. You will need to come back on the second or third day of your next menstrual cycle to start the actual ovarian stimulation.

The Antagonist Protocol requires fewer injections and the entire treatment begins on the second day of the menstrual cycle.

In both protocols, injections have to be taken at approximately the same time every day. It is advisable to come to the hospital for your injections, but if you can't, our medical staff will teach you how to self-administer the injections or you can have them taken locally by a doctor. These medications can cause mild side effects like acidity and some discomfort.

c. Ultrasound Examination

A vaginal ultrasound examination is conducted at regular intervals to assess the response of injections on your ovaries . If the response is poor, there is a possibility that your doctor might advise you to cancel the IVF cycle. This will be a joint decision between yourself and your doctor.

d. HCG Injection/GnRH Injection

This is given to trigger the final maturation of the eggs and make them ready for collection, which happens about 34 to 36 hours later.

e. Ovum Pickup (Egg Collection)

Eggs are removed from the ovaries under general anaesthesia, with the help of transvaginal sonography. The procedure takes 15 –30 minutes and the number of eggs collected will depend upon your response to the injections. You can go home approximately 2 to 3 hours after the procedure. Occasionally one could have some vaginal spotting and some abdominal discomfort, but this settles in a day or two.

f. Sperm Collection

Usually, a fresh semen sample is collected on the day of ovum pick-up (egg collection). Some men find it difficult to produce a semen sample on request, so it may be collected at home/elsewhere and brought to the centre within 30 minutes of collection. Generally, to produce the best sample, abstinence of three to five days is recommended and lubricants should not be used. However, if a fresh sample cannot be produced on the same day or if the husband is not available on the day of egg collection, a previously frozen sample can also be used; in fact we encourage you to have a semen sample frozen for this eventuality.

g. After Ovum pickup

Following ovum pick-up, the eggs will be fertilised in the lab either by standard IVF or by ICSI. On the next day, the embryologist will examine the eggs for fertilisation and later on for further development of embryos.

If there are more than three well-developed embryos, it is possible to freeze them for a later transfer, if necessary.

h. Embryo Transfer

This is performed two or three or five days after egg collection. The day of embryo transfer and the number of embryos to be transferred will be discussed with you. In this procedure the embryo is transferred through the cervix into the uterus via a thin, soft plastic tube guided by sonography. After the transfer, you will be given a course of medication to support the luteal phase.

If there are excess good quality embryos, it is possible to freeze them for a later use.

i. Pregnancy Test

About two weeks after the embryo transfer, you will be given a beta-HCG test to check if gestation has been achieved. If the test is positive, a vaginal ultrasound scan will be performed 1 week later to confirm the pregnancy and view the gestational sac.

If the beta-HCG test is negative, further treatment will depend on whether you have frozen embryos or not.



Precautions after an IVF treatment


i. Any vigorous exercise, heavy lifting and other activities that involve jarring or potentially jarring movements ( bicycle riding, jogging, skiing, tennis etc. ) are generally discouraged. All routine day to day activities are allowed.
ii. Take medications as prescribed by the treating doctor as these have been prescribed to improve your chances of achieving pregnancy. If you become pregnant you might be asked to continue some of these medications until the twelfth week of pregnancy, when the body usually starts producing enough.
iii. Avoid, smoking, exposure to cigarette, alcohol, exposure to X-ray.
iv. Please consult your doctor before taking any medication.

You can submit your queries to our Infertility Specialist here : Ask a Doctor

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