What is IVF?
IVF or In vitro fertilisation in simpler terms means fertilisation or woman’s eggs and men’s sperms meeting outside the body in a test tube (Test Tube Baby). The fertilised egg (embryo) is then inserted in the uterine cavity.
Who needs IVF?
For normal conception to happen, a healthy sperm with good motility should pass through cervical mucus, swim through uterus and reach fallopian tube to meet egg around the time of ovulation (when egg is released in the body). Eggs and sperms meeting in the fallopian tube form an embryo which goes to uterine lining and implants there. It means for normal conception to happen we need healthy motile sperms, open fallopian tube, good eggs, ovulation happening on its own and good uterine lining. If there is issue with any of them, we might need to think about assisted reproduction. So, you might need IVF if you are suffering from:
1) Male Infertility: sperms less in number (oligospermia), sperms not motile (asthenospermia), sperms abnormal in shape (teratospermia), or all three issues (Oligoasthenoteratospermia or OATS). It might also be possible there are no sperms seen in your routine analysis (Azoospermia)
2) Female Infertility: A female might be sub-fertile due to number of reasons like:
- Issues with tubes- blocked tubes, fluid in tubes (hydrosalpinx), adhesions
- Issues with eggs- Polycystic ovarian syndrome (PCOS)- no egg releasing or anovulation; low number of eggs – advanced age, low AMH; endometriosis-cyst in ovary
- Issues with uterus – fibroid, adenomyosis, poor endometrial lining or thin ET (endometrial thickness), adhesions in uterus (Ashermann syndrome)
Who does IVF?
IVF is done by only trained IVF specialist who have worked in the field of Reproductive Endocrinology. It is very important to choose the right doctor with impeccable qualifications.
Is there any investigation required before IVF?
Besides routine investigation and viral serology, your IVF doctor needs to do a transvaginal ultrasound to look at the uterus and ovaries. They will be look at endometrial thickness (ET) as well as the number of eggs in Ovary (Antral follicle count or AFC). Also, hormonal investigations including AMH (Anti Mullerian Hormone) will be done. Hysteroscopy might be required prior to IVF if there are issues with uterine lining.
How much time does the process of IVF take?
If the process is started from Day 2 of your cycles, the whole treatment till embryo transfer is completed in a duration of 15-20 days.
What are the steps involved in the process of IVF treatment?
1. Initial Consult: In your first consult, the doctor will be taking a detailed history, have a thorough look at your old records and investigations. Also, a Transvaginal examination will be undertaken. It is always a good idea to bring all your old records including any Hystero-salpingogram (HSG) X-ray done for you. A follow-up detailed plan will be accordingly made on your first visit.
2. Ovarian Stimulation: For an IVF cycle to succeed, we need to get more eggs, to have more good quality embryos and to increase our chance of success. This is done by taking hormonal injections. These are pen style injections and can be self- administered by the patient.
3. Ultrasound Monitoring: To see the response of hormonal injections, trans vaginal ultrasound (TVS), is done at interval of 4-5 days.
4. EGG Retrieval: After the follicles are ready eggs are retrieved under anaesthesia using vaginal approach. So, there is no incision, no mark. This surgery is quite safe.
5. Embryology lab: The day your eggs are taken, the same day your husband’s sperm sample is taken. Eggs are then fertilized by sperms using conventional IVF or advanced techniques like ICSI (Intracytoplasmic Sperm Injections), IMSI, PICSI etc. The next day the number of eggs fertilised is seen under microscope or embryoscope. Embryos are then developed to day 2, day 3 or day 5 (Blastocyst) stage. Lab keeps you updated about the progress and accordingly plans for embryo transfer.
6. Embryo Transfer: Embryo transfer is done under ultrasound guidance and is just like IUI procedure and there is no need for anaesthesia. The best embryos are transferred and if there any surplus embryos left; they are frozen.
How much does IVF cost?
The cost of IVF is variable and depends on multiple factors:
1. Patient factor: Age of patient, weight of patient. As there is increase in the age of patient or weight of patient, there is need for more hormonal injection and increased cost.
2. Need for advanced techniques: If advanced technique like ICSI, Blastocyst culture, Embryo Freezing, PGD, Embryoscope is used, there is increase in the cost of IVF cycle.
3. Third Party Reproduction: If there is need for egg donor or surrogacy, there is substantial increase in the cost of IVF cycle. From conventional IVF starting at one lakh forty thousand, the cost increases if any of these factors are involved.