In vitro fertilization (IVF) is a procedure in which a physician will remove one or more eggs from the ovaries that are then fertilized by sperm inside the embryology laboratory. IVF is the most successful treatment you can do using your own eggs and sperm (or donor sperm). IVF has become mainstream and widely accepted, and continues to grow due to significant technological advances.
COMMON INDICATIONS FOR IVF TREATMENT
There are many types of diagnoses that may lead to IVF. Here are some of the most common indications for IVF treatment:
Fallopian tube damage/tubal factor/tubal ligation
Male factor infertility
Advanced maternal age
Recurrent pregnancy loss
What To Expect
THE IVF TIMELINE
In a normal ovulation cycle, one egg matures per month. The goal of an in vitro fertilization (IVF) cycle is to have many mature eggs available, as this will increase your chances of success with treatment. In order for there to be more than one egg available, stimulation of the ovaries needs to occur. It’s important to note that the eggs being stimulated would have grown or died that month, so stimulating the ovaries does not deplete eggs for the future. This is a common question that patients ask, so rest assured.
PART I: STIMULATION OF THE OVARIES
In the stimulation phase of an IVF cycle, you will use injectable medications for approximately 8 to 14 days to stimulate the ovaries to produce eggs. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH), both produced naturally within the body, comprise the medications. During this phase, you will come into the office approximately 7 to 8 times for morning monitoring, which allows the physician to track the progress of your cycle and adjust medication dosages as needed.
The trigger shot is the final step in the stimulation phase of treatment. Depending on your individual protocol, you will either have a human chorionic gonadotropin (hCG) or Lupron trigger shot. This shot helps the developing eggs complete the maturation process and sets ovulation in motion. Timing is very important here, as the physician must perform the egg retrieval prior to the expected time of ovulation.
PART II: EGG RETRIEVAL
A physician will perform your egg retrieval procedure at Bedi IVF Centre Chandigarh. On the morning of your egg retrieval, a physician will meet with you before the procedure to review your protocol. You will also meet with an anesthetist, who will review your medical history and will administer the intravenous fluid you will receive prior to the start of the procedure to induce sleep.
Obtaining the sperm: If you are using a fresh sperm sample, a lab technician will come to accept the sample. If you are using a frozen sperm sample or donor sperm collected previously, the technician will verify those details with you. Our andrology laboratory will wash and prepare the sperm, so that the healthiest sperm are brought together with the eggs for fertilization (after the physician performs the egg retrieval).
Obtaining the eggs: The egg retrieval itself takes about 20 to 30 minutes. During the procedure, the physician will guide a needle into each ovary to remove the egg-containing fluid in each follicle. The physician utilizes an ultrasound during the procedure to see where to guide the needle.
Recovery will take about 30 minutes and you will be able to walk out on your own. It’s important that a responsible adult drive you home after the procedure, as it is unsafe to drive after receiving anesthesia. The person who is driving you will need to stay at our center during your procedure—he or she should anticipate being at our center for approximately 3 hours in total.
PART III: FERTILIZATION
After the egg retrieval, the embryologist will sort and prepare the eggs and sperm. There are two ways that fertilization can take place: conventional insemination or intracytoplasmic sperm injection (ICSI). The physician will discuss with you which method to use based on sperm quality; this is traditionally planned in advance. In some cases, the embryologist may see that semen parameters for conventional insemination are not being met, so she or he will recommend the switch to ICSI to produce the greatest chance of success. Your clinical team will let you know if they recommend an unanticipated ICSI procedure.
Conventional insemination: For conventional insemination, the embryologist takes the prepared sperm sample and isolates the healthiest sperm. He or she will then incubate this sperm with the eggs in a Petri dish. This gives the egg and sperm the opportunity to find one another and fertilize.
ICSI: Learn more about ICSI.
PART IV: EMBRYO DEVELOPMENT
Embryo development begins after fertilization. An embryologist examines each developing embryo over the course of the following 5 to 6 days. The goal is to see progressive development, with a two- to four-cell embryo on day 2 and an six- to eight-cell embryo on day 3. After the eight-cell stage, rapid cell division continues and the embryo enters into what is called the blastocyst stage at day 5 or 6. It is your physician’s goal to transfer the highest-quality embryo(s) to give you the greatest chance of reproductive success.
PART V: EMBRYO TRANSFER
The embryo transfer is a simple procedure that only takes about 5 minutes to complete. There is no anesthesia or recovery time needed. When your nurse schedules your transfer, she will notify you and provide instructions on when to arrive and how to prepare. You need to have a full bladder for the procedure as a full bladder ensures good visualization of the lining of the uterus and proper placement of the embryos. It’s important to drink the specific amount of liquid recommended 30 to 40 minutes ahead of time.
You will review your cycle with the physician and the number of embryos recommended for transfer. The embryologist will load the transfer catheter in the embryology lab with the embryo(s); upon entering your procedure room, the embryologist will again confirm your last name and the number of embryos in the catheter. The physician will insert the catheter into the uterus and push the embryo through with a small amount of fluid. An external abdominal ultrasound provides visual guidance via a monitor to the physician throughout the procedure.
Once the physician transfers the embryo, he or she will slowly remove the catheter. Since the embryo is invisible to the naked eye, the embryologist will then examine the catheter under a microscope in the lab to ensure that the catheter did indeed release the embryo. The nurse will give you instructions for the following 2 weeks until it’s time for the beta pregnancy test.
PART VI: THE BETA PREGNANCY TEST
Two weeks after the embryo transfer, a nurse or clinical assistant will perform a blood pregnancy test. This test is frequently called a “beta” because it measures the beta chain portion of the hCG hormone emitted by the developing embryo.
Is it possible to evaluate fertility center IVF success rates objectively?
It can be difficult to interpret all of the various statistics quoted by fertility programs. However, there is a mechanism in place to help understand statistics associated with IVF and other assisted reproductive technologies (ART). Fertility centers report (in a standardized format) their annual statistics to the Society for Reproductive Medicine (SART). This report is comprehensive and provides valuable information about a program including:
Number of cycles performed
Pregnancy rates by age, with or without male factor infertility
Average patient age
An analysis of this data will reveal trends or patterns that will provide insight as to the quality, stability, and experience of the programs being considered, especially if evaluated over time.
How do I evaluate fertility centers on their current statistics?
It is reasonable and recommended that you request documentation on the statistics being discussed as well as a breakdown by age and diagnosis. Since the inception of our IVF program in 2011, Bedi IVF Centre has remained committed to providing to the public a comprehensive statistical analysis of all ART performed in our center and their outcomes. This information is updated annually and is available in our patient packets upon request. We strongly encourage anyone considering advanced fertility treatment to obtain the same comprehensive information from each program they are considering.
Are babies born through IVF different?
Children born through IVF are no less real than any other child. They come from an egg and a sperm, they’re healthy, and they bring joy to their families.
Does undergoing IVF treatment mean that you will have multiples (twins, triplets, etc.)?
In the early days of fertility treatment, it was certainly more common for women to have multiples. In the last 10 years, however, technological advancements have drastically reduced the potential for multiples, with the twin rate decreasing to around 16 percent and triplets to less than 1 percent of live births in women under 35. We continue to make great strides in this area, and through elective single embryo transfer (eSET), the incidence of multiple pregnancy has continued to drop at our practice.