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Undergoing IVF Treatment
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Dr. Aniruddha Malpani
Renowned infertility specialist. He runs an infertility clinic in Mumbai and has written many books. Have a question? Click here...
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 Most couples embark on IVF treatment with a lot of hope - mixed with anxiety as well!
You know that IVF maximises your chances of having a baby, and gives you your best shot at getting pregnant. However, you also know that the technology is still not perfect; that final outcomes are always uncertain, and that this is a process, which may take time, and end up costing a lot of money as well. This is why it's important that you be well informed about your treatment, so that you have peace of mind that you did your best!
What is IVF?
IVF is the basic assisted reproduction technique, in which fertilization occurs in vitro (literally, in glass). The man's sperm and the woman's egg are combined in a laboratory dish, and after fertilization, the resulting embryo is then transferred to the woman's uterus. The five basic steps in an IVF treatment cycle are superovulation (stimulating the development of more than one egg in a cycle), egg retrieval, fertilization, embryo culture, and embryo transfer.
Who is IVF most useful for?
IVF is a treatment option for couples with various types of infertility, since it allows the doctor to perform in the laboratory what is not happening in the bedroom - we no longer have to leave everything up to chance!
Initially, IVF was only used when the woman had blocked, damaged, or absent fallopian tubes (tubal factor infertility). Today, IVF is used to circumvent infertility caused by practically any problem, including endometriosis, immunological problems, unexplained infertility, and male factor infertility. It is a final common pathway, since it allows the doctor to bypass nature’s hurdles, and overcome its inefficiency, so that we can give Nature a helping hand!
What tests need to be done prior to doing IVF treatment?
In order to perform IVF, only 3 things are required - eggs, sperms and a uterus, and before starting the IVF cycle, the doctor will check these.
First, a sperm survival test is carried out. This is a "trial" sperm wash; using exactly the same method as will be actually used in IVF, to assess whether an adequate numbers of sperms can be recovered in order to do IVF. This test will also help the laboratory to decide which method of sperm processing should be used during IVF.
A blood FSH level will provide an idea of the "ovarian reserve", and provide information on whether or not the woman will produce enough eggs after superovulation. For older women, some clinics do a clomiphene citrate challenge test. If the level is very high, this suggests early ovarian failure, and it may be a better idea to consider donor eggs.
Many clinics may do a hysteroscopy, in order to assess that the uterine cavity is totally normal. They may also do a "dummy" embryo transfer to make sure there are no technical problems with this procedure. Some clinics also do a cervical swab test, to rule out the presence of infection in the cervix.
If a woman has blocked fallopian tubes with large hydrosalpinges, some clinics will remove these prior to the IVF cycle, because they feel that the presence of a hydrosalpinx decreases pregnancy rates after IVF.
For men who have difficulty in producing a semen sample "on demand", the clinic may also freeze and store the sample prior to treatment, as a backup. This can help to prevent the tragedy of having to abort an entire treatment cycle because the man could not produce a semen sample when needed.
Blood tests which may be done include tests for immunity to rubella; and tests for Hepatitis B, and AIDS. Most doctors will also advise patients to start taking folic acid, as part of pre-pregnancy care, as this helps to reduce the risk of certain birth defects.
Patients who stand a very poor chance of success with IVF include the following:
Older women, whose ovaries are failing. However, there is no upper age limit at which IVF should not be done - and in fact, for older women, it might represent their only chance of success. It's not really the age of the woman, which is the limiting factor - it's the quality of her eggs.
Men whose sperm count is very low. Most clinics will consider doing IVF only for men with at least 3 million motile sperm in the ejaculate. If the sperm counts are lower than this, then ICSI (or microinjection) is a better option.
Women with a damaged uterus (for example, because of healed tuberculosis) because the chance of successful implantation of the embryo in the uterus becomes very poor.
It is also not advisable to go in for IVF treatment without trying simpler treatment options first. IVF is a complex procedure involving considerable personal and financial commitment, so other treatments are usually recommended first.
What are the 5 basic steps of an IVF treatment cycle?
These are:
- Superovulation.
- Egg retrieval.
- Fertilisation.
- Embryo culture.
- Embryo transfer.
To know more ask our expert.
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