Dr. C. S. Sada
What is IVF / Test Tube Baby?
IVF 'InVitro Fertilization' is a process in which egg from a woman's body is fertilized outside of her body and later the egg is put inside the same woman's uterus to develop further.
This is a very useful treatment to treat infertility. If you choose hope, everything is possible.
Below are some of the stages through which the IVF treatment is carried. The treatment is different for different type of couples who want to conceive with the help of IVF.
A thorough medical inspection and tests are carried to identify the infertility causes and then the treatment is suggested accordingly. Below are the stages through which the IVF treatment is carried.
1. Sperm Preparation
Sperm is usually provided the morning of the egg retrieval. Occasionally the sperm is collected ahead of time and frozen for use after the egg retrieval. We can obtain sperm from the male partner through normal ejaculation or through more advanced sperm retrieval procedures such as microepididymal sperm aspiration (MESA), or testicular sperm extraction (TESE).
If your partner will be providing a semen specimen on the day of the egg retrieval, we recommend abstaining from intercourse for at least two days prior to the IVF procedure but not more than 6 days. This will help to obtain optimal sperm quality for the IVF procedure. Donor sperm may also be used; it will be thawed and prepared by the laboratory staff the morning of the retrieval.
After the lab receives the semen, the andrologist will first rinse the sample with a special solution that removes dead sperm and cellular debris while also protecting the living sperm. The andrologist then takes one ml of the sperm solution and removes extra fluid by centrifuging, spinning the sperm cells through a special medium to bring the concentration up to 30,000 motile sperm per ml. This concentrated sperm solution is then used to inseminate the eggs by adding a very small quantity of the sperm to each drop of culture medium containing the eggs.
2. Ovarian Stimulation
Ovarian stimulation is the second stage of IVF fertility treatment. The goal is to harvest as many mature eggs as possible from the woman’s ovaries. Harvesting many eggs maximizes the chances one of the eggs can be fertilized, implanted back into the uterus, and become a healthy baby.
Because the natural female reproductive cycle is incredibly complex, ovarian stimulation is also a complicated process. An IVF cycle can be stressful, especially when you’re going through it for the first time.
In an IVF cycle, you maximize your chances of success by generating as many mature eggs as possible. The stimulation phase involves the injection of medications for 8-14 days, to induce the ovaries to produce many eggs. The stimulation phase takes longer if your follicles are slower to mature.
The medications stimulate (and are derived from) two key hormones, Follicle Stimulating Hormone (FSH) and Lutenizing Hormone (LH).
3. Transvaginal Oocyte Removal
Approximately 35 hours after the hCG injection, the egg (oocyte) retrieval will be performed under sedation. Intravenous medications will be given to prevent discomfort during the procedure. You will be asked not to have anything to eat or drink after midnight the night before the egg retrieval.
Once you receive the intravenous medication, the vagina will be cleansed with sterile water. A needle will be placed through your vagina and into the ovary, under ultrasound guidance. Most women will not feel this procedure at all due to the effects of the intravenous medications. The follicular fluid (which contains the eggs) from the follicles in your ovaries is collected in test tubes and passed to the embryologists in the In Vitro Fertilization (IVF) Lab. The egg retrieval takes approximately 20-30 minutes.
After the procedure is completed, you will be transferred to the recovery room to rest for about an hour. Risks from the egg retrieval include pain, infection in the pelvis and ovaries, injury to the bowel, bladder, uterus, ovaries or major blood vessels. Since the procedure is done under ultrasound guidance and the needle can be seen on the ultrasound, the chance of serious problems is extremely small.
4. Oocyte or Embryo Preservation
Egg freezing, or oocyte cryopreservation, is a process in which a woman's eggs (oocytes) are extracted, frozen and stored as a method to preserve reproductive potential in women of reproductive age.
Oocyte cryopreservation has advanced greatly over the past few years, with improved overall success of eggs surviving the freezing process.
For those undergoing IVF, we offer the preservation of additional embryos using a vitrification protocol. Vitrification is specially indicated for preserving embryos and eggs. For patients, this means an extra opportunity to return for additional treatment without having to undergo ovarian stimulation.
For single women or women seeking fertility preservation following a diagnosis of cancer, we can vitrify eggs to allow the possibility of having a baby using those eggs in the future.
Once eggs reach the lab, experts examine them to determine maturity and quality. Mature eggs are transferred into a special culture medium, placed in an incubator and within a few hours of egg retrieval are fertilized with sperm.
There are two ways to fertilize an egg: conventional insemination or intra-cytoplasmic injection (ICSI).
Which process is used will be determined by your IVF team (physicians and embryologists) and depends on multiple factors related to the couple going through IVF. Both methods have approximately the same success rate. ICSI is used approximately 70% of the time when factors make fertilization less likely due to poor semen quality or previous IVF failure.
For the conventional method, sperm is placed in the culture medium in a small petri dish containing an egg; the sperm and eggs are incubated together in the dish in the lab, allowing the sperm to enter the egg on its own. For ICSI, one sperm is injected into the cytoplasm of the egg using a needle and a sophisticated operative microscope. No matter which process is used, fertilization is checked the next morning.
6. Embryo Culture
Following fertilization, the IVF team and the couple determine exactly when embryo transfer will take place – anywhere between 1 and 6 days but usually 3-5 days after egg retrieval.
7. Embryo Transfer
When the embryos are big enough, they can be implanted. This normally occurs three to five days after fertilization. Implantation involves inserting a thin tube called a catheter inserted into your vagina, past your cervix, and into your uterus. Your doctor then releases the embryo into your uterus.
Because only unaffected embryos are transferred to the uterus for implantation, preimplantation genetic testing provides an alternative to current post-conception diagnostic procedures (ie, amniocentesis or chorionic villus sampling), which are frequently followed by the difficult decision of pregnancy termination if results are unfavorable. PGD and PGS are presently the only options available for avoiding a high risk of having a child affected with a genetic disease prior to implantation
About 12 days after an embryo transfer, you’ll have a blood pregnancy test. If a pregnancy is confirmed, you’ll be followed with blood tests and eventually, ultrasounds, to confirm viability and whether there’s a multiple pregnancy. If the pregnancy appears normal at 9-10 weeks, you’ll be referred back to your obstetrician!