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What is IVF Process?

In vitro fertilization, popularly known as IVF, is a boon to couples who find it difficult to conceive despite several attempts and fertility treatments. IVF is the most popular assisted reproductive technology (ART) around the world. Data from the International Committee for Monitoring ART (ICMART) reveals that since the first successful IVF birth in 1978, more than 8 million babies have been born from IVF around the world.

The IVF process involves handling egg and sperm externally and facilitating fertilisation in a controlled lab setting to form an embryo. It is called in vitro because fertilisation happens in a petri dish. Then, healthy embryos are identified and transferred into the woman’s uterus where they must implant in the uterine wall and develop into a baby. An IVF cycle is typically completed in three weeks.

The IVF Process in Five Steps

Once you approach an infertility expert, you and your spouse will require several screenings before starting an IVF cycle. Based on your combined diagnostic test results, you could be put on certain medications or supplements to enhance the quality of eggs and sperm. In addition, the female partner will be asked to take folic acid supplements in anticipation of successful implantation and pregnancy. Once you and your partner are ready for the IVF process, you will go through these five IVF stages:

Ovarian hyperstimulation

You will be put on a combination of hormone therapy using Follicle Stimulating Hormone or FSH and fertility drugs to stimulate your ovary to mature and release more than one egg in the next cycle. The higher the number of mature eggs formed, the more the chances of getting optimum eggs for fertilization. The ovary stimulation medications are taken as oral drugs and injections for 5 to 10 days. The step is called hyperstimulation or superovulation.

Egg retrieval

Once you start ovary stimulation medication and injections, your doctor will periodically perform a transvaginal ultrasound to monitor ovary stimulation. It is done to check when the ovary is ready to release mature eggs into the fallopian tube, where they would get fertilized in case of a natural pregnancy. In IVF, when your ovaries have optimal mature eggs, you will be given a hormone injection to control ovulation just a day before the scheduled egg retrieval process. This procedure, also called follicular aspiration, is a day procedure and is usually performed under general anaesthesia.

During this IVF process, your doctor will extract mature and almost mature eggs from your ovaries using an ultrasound-guided thin needle. The needle is inserted through the vagina. The procedure rarely causes extreme pain. However, you may experience some cramping and discomfort for a day.

Sperm collection

While the female partner undergoes egg retrieval, the male partner must provide the sperm sample to the fertility clinic’s lab. There, the sperm sample will be washed and put through a spin cycle to get the best and healthiest sperm batch of the lot. Mostly, it is recommended to practice sexual abstinence for a minimum of two days and a maximum of seven days before giving a sample for the IVF process.

Fertilisation

Now the mature eggs from the female partner and the healthiest sperm from the male partner are ready to unite and initiate fertilisation. In a regular IVF cycle, where there are no structural or motility issues with the sperm, the mature egg and sperm are left on a petri dish to combine naturally. In case, there are problems with sperm motility, your doctor may recommend the process called intracytoplasmic sperm injection or ICSI where the sperm is injected into the egg. This enhances the chances of fertilization. Fertilisation of the egg usually takes a few hours.

Embryo Transfer

While your embryos continue to grow in a controlled-lab environment, you will be put on a new set of medications to prepare your uterine lining for embryo implantation. Just around the midway into your next menstruation cycle, that is around ovulation (14th day), your doctor will start monitoring the thickness and health of your developing uterine lining. Again, this is done using transvaginal ultrasound. When your uterine lining is at its best, your doctor will transfer the healthy embryo(s) into your uterus using a catheter.

From here on, you are on the same track as a natural pregnancy. The embryo must implant in your uterus lining naturally and grow into a baby. Sometimes, more than one embryo may get implanted in the uterus wall. This is why IVF is believed to increase the chances of twins and triplets, depending on the number of embryos transferred in a cycle.
Next, you hope the embryo(s) implants itself in the uterus leading to a successful pregnancy. After transfer, you must wait at least 15-20 days before performing a pregnancy test to know the result.

Who needs IVF treatment?

IVF is usually recommended as the first line of treatment for infertility in women over the age of 40 years. The IVF stages follow the same processes as natural pregnancy, except where the egg is fertilized outside of the body and the embryo is transferred to the uterus. But this one step increases the chances of a positive pregnancy significantly among couples facing one or more following problems:

● Blocked fallopian tubes
● Severe male infertility factor
● Ovarian insufficiency
● Low ovarian reserve
● Endometriosis - a condition where tissue resembling endometrium or uterine lining starts developing outside the uterus
● Uterine tumours
● Uterine fibroids
● Before tubal removal or sterilization. IVF could be a better choice if you want to get pregnant after a tubal ligation than going for a surgical procedure to undo it.
● Reduced sperm count or function
● Undiagnosed infertility

Also, if you or your partner has a family history of certain genetic conditions, then IVF can help you bypass the risk. While not all genetic issues can be detected, the eggs and embryos are screened for specific genetic issues during the IVF process. Only healthy and the most promising embryos are transferred into the female partner to initiate pregnancy.

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