What is In-Vitro Fertilization (IVF)?

In vitro fertilization (IVF) literally means “fertilization outside the human body” or, in broader terms, in the laboratory. This term applies to any form of assisted conception where fertilization takes place outside the body.

Who are the couples that require IVF?

• When the fallopian tubes are blocked or unhealthy

• When the sperm count is less than 10 m/ml or they are abnormal in shape and non motile

• Unexplained infertility

• Advanced maternal age with low ovarian reserve or low AMH 

• Previous IUI failures

• Ovulatory dysfunction as in cases of polycystic ovaries where ovulation induction and IUI’s  have failed

• Grade 3 or 4 endometriosis when the tubes are blocked 

How do you counsel the patient?

Counselling is an integral part of the IVF. Before a couple is taken for IVF, the couple is thoroughly counselled regarding the procedure, the preliminary tests and procedures involved like hysteroscopy (where indicated), the protocol to be used, the success rate which averages 40 – 45%, the short term and long term implications of the procedure.

How is IVF done?

After we are done with all the preliminaries like pre IVF investigations, counselling and filling up of all consent forms, the IVF procedure involves basically these major steps:

• Ovarian Stimulation – The woman is stimulated with gonadotropins injections (the treatment protocol and the dose is tailor made for each individual) to stimulate the ovaries with a aim to retrieve 7 – 8 number of eggs. The stimulation takes around usually 10 days of stimulation. Once 2 – 3 follicle reaches the size 18 mm or more , HCG (Human chorionic gonadotropin) or GnRHa trigger  is given to cause final maturation of the eggs in the follicles.

Ultrasound picture of stimulated ovary showing multiple follicles.Ovarian Stimulation was done for IVF using Gonadotropins . 

• Oocyte retrieval under general Anaesthesia  – 34 – 35 hrs after trigger  injection, the follicles are aspirated through vagina under ultrasound guidance using a special ovum pick up needle and cultured in petridishes. Simultaneously the male partner gives the semen sample in the laboratory by masturbation.

• Sperm Development – Collected sperms are prepared for the fertilization

• Fertilization of oocytes with sperms- The retrieved eggs and processed sperms are incubated together in a a culture media in petridishes and allowed to fertilize in a laboratory. Generally the fertilization is observed 17-20 hrs after inseminating semen sample.

• Embryo Transfer – The resulting embryo is then transferred either on day 2,3 or 5 to the patient’s uterus in the operation theatre under ultrasound guidance with the intent to establish a successful pregnancy. The embryo transfer itself is a very simple procedure, usually taking just few minutes, and usually requiring no anaesthesia or sedation. The patient is usually sent home 2 – 4 hours after embryo transfer.  

• Luteal Phase Support The luteal support is given with progesterone either in the form of injections or vaginal suppositories for 14 days. The couple is asked to refrain from sexual activity. She can do light work and we don’t recommend absolute bed rest.

• Confirmation of Pregnancy S.bhcg is performed 12- 14 days after embryo transfer to confirm pregnancy. A value more than 50 mIU/ml is suggestive of pregnancy.