IVF – IN VITRO FERTILIZATION
IVF - Do we Need It?
- If you're a couple who has had trouble achieving pregnancy in the natural manner and have not achieved positive results after 4 - 6 consecutive cycles of artificial insemination you will find IVF a source of immense hope.
- Both fallopian tubes are absent or blocked due to surgery or tubal pregnancy) or infection (STD, or Tuberculosis)
- Moderate to Severe Endometriosis
- Reduced sperm count or motility (IVF can be normally performed for counts which are more than 5 million per ml.for counts less than 5 million per ml,. ICSI is a better option.
- Patients where all other treatments such as ovulation induction with intra uterine insemination have proven unsuccessful.
- Patients with unexplained infertility where all the investigations performed on the couple are normal, but who still do not conceive with routine treatments.
- Patients who have failed to become pregnant inspite of all routine treatments of infertility.
- Patients who want to become pregnant by the procedure of embryo and egg donation. In our unit, the success rates of IVF are in the region of 30 to 40%, which are comparable to the leading units in the world.
IVF - How Is It Performed?
There are six major steps involved:
- Planning of cycle with a hormonal pill a month before IVF( which is optional).
- Boosting egg supply by daily injections of follicle stimulating hormone (FSH) for 10-12 days.
- Progress monitoring and final egg boost injection about 34-38 hours before egg collection.
- Egg collection involves ultrasound guided needle based extraction of eggs under anesthesia .
- The eggs are fertilised with your partner's sperm in controlled laboratory conditions and incubated for 2-5 days. You're given progesterone or hCG (chorionic gonadotrophin) to prepare the womb to recieve an embryo.
- Embryo transfer based on the counselling done beforehand and the patient's age and general health is performed.
IVF - India Or Abroad
IVF in India is now a popular medical technology with state of the art facilities. In fact recent trends suggest that IVF constitutes 32 % of medical tourism in India from the USA and the UK. Dr. Hrishikesh D. Pai and Dr. Nandita Palshetkar are amongst the foremost in IVF doctors in India and abroad with clinics in several major cities in India.
The Egg Retrieval Process
The retrieval procedure to obtain the eggs is performed trans-vaginally using a hollow needle guided by the ultrasound image (this is completely under anesthesia). Eggs are gently removed from the ovaries using the needle. This is called "follicular aspiration." Its timing is crucial because the egg will not develop properly if it is collected too early; if too late, the egg also may develop poorly or may have already been released from the ovary and lost.
The eggs are immediately identified by our embryologists in our special IVF laboratory. They are placed with the sperm in incubators to allow fertilization to take place. The eggs are examined carefully at intervals to ensure that fertilization and cell division have taken place; the fertilized eggs are now called embryos.
Embryos are usually placed in the wife's uterus 2 or 3 days after egg retrieval. A speculum is inserted into the vagina to expose the neck of the womb (cervix). The embryos are suspended in a tiny drop of fluid and then very gently introduced through a catheter into the womb, often under ultrasound guidance. The transfer is followed by 10-15 minutes rest, blood test after 14 days and possibly ultrasound examinations to verify if pregnancy has been established.
To summarize, the IVF procedure consists of:
- Controlled Ovarian stimulation with drugs (GNRH Analogues and Gonadotrophins with Antagonist) to produce many eggs.
- Monitoring of follicles and egg development with the aid of vaginal sonography and serial Estradiol hormone estimation.
- Administration of HCG injection, (Human Chorionic Gonadotrophins) when the two leading follicles are 18mm in diameter.
- Oocyte or egg retrieval under short general anesthesia, 35 to 37 hours after HCG injection.
- Identification and isolation of eggs in the laboratory.
- Sperm collection and processing in the lab.
- Fertilization of the egg with the sperm.
- Embryo formation 2 to 5 days after fertilization.
- Embryo transfer of good quality embryos back to the womb, after 2(four cell embryo), 3 (six-eight cell embryo) or 5 (blastocyst stage) days after egg removal.