Invitro Fertilisation Treatment

Invitro fertilisation treatment (IVF )is one of the more advanced treatment options available to couples with fertility challenges. Pregnancy occurs when, an egg is fertilised by a sperm. When fertilisation happens inside the body, it is called in vivo fertilisation. When fertilisation happens outside of the body, it is called in vitro fertilisation. IVF can help treat infertility in patients who have damaged fallopian tubes, male factor infertility, endometriosis, or unexplained infertility.

It is important that when a couple have gotten to a point where they have both agreed, that the is a challenge with getting pregnant, the first step is now to inform your fertility specialist, that you are now ready to proceed. This should be done soon after you have been assessed, and you are found to require, more specialised and advanced treatment option.

The clinician would have all the treatment option available known to you, and you should have an informed knowledge of the option, that would suit you peculiar need.

courtesy BBC.

I must point out that at this point, you should have psychological support, which can be either from your spouse or partner, or from the clinic, through a counselor.

Inability to conceive is one of the most stressful experiences one can go through in life. Yet many people find it difficult to seek out emotional support, whether it be from friends, family, a spouse, or a mental health professional.

Please do not wait till you are at your wits end, have depleted your emotional reserves before turning to help. Several couples have regretted not seeking help earlier, as stress on its own, would hinder your getting pregnant. Seeking help early enough, can be seen as a positive step towards emotional healing and stress management rather than as a sign of weakness.

There is much peace, when you talk things over with your spouse or partner, a professional counselor, and close family.

IVF, is simply a process whereby the male gamete, sperm is brought in contact with the female gamete, egg, in a controlled environment, the incubator, to mimic the human invivo ( natural) conditions in the female womb. This is carefully done to achieve fertilisation, and the resulting embryo, from the fusion of the nuclei from the sperm and the egg , is transferred back into the female uterus after culturing for a certain number of days. • Egg quality and quantity Ivf is a very effective treatment for infertility, and the quantity and quality of the female egg , and sperm quality, even though not as pivotal as the egg, must have a minimal quality for this process to succeed. This is directly related to the age of the woman.

These two indicators decrease with age. In most clinics, the female is made to do certain tests, that would give a pointer to the Ovarian reserve, which basically is the amount of potential oocytes (eggs ) , that is likely to be produced by the woman.

These tests include :AMH – Anti mullerian Hormone.

Antrial follicular count, and the day 3 FSH level. • Age of the woman The chances of the woman reaching the egg collection stage and possible embryo transfer, reduces with her age. This is so because; it is likely that there would be a high rate of cancellation of the treatment cycle, because of failed response to stimulation. There is also a marked drop with pregnancy and likelihood of a live birth, as the woman increases in age. This is so because implantation rate decreases with age, because of the poorer quality of the resulting embryos from poor egg. This also invariably, results in increased rates of miscarriage.

There is emphasis on the age of the woman. A woman that is about her mid 30’s is advised to commence IVF treatment quickly, if not able to conceive quickly.

Many clinic would offer a woman in her mid 40’s the egg donation programme, whereby, eggs from a younger woman is used. Most clinic would accept women up to age 42 , to use her own eggs, and thereafter, they are directed to the egg donation programme. The cut off limit varies from one clinic to another.

The big difference between an IVF cycle and a regular menstrual cycle is that ovulation does not take place in an IVF cycle. Instead, the eggs are retrieved at the point of maturation and are fertilised in the IVF lab. Embryos are then transferred to the uterus to initiate pregnancy. Once the embryos are transferred back into the uterus, there is nothing distinguishable between embryos fertilised in the body or in an IVF laboratory.

1. Monitor the development of ripening egg(s) in the ovaries: Fertility medications are prescribed to control the timing of egg ripening and to increase the chance of collecting multiple eggs. To monitor egg development, GIVF utilizes ultrasound examinations of the ovaries (a painless method of imaging the enlarging follicles contain- ing the eggs), and the measurement of serial blood hormone levels.An injection of the hormone HCG is then precisely timed to cause final ripening of the eggs.

2. Collect eggs: Retrieval of the eggs is performed through the vagina, using an ultra sound guided needle, , in a completely comfortable procedure under sedation and local anesthesia.

3. Obtain sperm: The eggs aspirated from the ovarian follicles are immediately identified by embryologists and placed with the partner’s or donor’s sperm, which will have been carefully processed. If the sperm are considered less likely than usual to achieve fertilisation, the sperm is injected, singly , into each egg using special micromanipulation equipment in an ICSI procedure.

4. Egg and Sperm : fertilised, and embryo culture done. Place eggs and sperm together in the laboratory, and provide correct conditions for fertilisation and early embryo growth. The sperm and eggs are placed into incubators and examined carefully at intervals to ensure that fertilisation and cell division have taken place, after which the fertilised eggs are then known as embryos. courtesy BBC. 5. Transfer embryos into the uterus: Two to five days after eggretrieval, embryos are ready to be placed in the woman’s uterus. Blastocyst transfer of embryos at about five days postretrieval is known to give more viable embryos. A speculum is inserted into the entrance of the uterus and the embryos, suspended in a tiny drop of fluid, arevery gently introduced through a catheter into the womb, often under ultrasound guidance. The embryo transfer is followed by a brief period of rest. Subsequent blood tests and ultrasound examinations, usually on day 12 to 14 post transfer, are used to determine if pregnancy has been successfully established.

A luteal phase ( period after the embryo transfer ) support is given to support the embryos, with necessary requirements, to aid good growth and possible implantation.

• Success rates using own eggs starts to drop in the late 20s and drops faster in the mid 30s and early 40s. This drop is caused by decreasing egg quantity and quality

• Live births are rare at age 44 and above using the female partner’s eggs

• There is no drop in success rate with age when using young donor eggs

• The age of the eggs is very important

• The age of the recipient (uterine age) has very little effect on success rates when using donor eggs.

• Most donors are in their 20’s - so the “egg age” is excellent with egg donation cycles. (Advanced fertility centre).

This whole process is simple, and if performed properly, with the full cooperation of the patient, the outcome is usually satisfactory.