IVF when and How

By:  Dr. Umesh N Jindal On:  June 28, 2016 11:25 AM
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IVF (In-Vitro Fertilization) known colloquially as test tube baby is the product of Noble prize winning extensive scientific research which has become a blessing for millions of infertile couples the world over. The restricted use of IVF is because of inhibitions in the mindset of couples and their relatives and also the myths surrounding the IVF procedure. This results in significant delay in proper and effective treatment.

Reasons in female partner
i. When both fallopian tubes are blocked or have Hydrosalpinx (i.e. swelling in the tubes)
ii. Previous tubal surgeries like tubal re- canalization or ectopic pregnancy
iii. Endometriosis (chocolate cysts)
iv. PCOD cases not responding to ovulation medicines
v. Genital tuberculosis
vi. Prolonged unexplained infertility
vii. After 6 cycles of IUI (Intra Uterine Insemination) failure

Reasons in Male partner
i. Low count of sperms
ii. Zero count of sperms (If sperms are developing in testis but not coming out)
iii. Retrograde ejaculation (when sperms go back to male partner’s urinary bladder and do not come outside)
iv. Poor active motility and morphology of sperms
v. Other sexual problems

Relative indications for IVF
i. Increasing age of female partner > 33-34 years
ii. Three cycles IUI failed
iii. Doubtful tubal status
iv. Non-resident Indians and foreigner’s with short time
v. Unexplained infertility after 3-4 years of marriage even in young females

Pre-IVF workup

Before IVF is planned the couple is investigated to confirm the suitability of the case for IVF. An infection screen is done for both partners to rule out transferable infections. Also, assessment is done for ovarian reserve and semen analysis. A trial embryo transfer is done to anticipate problems during embryo transfer. IVF treatment requires planning. The planning starts at least 10 days prior to the coming menses.

Step I – Suppressing the natural monthly hormone cycle. As a first step of IVF process injections are given a drug to suppress the natural menstrual cycle. Treatment is given either as a daily injection or single depot injection. Single daily injections can be self-administered. The Injections continue for about two weeks or until next menses.

Step 2 – Boosting egg formation after suppression of the natural cycle. Injections of fertility hormones called FSH (Follicle Stimulating Hormone) are given. This is a daily injection for around 8 – 12 days. This hormone will increase the number of fertilizable eggs and gives a greater choice of embryos to select the best embryo. Moreover, one can freeze spare embryos for future use.

Step 3 – Monitoring by ultrasonography and blood tests. The number of follicles and their growth is monitored by ultrasound. Few blood tests like E2, LH may also be done. The final injection for maturation is given 34 – 35 hours before egg collection for maturation.

Step 4 – Collection of sperm sample. The fresh semen sample is collected just after the egg collection. Stored or cryofrozen semen can also be used for IVF but fresh sample is preferable. In case of azoospermia (zero count of sperms) the sperms can be collected from testes with needle under local anesthesia.

Step 5 – Fertilizing the eggs. The collected eggs are then washed with culture media and fertilized with the partners’ sperms by leaving them together in a pertri dish (IVF). The advanced technique of Intra cytoplasmic sperm injection (ICSI) is done by manually injecting one sperm into every egg (ICSI). These embryos are then kept in the incubators at a standard temperature, humidity and high CO2 atmosphere.

Step 6 – Embryo transfer. Good embryos are then selected and transferred vaginally without any anesthesia. The decision of the number of embryos to transplant is taken depending on the patients’ age and cause of infertility. The number ranges from one to three embryos. The rest of the embryos are then frozen for future use with the consent of couples.
A blood test for pregnancy is done 12 days after Embryo Transfer to confirm the implantation.