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In Vitro Fertilization-The Pros and Cons

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.
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