Fertility treatments are getting more and more advanced with each passing
year. Newer techniques and procedures are helping many couples fulfil their
dream of becoming parents.
India is at the forefront when it comes to fertility treatments. The IVF
doctors in India are well-versed with the latest advancements in fertility
treatments and have all the required training and experience in this field.
Affordable treatment options and high success rates have made India a
preferred destination for IVF treatment. In this article, Dr. Mohit Saraogi, a reputed IVF
specialist in Mumbai, will tell us about the IVF procedure and
its pros and cons.
What is the IVF Procedure?
IVFstimulation works on the natural
femaleovulation process. Three hormones areinvolved in a feedback loop. It is a
small gland in the brain called the pituitary, produces a hormone called FSH.
FSH does two things; the first is it stimulatesthe ovary to produce estradioland
the second to grow egg-containingfollicles.
When estrogen goes up a secondhormone is
released by the brain, thishormone is LH or luteinizing hormone. Artificial
ovarian stimulation works bymimicking this natural process.The doctors useinjectable
gonadotropins. On day ten, a trigger shotcalled HCG is used tomature the eggs.
The eggs would bereleased by forty-two hours but theretrieval occurs at about
thirty-fourhours.
The eggs are retrieved using atransvaginal
technique involving anultrasound-guided needle piercing thevaginal wall to
reach the ovaries. Through this needle, follicles can beaspirated and the eggs
are floating inthe fluid. It is common to remove betweensix and twenty eggs. The
retrievalprocedure takes about 20 minutes and it is usually done under
anesthesia.
Thesperm and the eggs are incubated togetherat a
ratio of about 75,000 to one in theculture.Certain situations such as lowsperm
count or motility or abnormalsperm morphology, a single sperm may beinjected
directly into the egg usingintracytoplasmic sperm injectionalso known as ICSI.
Eighteen hours later, sixty percent of the eggs
would befertilized and the resulting embryoswill show two pronuclei. By 48
hours, onday three the embryos consist of six toeight cells. Sometimes doctors
choose togrow them for two additional days.
Atthis stage, on day five, the embryos arecalled
blastocysts. A good qualityblastocyst has the best chance ofimplanting. Prior
to transfer,abnormalembryos are discarded.
The number of embryos to be transferreddepends
on the number of factors, the ageof the woman, and the quality of theembryos. For
example, two perfect embryosare equal to three average embryos.
Embryos are graded by the embryologist based on
the degree of fragmentation, thenumber of cells, and evenness of growth.
Dr. Mohit Saraogi mentions that the example of a
perfect day threeembryo would be a great one eight cells. A perfect blastocyst
would be graded as 4AA.
Most clinics and country regulatorybodies seek
to minimize the risk ofmultiple pregnancies.
The final procedureis embryo transfer. It does
notrequire anesthesia. It is a very excitingand happy moment when the idea of havinga
baby starts to feel more real. The embryos judged to be the best are
transferredto the patient's uterus through a thinplastic catheter that goes
through thevagina and the cervix.
The firstsuccessful birth of a test-tube
babyLouise Brown occurred in 1978 in theUnited Kingdom. 3.5 million IVF
babieshave been born since then and each yearabout 200,000 IVF babies are
bornworldwide.
The advantages and disadvantages of In vitro
fertilization
Since IVF was pioneered by Sir RobertEdwards and
Patrick Steptoe in 1978, IVFhas helped millions of people becomeparents. In
this article,we have outlined some of the advantagesand disadvantages
associated with IVF.
What are the Advantages of
IVF?
IVF helps many patients whowould be otherwise
unable to conceive. The ultimate advantage of IVF isachieving a successful
pregnancy and ahealthy baby. IVF can make this a reality for peoplewho would be
unable to have a babyotherwise.
1. Blocked
tubes:
For women
withblocked or damaged fallopian tubes IVFprovides the best opportunity of
having a child using their eggs.
2. Olderpatients
with a low ovarian reserve:
IVFcan be used to maximize the chance ofolder
patients conceiving as the ovarian reserve of a woman goes down as her age
progresses.
3. Maleinfertility:
Couples with a maleinfertility problem will have
a muchhigher chance of conceiving with IVFthan conceiving naturally.
4. Unexplainedinfertility: One in six couples willsuffer fertility
problems and sometimesthese remain undiagnosed afterinvestigation. These
patients may benefitfrom intervention.
5. PCOS:
Polycystic ovarysyndrome is a common condition
in whichthere is a hormone imbalance leading toirregular menstrual cycles. IVF
hasproved very successful in patients withPCOS who will not conceive withovulation
induction.
6. Endometriosis:
Patients with endometriosis where partsof the
womb lining grow outside the wombmay like to try IVF as it has provedsuccessful
in this group.
7. Prematureovarian
failure:
Women with
prematureovarian failure or menopause can haveIVF treatment using donor eggs
whichtypically has high success rates.
IVF canbe more successful than IUI andother
forms of assisted reproductivetechnology. IVF success rates have beenincreasing
year-on-year since itsconception thanks to technologicaladvances.
Although IUI and other forms ofassisted
reproduction technology can besuccessful for some patients on thewholethey have
not undergone the same levelof improvement and did not currentlyhave as high
success rates. IUI withdonor sperm can however be a usefulfirst option in
single women andsame-sex couples.
IVF can help to diagnose fertilization problems
in somecases of unexplained infertility. Therecould be a problem with
fertilizationcases such as these may not be diagnoseduntil fertilization is
attempted in thelaboratory. Although this would be adisappointing outcome, it
is useful to beable to uncover such problems so thatsolutions could be reached
for futuretreatment with ICSI.
Unused embryos canbe donated to research or
another coupleif you are lucky enough to have embryosto spare. These can be
used to help otherpeople and even save liveswith the permission of the
biologicalparents. Unused embryos can be donatedfor research purposes or to
anothercouple to enable them to have a child.
Embryos can be used to screen forinherited
diseases for individuals whoare known carriers of genetic disorders such as
cystic fibrosis, Huntington'sdisease, and muscular dystrophy.
IVF withpre-implantation genetic diagnosis isone
of the most reliable ways to ensurethat a child conceived will not sufferfrom
the disorder. Pre-implantationgenetic screening can improve thechances of a
successful outcome as itscreens embryos for chromosomaldisorders such as Down
syndrome.
What are the Disadvantages
of IVF?
An IVF cycle may beunsuccessful. The success of
IVF is notguaranteed and patients often have toundergo more than one cycle of
treatmentbefore they are successful. Thisnaturally varies woman to woman and
afertility specialist will be able to give a more accurate and personalizedlikelihood
of success. It is important tobe realistic but positive about thechances of
success.
There may be associated side effects andrisks as
a medical treatment
IVF comes with a small chance ofdeveloping side
effects, the most severeof these being severe ovarianhyperstimulation syndrome.
Fortunately, the use of fewer or no drugsin
natural and mild IVF cycles meansthat the already small likelihood ofdeveloping
unwanted risk of OHSS isdramatically decreased or eliminated.
Multiple pregnancies in IVF treatments: There is
often more than one embryo putback into the uterus and this leads to ahigher likelihood
of multiple pregnancies. Around 20 to 30% of IVF pregnancies canresult in
multiple pregnancies. Multiplepregnancies do carry associated healthrisks to
mother and baby. There is anincreased chance of premature labor, miscarriage,
need for a cesarean, stillbirth,and infantile health problems with
multiplepregnancies.
It is important for allfertility clinics to have
robust single embryo transfer policies to avoid therisks of multiple pregnancies.
There is aslightly higher chance of
ectopicpregnancy with IVF treatment. The risk of an ectopic pregnancy doublesto
one to three percent particularly inwomen with damaged fallopian tubes.
Thereis evidence that high estrogen
levelsassociated with high stimulation IVF canincrease the risk of prematurity
and lowbirth weight in babies.
There is growingevidence that giving high
stimulationduring IVF increases the chance that ababy is born prematurely and
with lowbirth weight. This has been linked tolong term health problems for the
child. It is theorized that high estrogenlevels can affect the
intrauterineenvironment.
With drug-free and low drugapproaches, it has
been observed thatbabies born are more likely to be bornat full-term and with a
higher birthweight than those born through highstimulation IVF associated with
highestrogen levels.
IVF treatment can take an emotional
psychological toll. Going through IVFtreatment can be a highly emotive
andstressful experience for patientsundergoing treatment. It can bephysically
and emotionally demanding forpartners. It can be difficult to watch aloved one
go through a stressfulexperience. It is important to prioritizeyour
psychological health and this isalso good for the health of the body.
IVFtreatment can be expensive. IVF treatmentis
not cheap and after paying formedication and blood tests, the costs canquickly
mount up.
It is good to have a clear idea of thecosts
involved before starting treatmentand to have your finances in order
Before beginning, some patients may beconcerned
about ethical issues. The ideaof selecting some embryos andpotentially
discarding others may notsit well with everybody before startingtreatment. Consider
your stance andwhat you would be comfortable with.
