In Vitro Fertilization, IVF for short, is an example of assisted reproductive technology (ART). In this procedure, eggs are taken from a woman’s ovaries and fertilized with sperm. Known as an embryo, this fertilized egg is a cell. The embryo may subsequently be placed in a woman’s uterus or preserved for later use.
IVF is used to help with fertility, prevent genetic issues, and aid in child conception.
In IVF, mature eggs are removed from ovaries and fertilized in a laboratory using sperm. The fertilized egg (or eggs) is/are then transported to a uterus. IVF cycles are completed in roughly three weeks. When these processes are divided into separate sections, the process might sometimes take longer.
TERMINOLOGY
In an effort to standardize language for patients, doctors, and researchers, the European Society for Human Reproduction and Embryology (ESHRE) and the American Society of Reproductive Endocrinology (ASRM) have developed terminology recommendations, thus –
The term “assisted reproductive technology” (ART) refers to “any procedures that include treating human oocytes, sperm, or embryos in vitro for the aim of reproduction.
In vitro fertilization (IVF) and embryo transfer (ET), intracytoplasmic sperm injection (ICSI), embryo biopsy, preimplantation genetic testing (PGT), assisted hatching, gamete intrafallopian transfer, zygote intrafallopian transfer, gamete, and embryo cryopreservation, semen, oocyte, and embryo donation, and gestational carrier cycles are examples of these procedures, but they are not the only ones.
As a result, assisted insemination using sperm from either a woman’s boyfriend or a sperm donor is not included in ART and is not listed on ART-only registries.”
The term “infertility” is described as “a condition where a clinical pregnancy cannot be established after 12 months of frequent, unprotected sexual contact or when a person’s ability to reproduce, either alone or with a partner, is impaired.
Based on a patient’s medical, sexual, and reproductive history, age, physical characteristics, and results of diagnostic tests, fertility therapies may be started in less than a year. Infertility is a disorder that results in functional impairment and disability.” Males and females can both experience infertility.
The term “sequence of operations” used to describe in vitro fertilization (IVF) is “extracorporeal fertilization of gametes.” ICSI and traditional in vitro fertilization are included. In vitro fertilization, egg harvesting, in vitro insemination, and transfer of the resulting embryos to the uterus are all steps in the IVF process.
ICSI stands for intracytoplasmic sperm injection, which is “the injection of a single spermatozoon into the cytoplasm of the oocyte.” Usually, severe male factor infertility is treated with this technique.
“Intrauterine insemination” (IUI) is the term used to describe the technique of inserting laboratory-processed sperm into the uterus in an effort to conceive.
In order to cure various types of reproductive impairment and infertility, medically assisted reproduction, or MAR, involves “reproduction brought about by various treatments, procedures, surgeries, and technology. Inducing ovulation is one of these.
Among these are ovulation induction, ovarian stimulation, ovulation triggering, all ART treatments, uterine transplantation, and intrauterine, intracervical, and intravaginal insemination using the semen of a donor or the husband/partner. Compared to ART, this is a more comprehensive term.
WHAT ELEMENTS AFFECT IVF RESULTS?
A number of pre-procedure variables might impact IVF outcome (eg, female age, type of infertility diagnosis, and past reproductive-obstetric history)
Age of the donor —
The biological age of the person giving the oocytes is a key factor in determining the outcome of IVF. IVF can successfully treat infertility in young women, but it cannot stop the age-dependent reduction in fertility in older women, especially those over 40.
This decline in success is consistent with what is observed with other types of reproductive therapy in older ladies Particularly with regard to IVF, the reduced success is brought about by both decreased ovarian response to gonadotropin stimulation, which lowers the number of oocytes accessible for IVF, and a reduced implantation rate per transplanted embryo as a result of subpar egg quality.
Additionally, with rising female age, the probability of pregnancy loss (i.e., miscarriage or spontaneous abortion) and chromosomal abnormalities increases.
The maximum age for utilizing autologous eggs in IVF (i.e., without using donor eggs) is debatable and varies by location, however, it commonly falls between 41 and 45 years of age. Cycles were abandoned prior to retrieval in 30% (70 of 231) of the ladies in one series who had IVF using autologous eggs; the total pregnancy rate per retrieval was 21%. (34 of 161). Only five of the 34 pregnancies, all of which were in patients, gave birth to living children.
Poor ovarian reserve: – Patients with poor ovarian reserve should be provided alternative kinds of treatment, such as oocyte donation, as they have a lesser chance of having a live birth with their own oocytes. (For more information on ovarian reserve assessment, see “In vitro fertilization: Procedure,” section.)
Blocked Fallopian Tubes: The live birth rate is just half that of women without blocked tubes in studies that have repeatedly demonstrated the association between blocked tubes and poor IVF outcomes. Furthermore, randomized trials have shown that removal of the tubes before IVF enhances pregnancy rates in women with blocked tubes and should be advised.
Mechanical forces, bacteria, endotoxins, and other entities may function as mediators for these negative consequences.
Tobacco usage – Smoking cigarettes lowers IVF success rates (fewer ova are recovered) and is linked to a number of detrimental impacts on general health. We encourage smokers to quit.
Fibroid– The impact of fibroids on IVF depends on where they are located; submucosal fibroids appear to have a lower success rate than subserosal fibroids. It’s unknown how intramural fibroids will behave.
Endometriosis and endometrioma – It is debatable whether an asymptomatic endometrioma should be removed before IVF; the best course of action is not universally agreed upon. We don’t usually remove endometriomas before starting IVF since doing so can harm ovarian reserve and doesn’t improve the results of assisted reproductive technology (ART). When receiving ART, endometriosis-affected women appear to have a comparable probability of having a live delivery.
Previous pregnancies: Although a history of one or more losses does not significantly lower the chance of success, it is connected with a greater likelihood of successful IVF.
Previous unsuccessful IVF cycle – Up until the fourth failure IVF cycle, the success rates of following treatments are not significantly impacted.
Obesity – Women with body mass indices [BMIs] of 25 to 29.9 and over (30 kg/m2, respectively) are more likely to have infertility, and IVF treatment may be less effective in these women.
In Vitro Fertilization: How Does It Work?
The most successful type of assisted reproductive technology is IVF. The process is possible with the use of the couple’s own sperm and eggs. A known or unknown donor’s eggs, sperm, or embryos may also be used during IVF.
A gestational carrier also known as a surrogate is a person who is carrying an unborn child for another person.
IVF success rates are influenced by a variety of variables, including your age and the underlying reason for your infertility. IVF can also be costly, intrusive, and time-consuming. IVF can lead to pregnancy with more than one fetus if more than one embryo is placed in the uterus (multiple pregnancies).
Your doctor can explain IVF’s operation, possible hazards, and suitability for you as an infertility treatment option.
The IVF process consists of five steps:
Stimulation of egg retrieval, insemination, and transfer of embryos
1. Stimulation
Each menstrual cycle typically results in one egg being produced by a woman. However, several eggs are needed for IVF. Using more than one egg enhances the likelihood of creating a healthy embryo. To enhance the quantity of eggs your body produces, you will be given fertility medications. Regular blood tests and ultrasounds will be done during this period by your doctor to track the development of the eggs and inform them when to be removed.
2. Egg Recovery
Follicular aspiration is the term for egg extraction. It’s a surgical operation done under anaesthetic. Your doctor will insert a needle into an egg-containing follicle in your ovary after using an ultrasound wand to guide it through your vagina. Each follicle will have eggs and fluid suctioned out of it by the needle.
3. Insemination
A sample of semen must now be provided by the male partner. In a petri dish, a technician will combine the sperm and the eggs. In the event that ICSI is chosen by your doctor and does not result in embryos.
4. Culture of Embryos
The fertilized eggs will be observed by your doctor to make sure they are dividing and growing. At this point, the embryos could be subjected to genetic condition testing.
5. Transfer
Embryos can be implanted once they are large enough. Three to five days following conception, this often happens. A catheter is introduced into your vagina, through your cervix, and into your uterus during an implant procedure. The embryo is subsequently implanted into your uterus by your doctor. When the embryo embeds itself in the uterine wall, pregnancy occurs. It can take six to ten days. You can find out whether you’re pregnant with a blood test.
When to Use IVF
- Infertility or genetic issues are treated by in vitro fertilization (IVF). If intrauterine insemination (IUI) is used to treat infertility, you and your partner may be able to try less invasive treatment options before attempting IVF, such as fertility medications to boost egg production or IUI, in which sperm are placed directly in the uterus close to the time of ovulation.
- IVF is occasionally recommended as the first line of therapy for infertility in women over the age of 40. If you have specific medical issues, IVF may still be an option. IVF, for instance, could be a choice if you or your partner have:
- Obstruction or injury to the fallopian tube. It is challenging for an egg to become fertilized or for an embryo to move to the uterus when the fallopian tube is damaged or blocked.
- ovarian dysfunction. Fewer eggs are accessible for fertilization if ovulation is sporadic or nonexistent.
- Endometriosis. Endometriosis develops when tissue resembling the uterine lining implants and spreads outside of the uterus, frequently impairing the ovaries’, uterus’, and fallopian tubes.
- Tumours In The womb. In the womb, fibroids are benign tumors. In women in their 30s and 40s, they are typical. Fibroids may prevent the fertilized egg from implanting properly.
- After fallopian tubes removal or sterilization: The fallopian tubes are cut or blocked during a procedure known as tubal ligation to permanently end pregnancy. IVF may be a better option than tubal ligation reversal surgery if you want to become pregnant after having your tubes tied.
- Reduced sperm count or sperm quality: Sperm may have trouble fertilizing an egg if they have low concentration, limited movement (poor mobility), or abnormalities in size and form. A consultation to an infertility expert may be required if abnormalities in the semen are discovered in order to determine whether there are any treatable issues or underlying medical problems.
- Unaccounted-for infertility Despite testing for typical reasons, unexplained infertility refers to the absence of a cause.
- An inherited condition. You can be eligible for preimplantation genetic testing, an IVF treatment, if you or your spouse are at risk of passing on a genetic condition to your kid. Although not all genetic issues may be detected, the eggs are checked for specific genetic issues after being extracted and fertilized. Embryos that don’t have any known issues can be placed into the uterus.
- Maintenance of fertility in the face of cancer or other illnesses. IVF for fertility preservation may be an option if you are about to begin cancer treatment that might affect your fertility, such as radiation or chemotherapy.
- It is possible for women to have their ovaries removed and their eggs preserved unfertilized for later use. Or, the eggs can be fertilized, then the embryos can be preserved for later use.
- If a woman’s uterus isn’t functioning or pregnancy offers a major health risk, she may select IVF with a donor pregnancy (gestational carrier). In this instance, the sperm and the woman’s eggs are fertilized, but the resultant embryos are then implanted in the uterus of the gestational carrier.
Preparing For IVF: What You Should Do
Request specific details on the fees involved with each procedural stage.
Numerous factors influenced a hospital’s success rate. These include –
The ages and health conditions of the patients, The types of patients being treated at the clinic, and The methods of therapy.
You and your spouse will probably require a number of tests before starting an IVF cycle with your own eggs and sperm, such as:
- Testing for ovarian reserve. Your doctor may do blood tests to measure the levels of follicle-stimulating hormone (FSH), estradiol (estrogen), and anti-Mullerian hormone during the first few days of your menstrual cycle in order to evaluate the number and quality of your eggs.
- Results from tests, which are frequently combined with an ultrasound of your ovaries, can aid in predicting how your ovaries will react to fertility drugs.
- Semen examination. Your doctor will do a semen analysis just before the beginning of an IVF treatment cycle if it wasn’t done as part of your first fertility assessment.
- Screening for infectious diseases. You and your partner will undergo HIV and other infectious disease screenings.
- Practice transferring embryos. To establish the depth of your uterine cavity and the procedure most likely to properly implant the embryos into your uterus, your doctor may perform a mock embryo transfer.
- Exam of the womb. Before you begin IVF, your doctor will check the uterus’ inner lining. In order to produce pictures of your uterine cavity, an ultrasound and a sonohysterography, in which fluid is injected via the cervix into your uterus, may be used. It might also involve a hysteroscopy.
DONOR EGGS: WHEN ARE THEY USED?
Eggs from a donor or those from the IVF patient can be used in an IVF cycle. known or anonymous donors may provide donated eggs .
Common reasons for utilizing donor egg are –
- Older than the reproductive age
- Diminished ovarian reserve, regardless of the cause
- There may be a genetic issue.
- Poor egg or embryo quality, many failed ART efforts, or other factors
- Hypogonadism that is hypergonadotropic
- Insufficient biological oocytes (males or trans females)
Donor screening and selection —
A number of society recommendations are available to direct donor screening and selection as well as the administration of fertility laboratories. A thorough medical history is taken to check for any current illnesses and potential hereditary conditions, and the potential oocyte donor is then subjected to a physical examination, lab tests, and a psychoeducational evaluation.
All egg donors must submit to an infectious illness test, which is well governed.
Egg donation —
For both personal and donor eggs, the procedures for ovarian stimulation, egg harvesting, and egg cryopreservation are the same. Fresh or frozen-thawed oocytes can be used for oocyte fertilization and subsequent embryo development. Although fresh cycles are more difficult since they need for hormonal synchronization between the egg donor and intended recipient, using fresh donor eggs may increase the live birth rate.
IVF COULD BE UNSUCCESSFUL
The majority of the time, IVF has a respectable success rate. When more than one round of IVF is performed, the overall success rates are greater and about 30% of IVF cycles will result in a live delivery.
However, a person’s likelihood of success is influenced by a number of variables, such as her age, the reason for her infertility, and the type of treatment she receives.
For instance, in the United States in 2017, the live birth rate for each IVF cycle initiated is around 47% for women under the age of 35, 34% for women in the 35–37 age range, 21% for women in the 38–40 age range, 10% for women in the 41–42 age range, and 3% for women above the age of 42.
The Society for Assisted Reproductive Technology (www.sart.org) makes available online the success percentages of certain infertility clinics. The emotional highs and lows of infertility therapy can be challenging to manage.
This is particularly true if the lady (and her partner) have been trying to get pregnant for a long time, if the therapy is not covered by insurance, or if the couple is experiencing any underlying issues (eg, medical, family or partner, job, financial).There are several infertility treatment facilities that offer support groups and counseling services, as well as online (see “Where to find more information” below).
Speak with your healthcare practitioner to learn where to locate a reliable organization.
SUGGESTIONS FOR FURTHER INFORMATION
The finest source of information for queries and worries pertaining to your medical issue is your health care practitioner.
On our website, this material will be updated as necessary. Related patient-related issues and a few articles are created for general reading.
