In Vitro Fertilization (IVF)
IVF involves fertilization outside the body in an artificial environment. This procedure was first used for infertility in humans in 1978 at Baurne Hall in Cambridge, England. To date millions of babies have been delivered worldwide as a result of IVF treatment. Over the years the procedures to achieve IVF pregnancies have become increasingly simpler, safer and more successful. There are times when it is difficult or impossible for the sperm and egg to meet in the fallopian. IVF offers an opportunity to avoid such problems by allowing fertilization to occur outside the body in a glass dish; hence the use of the latin words “ïn vitro’’ which literally means ‘’in glass’’ and the baby named as ‘’test tube baby’’.
What types of fertility problems might be helped by IVF?
- Absent fallopian tubes or severely damaged tubes or bilateral tubal blockage that cannot be treated successfully by surgery.
- Endometriosis that has not responded to surgical or medical treatment.
- A male factor contributing to infertility, in which sperm counts or motility are low but there are enough active sperms to allow fertilization in the laboratory.
- Unexplained infertility that has not responded to other treatments.
- Infertility secondary to sperm antibodies.
- Pelvic adhesions.
- Chronic anovulation where needs lots of drugs for getting mature eggs.
Our IVF/ICSI co-ordinator discusses in depth with the couple about the procedure, risk involved, cost and success of the treatment.
Prior to becoming eligible for treatment in an IVF cycle couple will need to complete the tests recommended by physician, have to have current infectious disease testing (good for 1 year), and consent forms must be signed and returned before starting each cycle.
Treatment involves several steps
- Down regulation which temporarily switches off the pituitary.
- Stimulation of the ovary to produce several fertilizable oocytes (eggs).
- Monitoring by ultrasound.
- Retrieval of the oocytes and culture of the embryos in the laboratory.
- Placement of the embryos into the uterus for implantation (Embryo transfer or ET)
Step 1: Down regulaton:
It is done to stop the function of the pituitary gland so it can not interfere the artificial treatment cycle. It starts on D2 or D21 of regular or progesterone withdrawal cycle. Inj suprefact (GnRHa) .5ml sc daily is given in long protocol for 14 days. It takes 2-3 weeks for complete down regulation. It is tested by doing USG and observing the endometrial and ovarian status. Emdometrium becomes thin and ovaries become acystic. Sometimes blood testing for E2 and LH is needed.
Step 2: Stimulation:
Once down regulation achieved injection gonadotropin is given to produce multiple eggs. Dose of gonadotropin is fixed according to patients’ age and ovarian reserve. It takes 10-12 days stimulation to get mature eggs. Regular ultrasonographic monitoring is done to see the recruitment and development of eggs and to adjust the dose of gonadotropin according to response of the patient. Development of 10-12 follicles is optimum. Monitoring also needed to avoid ovarian hyperstimulation syndrome ( development of too many follicles). When follicles attain the size of 18 mm or more ( at least 3 follilces) ovulation is triggered by giving injection hCG. Ovum pick up is scheduled 36 hours after hCG injection.