What Is IVF?
When a couple conceives naturally, sperm from the man fertilizes an egg from the woman in the woman’s fallopian tubes to form an embryo. This embryo travels to the womb and gets implanted there and pregnancy begins.
In IVF, this process of fertilization happens outside the woman’s body.
IVF was successfully performed for the first time by Dr Patrick Steptoe and Robert Edwards, which led to the birth of Louise Browne in 1978.
Who Can Benefit From IVF Treatment?
It was primarily introduced for women with damaged tubes. But now it is the first line treatment for many conditions like
• unexplained infertility
• Blocked fallopian tubes
• Polycystic ovaries
• Endometriosis and pelvic adhesion
• Failed IUI's and fertility medication
• Sperm quality issues
• Donated eggs or the woman's own frozen eggs are being used in the treatment
What Is The Success Rate Of IVF?
The chances of success with IVF depends on various factors like age of the patient, type and duration of infertility, type of procedure done - fresh or frozen embryo transfer, self or donor eggs. Our pregnancy rate is 40-45% per started cycle in women less than 35 years. About 85-90% of our patients conceive within three cycles.
We will be able to discuss your chances of success after a proper evaluation. Against all odds, we do our best to ensure that you experience parenthood.
What Preparation Is Needed Before IVF Is Started?
We first evaluate the basic fertility status of each couple. This includes hormonal blood tests, ultrasonography, semen parameters and other routine blood test to check your physical fitness.
This helps us select the ideal IVF protocol, which would give you the best chance of success. It could be the antagonist protocol, long protocol, short protocol or any other modified protocol.
Accordingly, we shall call you to Cocoon Fertility centre on the 2nd or 3rd day of your period to start your IVF process.
What Is A Typical IVF Process?
Step 1 - Boosting the egg supply
In IVF, the woman receives hormonal injections to stimulate the development of several egg follicles in her ovaries. These injections have to be taken at approximately the same time every day. It is advisable to come to the clinic for your injections, but if you are unable to do that, we can teach you how to self-administer the injections or you can have them taken locally by a doctor. These medications can cause mild side effects like acidity.
Step 2 - Checking on progress using Ultrasonography
A vaginal ultrasonography is conducted at regular intervals to assess the progress and growth of the follicles in response to the injections.
Once the leading follicle reaches a particular size, a trigger injection of HCG/GnRH is administered at a decided time in the night. This triggers final maturation of the eggs and make them ready for collection. The egg collection is performed between 34-38 hours (depending on what protocol is used) after this injection.
Step 3 - Collecting the eggs (Ovum Pickup / Egg Collection)
The eggs are collected from the ovaries using transvaginal ultrasound under a short acting general anesthesia. The procedure takes about 15-30 minutes depending on the number of follicles grown. You will recover within half an hour of the procedure and can go home in 2-3 hours. Occasionally one may experience some vaginal spotting or some abdominal discomfort, which generally settles in a day or two.
At the time of the procedure, our experienced embryologist is ready in the adjacent laboratory to screen the eggs. Reducing the time taken for eggs to reach the laboratory (being next door) and efficiency in being quick while handling the eggs delicately, improves our success rates further.
Step 4 - Getting the sperms ready
Usually, a fresh semen sample is requested on the day of egg collection. This can be done in a very private collection room which is located in a separate section of our centre. We recommend an abstinence of 3-5 days and avoiding lubricants to get the best sample.
Sometimes men may find it difficult to produce a semen sample on request, so for this eventuality, we prefer to have your sperm frozen any time before the day of the actual procedure. Sperm can also be frozen in advance as a backup in cases of very low sperm counts.
The sperm is washed and prepared in the andrology laboratory so that the active, normal sperm are separated from the poorer-quality sperm.
If prior stored sperm sample is present, it will be removed from frozen storage, thawed and used in the same way.
Step 5 - Fertilizing the eggs with sperm
The eggs are mixed with the prepared sperm and cultured in a glass dish filled with a nutritive medium in closely controlled laboratory conditions.
The next day, the embryologist will check the eggs for signs of fertilization. The fertilized eggs (now called embryos) will be grown in special mini-incubators for up to a maximum of six days.
The embryologist will monitor the development of the embryos and the best will then be chosen for transfer.
In Latin the word ‘vitro’ means ‘glass’. Since the embryos are formed in petri-dishes, the procedure is called "In-Vitro Fertilization." Fertilization can be also achieved by ICSI (Intra-Cytoplasmic Sperm Injection)
Step 6 - Embryo transfer
After two to five days in an incubator, one or two of the best quality embryos are chosen for transfer. The day, time and number of embryos to be transferred will be discussed with you.
During the procedure, a fine tube (embryo transfer catheter) is then passed through the cervix, into the womb using ultrasonography guidance. The embryos are gently passed down the tube into the womb for implantation to occur. The embryo transfer itself takes less than a minute.
After the embryo transfer, you will be asked to rest for ten minutes. This is normally a pain-free procedure and usually needs no anesthesia.
Step 7– Embryo freezing
The number of embryos transferred is restricted to one or two, because of the risks associated with triplets or multiple births. Any remaining embryos of suitable quality can be frozen for future use. These frozen embryos can be used for future transfers if the first one fails. Even if the first IVF cycle is successful and the couple gets a child, they could still use these frozen embryos years later, to get siblings for their existing child. Freezing is an essential part of the Cocoon IVF programme. You will be given details of your cycle including the number of eggs retrieved, number of eggs fertilized, and number of embryos formed, the quality of the embryos, number of embryos being transferred and number of embryos being frozen.
What Precautions Should I Take After An Embryo Transfer?
• After the embryo transfer you will need to take some oral tablets, vaginal gels and injections which provide hormonal support to the early pregnancy. Once you become pregnant you might be asked to continue some of these medications until the twelfth week of pregnancy.
• After the embryo transfer, you can continue with light activities for 3 - 4 days following which you can resume your daily routine as long as it does not involve any strenuous exercise, lifting heavy weights or outdoor physical sports.
• Avoid smoking and drinking alcohol, as recommended to anybody planning a pregnancy.
• Also avoid exposure to pesticides, chemicals and X-ray.
• Before taking any other medicines, please consult your doctor.
• Eat freshly cooked, preferably homemade food.
A pregnancy test in the form of beta-HCG level is done 15 days after the embryo transfer.
If the test is positive, a vaginal ultrasound scan will be performed about a week later to confirm the pregnancy. If the beta-HCG test is negative, further treatment will be planned depending on whether you have frozen embryos and other individual circumstances.