In vitro fertilization (IVF) is already almost a commonplace term. However, not long ago, a mystery infertility treatment generated what was then known as "test-tube infants." Louise Brown, born in 1978 in England, was the first such baby to be created outside of her mother's womb.
Beginning the IVF treatment procedure may be both thrilling and nerve-racking. IVF is usually attempted only after all previous reproductive treatments have failed. You might have been trying to conceive for months or, more likely, years.
However, this is not always the case. IVF is sometimes the first treatment considered.
In Vitro Fertilization Basics
After ovulation, when a mature egg has been released from the ovaries, a male sperm penetrates a woman's egg and fertilizes it within her body in a normal pregnancy.
The fertilized egg subsequently adheres to the uterine, or womb wall and continues to grow into a baby. This is referred to as natural conception.
Fertility treatment is a possibility when natural or unaided conception is not feasible.
Unlike artificial insemination, where sperm is put in the uterus and pregnancy occurs naturally, IVF involves mixing eggs and sperm outside the body in a laboratory. When an embryo or embryos develop, they are implanted in the uterus.
The success rate of IVF
In-vitro fertilization had resulted in the birth of about 6.5 million infants by 2016. (IVF). [1] According to the Centers for Disease Control and Prevention (CDC), around 1.6 percent of infants born in the United States each year are created using assisted reproductive technologies (ART). [2]
The success percentage of in vitro fertilization varies. The American Pregnancy Association reports that the live birth rate for women under 35 who undergo IVF is 41 to 43 percent. For women over the age of 40, this percentage drops to 13 to 18 percent. [3]
Some women need up to 5 cycles of treatment to be successful, while others never fall pregnant.
What Infertility Causes Can IVF Treat?
When it comes to infertility, IVF may be a possibility if you or your spouse have been diagnosed with any of the following:
Endometriosis
Male infertility, such as low sperm count or abnormalities in sperm shape
Obstacles to the uterus or fallopian tubes
Obstacles to ovulation
Antibody problems that damage sperm or eggs
Sperm's inability to enter or survive in cervical mucus
Eggs of poor quality
Unknown cause of infertility
Parents may also consider IVF if they are concerned about passing on a genetic disease to their children. Your doctor can test the embryos for congenital abnormalities in a medical facility. Then, a doctor only implants embryos that are free of genetic abnormalities.
Except in situations of total tubal blockage, IVF is never used as the initial step in the treatment of infertility. Instead, it is reserved for instances where other procedures, such as fertility medications, surgery, and artificial insemination, have failed.
If you believe IVF could be right for you, do your research before committing to a treatment center. Here are some questions to ask the fertility clinic staff:
1. How many pregnancies have you had as a result of embryo transfers?
2. What is your pregnancy rate for couples our age with our reproductive issues?
3. What is the live birth rate for all couples who have this procedure done at your institution each year?
4. How many of those births are twins or other multiples?
5. What is the total cost of the treatment, along with the hormone treatments?
6. How much does it cost to keep embryos in storage, and how long can we keep them?
7. Do you take part in any egg donation programs?
How is In Vitro Fertilization Carried Out?
Techniques may differ depending on the clinic, but the IVF and embryo transfer procedure consist of five key steps:
Step 1. Inhibiting the natural menstrual cycle
The woman is given a medication to suppress her regular menstrual cycle, generally in a daily injection for around two weeks.
Step 2. Abundant ovulation
The woman is given reproductive medications that contain the fertility hormone follicle-stimulating hormone (FSH). FSH stimulates the ovaries to generate more eggs than usual. Ultrasound scans of the ovaries can be used to monitor the process.
Step 3. Getting the eggs back
A minor surgical operation, known as "follicular aspiration “, is used to harvest the eggs. A very thin needle is put into an ovary through the vagina. The needle is attached to a suction device. The eggs are sucked out as a result of this. This procedure is carried out for each ovary.
Step 4. Artificial insemination and fertilization
The retrieved eggs are combined with male sperm and stored in an ecologically controlled room. The sperm should penetrate the egg after a few hours.
Sometimes sperm is put straight into the egg. This is regarded as an intracytoplasmic sperm injection (ICSI).
Frozen sperm obtained via testicular biopsy may be utilized. This is thought to be as efficient as fresh sperm in delivering a successful pregnancy.
The fertilized egg divides into two and develops into an embryo.
At this time, several clinics provide a pre-implantation genetic diagnosis (PGD), which may screen an embryo for congenital abnormalities. This is somewhat debatable and is not always utilized.
For transfer, one or two of the best embryos are chosen.
The mother is subsequently administered progesterone or human chorionic gonadotrophin (hCG) to assist the uterine lining in accepting the embryo.
Step 5. Embryo transplantation
Occasionally, more than one embryo is implanted in the womb. The doctor and the couple seeking to have a child must agree on the number of embryos to be transplanted. A doctor will usually only transplant more than one embryo if no perfect embryos are available.
The embryo is transferred using a tiny tube or catheter. It enters the womb via the vaginal canal. Healthy embryo development can begin when the embryo adheres to the uterine lining.
Cost of IVF
IVF is a complicated and costly treatment that only around 5% of infertile couples pursue. Financial costs vary greatly; however, each IVF cycle might cost several thousand dollars. Your health insurance may reimburse you for some IVF products if they are medically essential for you to become pregnant. Your private health insurance may cover other elements of therapy. In addition, there are the expenditures of medications, testing, and day surgery.
If you are contemplating IVF, you must consult with your doctor, the IVF clinic, and your health fund (if you have one) to understand what you will be paying for and what will be covered.
You must consider if it is both affordable and appropriate for you.
How Should I Get Ready for In Vitro Fertilization?
You will first have your ovarian reserve tested before commencing IVF. This entails obtaining a blood sample and analyzing it for follicle-stimulating hormone levels (FSH). The results of this test will provide information to your doctor regarding the size and quality of your eggs.
Your doctor will also examine your uterus. An ultrasound, which utilizes high-frequency sound waves to generate a picture of your uterus, may be used. A scope may also be inserted via your vagina and into your uterus by your doctor. These tests can show the condition of your uterus and assist your doctor in determining the best approach to implant the embryos.
Men will need to get their sperm tested. This entails providing a sperm sample, which will be analyzed in a lab to determine the amount, size, and form of the sperm. If the sperm are weak or damaged, you may require an intracytoplasmic sperm injection (ICSI) treatment. A technician injects sperm directly into the egg during ICSI. ICSI can be used as part of the IVF procedure.
IVF Safety and Risks
IVF is usually safe, although there are dangers, like with any medical treatment. Before you begin any operation, your doctor should go through all of the potential side effects and risks with you.
Ovarian hyperstimulation syndrome (OHSS) affects 10% of women undergoing IVF therapy. [4]
Cramping and pain may occur during or after the egg retrieval operation. Accidental penetration of the bladder, intestine, blood vessels, pelvic infection, or bleeding from the ovary or pelvic arteries are rare risks. [5] If a pelvic infection develops, you will be given intravenous antibiotics.
Although some studies have indicated that IVF may increase the chance of several extremely uncommon birth abnormalities, the risk remains relatively low. [6] In addition, research has revealed that using ICSI in conjunction with IVF in some instances of male infertility may raise the chance of infertility and specific sexual birth abnormalities in male offspring. This danger, however, is relatively minimal (less than 1 percent). [7]
When IVF Treatment Doesn't Work
If the pregnancy test comes back negative 12 to 14 days after the transfer, your doctor would advise you to discontinue the progesterone. Then you'll have to wait for your menstruation to begin.
You, your partner, and your doctor will decide on the next step. If this was your first cycle, you might need to repeat it. Keep in mind that your best chances of success will come after completing numerous rounds.
It is never easy to have a treatment cycle fail. It's a terrible situation. It's essential to remember, though, that just because one cycle fails doesn't imply you won't be successful if you try again.
Keep trying and hope for the best.
References
4. Zivi E, Simon A, Laufer N. Ovarian Hyperstimulation Syndrome: Definition, Incidence, and Classification. Semin Reprod Med. 2010;28(6):441-447. doi:10.1055/s-0030-1265669
5. Levi-Setti PE, Cirillo F, Scolaro V, et al. Appraisal of clinical complications after 23,827 oocyte retrievals in a large assisted reproductive technology program. Fertil Steril. 2018;109(6):1038-1043.e1. doi:10.1016/j.fertnstert.2018.02.002
6. Boulet SL, Kirby RS, Reefhuis J, et al. Assisted Reproductive Technology and Birth Defects Among Liveborn Infants in Florida, Massachusetts, and Michigan, 2000-2010. JAMA Pediatr. 2016;170(6):e154934. doi:10.1001/jamapediatrics.2015.4934
7. Lacamara C, Ortega C, Villa S, Pommer R, Schwarze JE. Are children born from singleton pregnancies conceived by ICSI at increased risk for congenital malformations when compared to children conceived naturally? A systematic review and meta-analysis. JBRA Assist Reprod. 2017;21(3):251-259. doi:10.5935/1518-0557.20170047
