A decade ago, hardly anyone had any knowledge about IVF. The fact that it is a fertility treatment or even what fertility treatment meant was like Greek. Today almost every individual is aware of some of the fertility problems and IVF treatment for fertility problems. Issues such as low sperm count and polycystic ovarian disease (PCOD) are familiar terms, even though most people may not know exactly what it means, but they know it has something to do with infertility and IVF.
Doctors recommend IVF treatment in cases of male infertility or female infertility or infertility of both partners. The inability to conceive can be due to a number of different reasons. Some of the conditions for which doctors recommend IVF treatment are:
- Blocked fallopian tubes or missing fallopian tubes
- Ovulation disorders like Polycystic Ovarian Disease
- Premature ovarian failure
- Poor sperm count and quality
- Vasectomy or no sperm in ejaculate
- Genetic disorders
- Unexplained infertility
A couple faced issues with infertility. The gynaecologist had told this young woman that she had an ovulation disorder. There was no way to cure her of this problem completely and that she would have to take medicines regularly to regulate her menstrual cycles and hormonal imbalance. The couple was also told that she would not be able to conceive naturally. The gynaecologist referred them to Medicover Fertility Clinic for Assisted reproductive Technology to help with getting pregnant.
Upon further medical examination, it was found that this young woman also had certain blockages in her fallopian tubes from a previous pelvic infection, besides her ovulation problem. The Senior Fertility Consultant at Medicover Fertility, Dr Shweta assessed her case and suggested that IVF treatment was the best course of action for this couple to have a child.
IVF treatment comes under the category of assisted reproductive technology (ART). This entails the fertilisation of the female egg and the male sperm in a glass petri dish in a laboratory under the expert supervision and guidance of an Embryologist. Generally, when fertilisation process is conducted in the lab, more than one egg is fertilised. There are a number of reasons for this. It helps to ensure successful fertilisation of at least one egg. The eggs that fertilise are called embryos. There are times when some embryos do not survive and may die little after fertilisation. The healthiest embryo is selected and placed in the female partner’s uterus in a process called IVF procedure. When there are multiple embryos, the embryologist can choose the best embryo for transfer.
IVF TREATMENT STEPS
There are multiple steps involved in IVF treatment. Some of these steps are scheduled in accordance with the menstrual cycle and ovulation of the patient. This is a brief overview of the IVF treatment. Let us go through the IVF treatment step by step to fully understand what the couple can expect to go through during their IVF treatment.
Decision: The first step and the most crucial one is deciding to do the IVF treatment. This decision involves both partners preparing themselves mentally and emotionally. The IVF treatment can cause a lot of ups and downs, and the couple has to be strong enough and prepared to take the failures and success equally. Possible complications may arise at any step due to failure of the body to respond to medication as expected, or due to other reasons. Success is not inevitable, and there is an equal risk of failure. Patients also have to be prepared to follow the doctor’s instructions as advised. Failure to comply with the doctor's instructions and take medications on time as prescribed can affect the successful outcome of the IVF treatment.
Medical Examination: A series of tests, including blood test and urine test for the female partner and semen analysis test for the male partner, are conducted. The test may also include ultrasound for the female partners, depending on her pre-diagnosed infertility. The test results are analysed, and the next course of treatment is determined accordingly. The Fertility consultant and the embryologist both study the condition of infertility before presenting the treatment options and prescribing medication.
Ovarian stimulation: The hormonal balance is checked when the female partner has her next menstrual cycle. The tests are conducted on the 2nd or 3rd day of her period. An ultrasound is also conducted to assess the condition of the ovaries. The female partner is then put on a course of medication to stimulate a greater number of follicles to mature and release eggs. The medication may continue for 8 to 12 days. This duration of medication depends on the strength of the medication and the response of the ovaries to the medication. The ovarian stimulation process is closely monitored through ultrasound and blood investigations. The quality and the quantity of the eggs are important, and the dosage may be altered accordingly. The development of the eggs is studied to ensure that they are maturing properly.
Egg retrieval: After the course of ovarian stimulation medication is over the patient is given one final injection for the final maturation of the egg. This also helps to trigger the release of the eggs from the follicles. The eggs are contained in the follicular walls and need to break loose, which is only done on complete maturity. About 36 hours after the trigger injection is administered, the eggs are ready for retrieval. The egg retrieval process involves extracting them directly from the ovaries using a syringe-like instrument. The egg extraction is done under the guidance of the ultrasound. During this process, the patient is sedated. The eggs that are retrieved are then taken to the ART laboratory and left in the care of the Embryologist for processing.
Sperm collection: On the day the eggs are extracted, the male partner has to give a fresh semen sample. This semen sample is washed, and the healthy sperm segregated from the semen and kept aside. The embryologist studies the sperm and selects the sperm that are active and healthy-looking.
If the male has a condition where his semen does not contain any sperm due to tube blockage, retrograde sperm, vasectomy or any other problem, the sperm are extracted from the testicles directly or from the epididymis.
Fertilisation: There are a number of different techniques that are used for fertilising the egg with the sperm in the lab. The most common process is to place a healthy egg in a culture dish with approximately 10,000 healthy-looking sperm. These are then left in an incubator in the hope that one sperm will successfully fertilise the egg. The process could take anywhere from 12 to 24 hours. Usually, 70% of the eggs do get fertilised unless the male partner has a severe case of male infertility, and the sperm are of very poor quality that they are not able to penetrate the egg.
Another fertilisation process that is gaining popularity is the ICSI procedure. Even though it is more expensive, but it has a slightly better success rate of 80% fertilisation success. In the Intracytoplasmic Sperm Injection (ICSI) process, one good looking healthy sperm is selected by the embryologist and injected directly into the egg. This process does not wait for the sperm to penetrate the egg by itself but is injected into the egg ready for fertilisation. The eggs are checked after about 18 hours to see if they have been fertilised. After fertilisation, the egg is referred to as an embryo.
Usually, an embryologist will place 4 to 6 eggs for fertilisation. This is to ensure that at least a few embryos are formed.
Embryo Transfer: The Embryologist will select the best embryo based on its growth and development. This embryo is then transferred to the uterus of the female partner in a process called the IVF procedure. A thin catheter-like tube is inserted through the cervix to the uterus, and the embryo is transferred through this tube into the uterus. Based on the conclusion reached between the doctor and the couple, the number of embryos to be transferred to the uterus is decided beforehand. The number of embryos transferred can vary from 2 to 3. Multiple embryos are transferred to increase the probability of implantation. However, multiple embryo transfers could also lead to multiple pregnancies. Multiple pregnancies pose health risks for the mother as well as for the babies.
Post IVF procedure: The next step after the IVF procedure is the implantation which takes place in the uterus. After the IVF procedure, the patient is expected to rest for a few hours before moving about and travelling home. There are also certain restrictions regarding physical exertion and indulging in strenuous activity during the next two weeks. Indulging in complete bed rest is also not advisable. Women are advised to continue with their life as usual with precautions regarding physical strain.
The IVF procedure is followed by 2 weeks wait commonly referred to a 2ww. The 2ww period is the duration in which the embryo will attach itself to the uterine lining. After successful implantation, the level of the HCG hormone in the body will increase. The whole process of implantation and the increase in the HCG level in the body takes approximately 2 weeks. After 2 weeks, the pregnancy test will give an accurate test result. A pregnancy test conducted before the HCG levels have sufficient time to increase may give a negative pregnancy result even when the patient is actually pregnant. Therefore, it is advisable to wait for at least 2 weeks before conducting the pregnancy test. In the meanwhile, the mother may begin to experience other pregnancy symptoms.
OVARIAN HYPER STIMULATION SYNDROME (OHSS)
It is normal for patients to feel some discomfort when the ovaries are being stimulated to a mature and excessive number of follicles. In normal ovulation, when the ovaries are maturing, a few follicles women suffer cramps and discomfort. This feeling is magnified as the number of follicles maturing is increased during ovarian stimulation. This discomfort is called Ovarian Hyper Stimulation Syndrome. The symptoms are similar to that of what women go through during their menstrual cycle, such as abdominal pain and cramps, tiredness, backache. Women with OHSS may have a more severe case of nausea and vomiting. These symptoms usually disappear once the ovarian stimulation medication is stopped. In the rare case, if the symptoms persist, it is advisable to seek immediate medical assistance.
Usually, the IVF procedure is done when the embryo is 2 or 3 days old. A popular technique today is the blastocyst technique. This is a procedure where the embryo is kept in an incubator for 5 or 6 days after fertilisation and before the IVF procedure. In a non-blastocyst transfer, the embryo is transferred to the uterus on the 3rd day. There are several advantages to the blastocyst transfer. The embryologist can monitor the growth and development of the embryo and likewise make a better decision regarding the best embryo for the IVF procedure.
Researchers have also found that in a natural pregnancy where the fertilisation takes place in the fallopian tube, it takes the embryo several days before it reaches the uterus for implantation. In the meanwhile, the uterine lining prepares for the implantation. A blastocyst transfer imitates the natural process more closely and thereby has a higher probability of successful implantation./p>
When the embryo is transferred to the uterus, it has to hatch from its outer covering before attaching itself to the uterine lining. Sometimes the implantation may fail because the embryo did not hatch. Recently doctors have started using a technique called assisted hatching. In the assisted hatching technique, the embryologist helps the embryo to hatch by making a small hole in the outer shell of the embryo before the embryo transfer.
The benefit of the blastocyst transfer is that the embryo begins hatching by the 5th day and hence the embryologist can monitor and help the embryo with the hatching process before the embryo transfer. By the time the embryo reaches the uterus, it has started to hatch, and the uterine lining is ready to receive it. There is no delay, and the process of implantation begins almost immediately.
IVF PREGNANCY SUCCESS RATE
The IVF procedure has a 30% to 50% success rate for the first cycle. The success rate increases to 70% by the 3rd cycle. If the conditions are conducive, doctors advise patients to try again if the first or second cycle did not succeed. Some patients may only get successfully pregnant after several tries. This is not unusual and even in a normal conception couple go through many unsuccessful fertilisation attempts as well as failed implantation attempts and miscarriages. Usually, the female is not even aware of what is happening inside her body and the number of attempts it took to get pregnant naturally. IVF is no different and hence may require several tries.
“We got to know about Medicover Fertility Clinic after I had already suffered many IVF cycle failures at a number of different hospitals. My first impression of Medicover was very good. When we walked in for our first appointment, I felt very positive, and like this was going to be successful. We met with the internationally trained and very experienced Dr Veenu Kadian. I started my treatment and am very impressed with the professional expertise of all the staff. The whole environment at Medicover is very clean and of an international standard. During my treatment, Dr Veenu was very conscientious of my medication and dosage. My IVF procedure was conducted a few months ago, and after about 8 days, I knew I was pregnant, I could just feel it. When I went for the pregnancy test after 2 weeks, it was such a joyous moment. After so many IVF cycle failures, I was finally pregnant. Thank you Medicover!”
IN VITRO FERTILISATION AT MEDICOVER
What makes Medicover Fertility Clinic the best IVF Clinic?
Medicover Fertility Clinic claims state of the art infrastructure, and this includes features and facilities like highly specialised labs outfitted with 7 stage Air purifiers using HEPA filters and total CCTV coverage so that the whole procedure can be viewed. Medicover labs are outfitted with the latest equipment and facilities.
Medicover has a panel of full-time Doctors and Embryologists who are internationally trained and certified. Medicover has over 2 decades of experience and a presence in 15 countries with over 100 speciality clinics. On a global scale, there is a consultation happening every 6 seconds and a Medicover baby is born every 3 hours. Medicover caters to over 18 lacs satisfied patients every year worldwide. And the numbers are steadily increasing.
In India, Medicover Fertility Clinic is a leading chain and has 6 centres in Delhi, NCR and Rohtak. A European brand with world-class facilities and the best infrastructure has made its mark on the Indian soil. Medicover offers a first free consultation which allows couples to visit Medicover and meet the fertility consultant before deciding if Medicover Fertility Clinic is the place they want to have their treatment. During your first meeting, the fertility consultant will assess your case and medical condition if you have any previous test reports. Based on this, the doctors will advise you of the fertility options, the treatment procedure and the total cost. The couple can then decide if they want to proceed or how they would like to proceed. In a world where the money is a constraint, Medicover offers an EMI facility to make the treatment decision even easier.