What is IVF?

Do you remember when you first heard the word IVF, you probably had to repeat it in your head at least a few times just to get the hang of it. At that point, most people are clueless about the treatment and the first image that flashes before their eyes was of a baby attached to tubes in a giant test tube. At some point you will realise how utterly wrong It was! As a first reaction, most of us rush to the Internet and search for information on IVF. There is a huge amount of information available online that can be bewildering and in the worst-case scenario, misguiding. From my experience, I can tell you that this is not what one should do as there is no way to tell authentic and genuine information from the inaccurate and unreliable. Therefore, instead of choosing to lurk and wallow in confusion, consult a clinician for all your questions and doubts. 

Trust your clinician, ask the right questions, and that will be your best bet at understanding IVF. Everything during the treatment is tailor-made. That is, during IVF, one person’s treatment is designed for that person alone and will vary from someone else’s. So, don’t try to relate to the experience of a random stranger you met online. You don’t know the person behind the online name “momtobe58” or “ivfwithme2017”; you also have no idea about their ethnicity which is an important factor in the success of IVF. But you do know your clinician and the embryologist; so, talk to them. Most developing societies like India’s have no law-enforced regulations on infertility treatments, but just guidelines. So, go to a well-reputed and well-reviewed clinic only at all times. Currently, all infertility clinics are required to adhere to the guidelines set by the Indian Council of Medical Research which are aimed to promote good, ethical medical practice and the benefit of the infertile couples/individuals. 

Before you find an answer to the question ‘what is IVF?’, here are two IVF facts of the greatest importance for the patient’s careful consideration.

Timing is of the essence!

The front desk at an infertility clinic transferred a patient’s call to the concerned clinician. 

Patient: “Hello doctor, today is the second day of my periods, but I need to travel to Mumbai due to a family emergency. I will be back on Sunday. Can I come and see you on 5th day of my period?” 

Clinician: “No, it is very important to adhere to the menstrual cycle and start the stimulation on the second day of your periods, otherwise the process is futile. We can start the cycle in the next month.” 

The timing of the hormone stimulation has to be perfect. Later on, the embryo transfer must also be done on time.

Each case is unique.

Opting for IVF is a big step, and it is totally reasonable if patients talk to other couples that have gone through a similar experience before walking into a fertility clinic. However, it must be borne in mind that each case is unique and comparisons don’t work. Consider the case of a well-read couple who said to the doctor, “Our cousin underwent IVF in Chicago last year and they opted for conventional IVF as it is closer to the natural process. We would like to have our child in the most natural way. Therefore, we have decided on conventional IVF over ICSI.” The clinician, pointing at the semen report, had to advise politely that, “The sperm count is not within normal parameters, and it would be best to use ICSI to maximize the chances.” Afterwards, the couple complied. In another case, on the basis of guru Google’s words, a patient said to the doctor, “I have been reading about this lady who is the same age as my wife. She was advised IVF after two simpler treatments. Why am I told to undergo IVF in the first attempt?” Acknowledging that this question was a good one, the doctor explained, “Because your case is different and more complicated, you will need to undergo IVF sooner than later.” With a sheepish grin, the patient shut the Google tab on his phone. 

Yes, it is important to understand the process and the steps involved in IVF but do so with the help of a clinician who is authorized and qualified to answers your questions and dispel any doubts you might have. 

What is IVF?

Assisted Reproductive Technology (ART) is a range of fertility treatments that encompasses a number of options offered to couples that have a problem conceiving. IVF is an advanced form of ART suggested to you by your clinician after evaluating your case history.

In-vitro fertilization (IVF)

The process of in-vitro fertilization (IVF) typically comprises three phases: ovarian stimulation, egg retrieval, and embryo development and implantation. However, each of these phases comprises multiple steps, all carefully choreographed to facilitate conception, pregnancy, and the birth of a healthy baby.
On paper, these steps seem relatively simple. In practice, an IVF cycle requires an average of four to six weeks of a woman’s life. For that reason, it’s important that couples exploring IVF as a fertility treatment option have a clear picture of what the process entails and what the IVF timeline looks like. This allows them to prepare and set aside a six-week window where the female patient can be available and present for the procedures, tests, and the diligent monitoring required throughout the process. However, during the course of the treatment you can lead a normal life and continue working; you just need to be available for the scans and the procedures that follow. In the process of IVF, the part of conception where the egg is fertilized by the sperm takes place outside the body, in a glass dish. The term ‘test tube baby’ originated from the belief that the process takes place in a test tube. The process was engineered in the 1960s and the first test tube baby was born in 1978.

A few minutes before midnight on July 25, 1978, the first ‘test tube baby girl’ was born in Oldham, England. Weighing 5 pounds and 12 ounces, her arrival marked a watershed in her parents’ lives and in medical history. The birth of Louise Brown was both celebrated and discussed heartily. This miracle was brought about by the doctor–embryologist team of Dr Patrick Steptoe and Dr Robert Edwards. Since then, the technology of IVF has improved greatly through constant research and development. Now, more than million babies have been born with the help of IVF. 

Once enrolled for IVF, the first step is counselling, as the treatment can take an emotional toll on patients. This will be followed by a course of hormonal injections  to stimulate the ovaries to produce eggs. This is done to ensure that a number of eggs are produced simultaneously. There will be regular blood checks and ultrasound scans to track the development of the egg.

When the eggs are ready, they will be removed by the doctor using a tiny needle with the guidance of an ultrasound scan while the patient is on general anaesthesia. This step is called retrieving the eggs or Ovum Pick-up (OPU). The eggs are put together with the partner’s sperms to activate or fertilize them. They are then incubated in the laboratory for a few days to allow them to divide and form embryos which are then transferred to the uterus. 

IVF is a broad term and may be divided into conventional IVF and ICSI (Intra Cytoplasmic Sperm Injection). Depending on your lab, one of the two procedures may be used. However, ICSI is more popular in India. You can check the mode of fertilization with your clinic so that you can make an informed decision. 

What is Conventional IVF

A stepwise representation of (conventional) IVF: 

  1. The female partner is stimulated by a course of hormonal injections that helps to grow eggs.
  2. The eggs are removed out of the body on the day of the procedure.
  3. Sperms are obtained from the male partner.
  4. Eggs are incubated with the sperm. The sperm self-selects and enters the egg.
  5. The embryo formed is grown in the lab.
  6. The embryo is transferred into the uterus of the female partner.

Pros: Natural selection. 

The sperm that fertilizes the egg depends on nature.

       Cons: Lower egg activation rate. 

Semen samples with low count have a lower success rate. 

The overall rate of success is considered to be 40 to 50%.

Factors to be taken into account before opting for (conventional) IVF:

  1. The age of the female patient and her ovarian reserve. 

This means that the age of the female patient and her medical history will determine how productive her ovaries are and how good her eggs are. As a woman grows older and reaches the age of 35, her productive capacity and egg quality drops exponentially. 

  1. The semen parameters of the male partner.

This means how good the semen is for reproduction. Very low count may not be a good candidate for conventional IVF.

The journey of the sperm to ultimately reach the egg is truly the greatest obstacle-course race designed by nature. Of the millions of sperms released during ejaculation, only one succeeds in fertilizing the egg. Only one survives the acidic environment inside the vagina and other several obstacles in its path, beating the other contestants, making it the true winner!

What is Intracytoplasmic Sperm Injection (ICSI)

A stepwise representation of ICSI:

  1. The female partner is stimulated by a course of hormonal injections that helps to grow eggs.
  2. The eggs are removed out of the body on the day of the procedure.
  3. Sperms are obtained from the male partner.
  4. A single sperm is injected in the oocyte by the embryologist in the lab. This is a lab procedure, and the patient is not involved.
  5. The embryo formed is grown in the lab.
  6. The embryo is transferred into the uterus of the female partner.

Pros: The fertilization rate with ICSI is higher as one sperm is manually inserted inside the egg. Entry of the sperm into the egg is guaranteed. Poor semen sample benefit from ICSI.

Cons: The procedure is expensive and invasive.

The only difference between conventional IVF and ICSI is in step 4. Whereas IVF relies on natural selection, in ICSI the embryologist selects the sperm that will fertilize the egg. Other steps remain unchanged. Remember, the more the number of fertilized eggs, the greater the number of embryos available for the procedure.

Navin Desaihttps://archishfertility.com
Embryologist and Co-Author – “Making babies the IVF way” He has 10+ years’ experience in the IVF industry having a unique skill set which involves both Core Embryology and Management. He is adept with core embryology skills like Gamete handling, Embryo biopsy and MACS. Having worked in eminent International Pharmaceutical like GSK, Lupin and Mylan he has extensive experience in Scientific Marketing and People Management.

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