Q. What is involved with in vitro fertilization?

There are five basic steps in the IVF and embryo transfer process:

  • Monitor and stimulate the development of healthy egg(s) in the ovaries.
  • Collect the eggs.
  • Secure the sperm.
  • Combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and early embryo growth.
  • Transfer embryos into the uterus.

Step 1: Fertility medications are prescribed to stimulate egg production. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. Transvaginal ultrasound is used to examine the ovaries, and blood test samples are taken to check hormone levels.

Step 2: Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity to remove the eggs. Medication is provided to reduce and remove potential discomfort.

Step 3: The male is asked to produce a sample of sperm, which is prepared for combining with the eggs.

Step 4: In a process called insemination, the sperm and eggs are mixed together and stored in a laboratory to encourage fertilization. In some cases where there is a lower probability of fertilization, intracytoplasmic sperm injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.

Step 5: The embryos are usually transferred into the woman’s uterus three to five days following egg retrieval and fertilization. A catheter or small tube is inserted into the uterus to transfer the embryos. This procedure is painless for most women, although some may experience mild cramping. If the procedure is successful, implantation typically occurs around six to ten days following egg retrieval.

Side effects of in-vitro fertilization

Although you may need to take it easy after the procedure, most women can resume normal activities the following day.
Some side effects after IVF may include:

  • Passing a small amount of fluid (may be clear or blood-tinged) after the procedure.
  • Mild cramping
  • Mild bloating
  • Constipation
  • Breast tenderness

If you experience any of the following symptoms, call your doctor immediately:

  • Heavy vaginal bleeding
  • Pelvic pain
  • Blood in the urine
  • A fever over 100.5 °F (38 °C)
Q. What are the risks associated with in vitro fertilization?

As with most medical procedures, there are potential risks. Fertility medications can have various side effects including headaches, mood swings, abdominal pain, hot flashes, and bloating, amongst other side effects. Although it is rare, fertility medications may cause ovarian hyper-stimulation syndrome (OHSS). Symptoms of OHSS may include abdominal pain or a feeling of being bloated. More severe symptoms include the following:

  • Nausea or vomiting
  • Decreased urinary frequency
  • Shortness of breath
  • Faintness
  • Severe stomach pains and heaviness.

If you experience any of these symptoms above, contact your doctor right away.

Additional risks of IVF include the following:

  • Egg retrieval carries risks of bleeding, infection.
  • The chance of a multiples pregnancy is increased with the use of fertility treatment. There are additional risks and concerns related to multiples during pregnancy including the increased risk of premature delivery and low birth weight.
  • Assisted reproductive technology (ART) involves a significant physical, financial, and emotional commitment on the pART of a couple. Psychological stress and emotional problems are common, especially if in vitro fertilization (IVF) is unsuccessful.
  • IVF is expensive, and many insurance plans do not provide coverage for fertility treatment. The cost for a single IVF cycle can range from at least Rs. 1 lakh 70 thousand to 1 lakh 80 thousand.
Q. How successful is in vitro fertilization?

The success rate of IVF depends on a number of factors including reproductive history, maternal age, cause of infertility, and lifestyle factors. It is also important to understand that pregnancy rates are not the same as live birth rates. Success rate is 40-50 %.

Q. What if I don’t produce healthy eggs or my husband semen is low?

You may choose to use donor eggs, sperm, or embryos. However, the clinician will tell you about what procedure to go for. You will also be informed about various legal issues.

Q. How many embryos should be created or transferred?

The number of embryos transferred typically depends on the number of eggs collected and maternal age. As the rate of implantation decreases as women age, more eggs may be implanted depending on age to increase the likelihood of implantation. We go for two embryos transfer at a time.

Q. Are there any restrictions on physical or personal activities during an IVF cycle?
  • Smoking
  • Drinking
  • Medications: If you are taking any medication, please inform your physician. Some medications may interfere with the fertility medications. A prenatal or multivitamin will be prescribed; if you are not taking a vitamin with folic acid. DO NOT USE HERBAL SUPPLEMENTS DURING YOUR IVF CYCLE.
  • An IVF cycle can be an emotional and stressful time for you and your patner. It may be helpful to have supportive personnel to speak.
Q. How does the ART laboratory operate and what safety measures are taken? What will happen to the eggs and sperm after retrieval?

On the day before the oocyte (egg) retrieval, oocyte culture dishes are labeled with the patient’s name and ART identification number.

The dishes are then placed in the embryology incubator for warming to body temperature. The incubator also adjusts the pH of the culture media to the human body. A large amount of rinsing media is equilibrated in the incubator.

Upon arrival in the operating room the patient’s identity is verified by the embryologist, physician, and safety nurse.

After all of the eggs have been aspirated, insemination with sperm, and culture is done.

The maturity and health of oocytes are assessed after an incubation period. Oocytes are graded as mature, intermediate, immature, or degenerate. Approximately 30 minutes after collection, when the semen liquefies, a semen analysis is performed. The sperm is prepared for insemination.

The physician aspirates the fluid from the ovarian follicles into a test tube. A nurse passes the test tube, to the embryologist. The embryologist then dispenses the fluid into a large dish and rapidly scans it under the microscope.

Twenty to twenty-four hours after retrieval, the oocytes are transferred to fresh dishes that were equilibrated on the day of retrieval. Fertilized oocytes are returned to the main embryology incubator for 24 hours. At that time the embryos are transferred to fresh dishes where the cell stage and overall health of the embryos are microscopically evaluated. The embryos are either transferred on day 3 or placed into new dishes with a specialized culture media to allow for progression to the blastocyst stage.

Q. When is the pregnancy test performed?

The blood pregnancy test is performed 14 days after the egg retrieval.

Q. What happens if I become pregnant?

If pregnant, you will be asked to return to us for an ultrasound to ensure an ongoing successful pregnancy.

Q. If I am not pregnant, when can we try again?

Usually we ask that patients wait one or two complete menstrual cycles before beginning another ART cycle. Sometimes tests are required that may delay subsequent cycles.

Q. Will I need a high risk pregnancy because I conceived with an ART procedure?

A high risk pregnancy only exists when there are complications that put the mother or baby at increased risk, or in the case of multiple births. Other than a higher incidence of multiple births, ART does not increase the risk to the fetus.

Q. Is there a higher miscarriage rate for ART patients?

The miscarriage rate is about the same for ART as the general population. Many times older females undergo ART and their miscarriage rates are naturally higher. Since pregnancy testing is done two weeks after embryo transfer, we often know about spontaneous miscarriages in the very early stages of pregnancy. These miscarriages would probably go unnoticed in the general population.

Q. What can be done to improve sperm quality?
  • During any fever or illness sperm count may be affected.
  • Discontinue alcohol and smoking.
  • If any medication has been taken during the last 3 months, notify it.
  • Do not begin any new form of endurance exercise during or 3 months prior to the ART cycle. Physical activity at a moderate level is acceptable and encouraged.
  • Abstinence not more than 2 days.
Q. How do we decide how many embryos to transfer?

Your consultant will discuss with you according to embryo quality, status of the endometrium, age and many other factors. These numbers may vary depending on individual diagnosis and clinical circumstance.

Q. Am I depleting my store of eggs by undergoing an ART cycle?

A woman is born with a full complement of eggs. There are far more eggs than will ever be used during a normal lifetime and ART procedures have no measurable “lowering” effects.

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Dakshin Marg Chandigarh – 160020