IVF Procedure

What is IVF/Test Tube Baby?

IVF (test tube baby) stands for in vitro fertilization. IVF (test tube baby) refers to the process of achieving fertilization between the sperm and ovum in the laboratory under artificial conditions, and placement of the dividing zygote into the uterus of the mother.

In vitro literally means 'in glass' and with this form of assisted conception, fertilization takes place in a glass (or more commonly, plastic) dish in the laboratory. (At one early stage, scientists used test tubes for fertilization, hence the term "test tube baby".) IVF (Invitro fertilisation) was originally devised to overcome infertility caused by blocked or absent fallopian tubes. Today, IVF(Invitro fertilisation) is used to treat many more reproductive problems, including irregular ovulation, low sperm count or motility, and unexplained infertility.

"We are so blessed, after 25 years of marriage, my wife and i have a baby girl. We had given up all hope when we came to know about egg donation IVF 
(test tube baby). After initial hesitation, we decided to go ahead and my wife became pregnant at the first try. It was too good to be true and now, after 9 months, we have a bouncing baby. God bless you Dr. Richa."

Who should be treated with IVF (in vitro fertilization)?

IVF(Invitro fertilisation) can be used as an effective treatment for infertility of all causes except for women with infertility caused by an anatomic problem with the uterus, such as severe intrauterine adhesions. It is generally used in couples who have failed to conceive after at least one year of trying who also have one or more of the following:
  • Blocked fallopian tubes or pelvic adhesions with distorted pelvic anatomy. Women who have had tubal ligation and are considering tubal reversal surgery as well as men that are considering vasectomy reversal surgery might also consider IVF(invitro fertilisation).
  • Male factor infertility (low sperm count or low motility). ICSI is an IVF(Invitro fertilisation) procedure that can fertilize eggs even with poor sperm quality.
  • Failed 2-4 cycles of ovarian stimulation with intrauterine insemination.
  • Advanced female age - over about 38 years of age. Reduced ovarian reserve, which means lower quantity (and sometimes quality) of eggs. A day 3 FSH and estradiol test, antral follicle counts and AMH hormone levels are often done as screening tests for egg quantity. Reduced egg quantity and quality is usually treated with either IVF(invitro fertilisation), or with IVF(invitro fertilisation) with egg donation.
  • Severe endometriosis.
  • Unexplained infertility when inseminations have failed. Unexplained infertility means standard fertility tests have not found the cause of the infertility issue.
How does IVF(in vitro fertilization) treatment work?

In a normal menstrual cycle, depending on a woman's age, anywhere between 1 and 30 follicles, known as 'recruits', will begin to develop in each menstrual cycle. Whatever her age though, only one of these developing follicles will dominate and ovulate at the level of the hormone FSH that a woman produces naturally.

With IVF (in vitro fertilization), the goal is to keep the level of FSH constant, and thus to encourage more of the recruits to develop into mature eggs which are collected surgically under vaginal ultrasound guidance.

The eggs are then fertilised in the laboratory, cultured for several days, and then one, two or more embryos are transferred back into the woman's uterus. If there are additional embryos, they may be frozen and stored for later use. (See Cropreservation)

How is IVF (in vitro fertilization) done?

IVF(Invitro fertilisation) procedure step by step involves : -
  • Stimulating the ovaries with injections of FSH
  • Preventing premature ovulation (the LH surge) by shutting down communication between the brain and the ovaries by giving another set of injections (GnRH agonists or antagonists) so that the eggs are not lost before they can be collected
  • 'Triggering' ovulation by replacing the LH surge at mid cycle with an injection of hCG
  • Collecting the eggs under general anaesthesia transvaginally using ultrasound guidance.
  • Fertilising the eggs with the sperm in the laboratory.
  • Culturing the embryos in the laboratory
  • Transferring the embryo into the womens uterus (normally not done under anaesthesia )
  • Supporting the endometrium after IVF(in vitro fertilization) with hCG injections or progesterone
  • Checking for a pregnancy on Day 10 after embryo transfer.

What are risk or concerns involved in IVF (in vitro fertilization)?

  • Risk of Ovarian Hyperstimulation Syndrome (OHSS)
  • Failure to recover eggs
  • Eggs recovered may not be normal
  • Sometimes male partners may not be able to produce semen specimen but this problem is treated by semen freezing as "back up"
  • Fertilization failure in spite of normal eggs
  • Abnormal development of embryos which are then not transferred.
  • Embryos transfer may be difficult or there may be implantation failure
  • Congenital malformation, genetic abnormalities, mental and other birth defects occur in 3% of spontaneously conceived children, may also occur IVF babies(Invitro fertilisation)

What to expect in an IVF (in vitro fertilization) pregnancy?

An IVF (in vitro fertilization) pregnancy is a very precious pregnancy so a lot of precautions are taken to ensure that the pregnancy does well. These involve oral medicines/ injections to relax the uterus. Also since many IVF (Invitro fertilisation) pregnancies may be twins or even triplets, early onset of labor can be anticipated. Many patients prefer to have an elective Caesarian section for the birth of their IVF children but normal delivery can also be done for IVF (Invitro fertilisation) pregnancies.

How many attempts of IVF (in vitro fertilization) can be undertaken?

Minimum three attempts would be a reasonable number for a couple to undertake. However, more attempts can be undertaken if the couple wants or if the IVF centre(in vitro fertilization) has something positive to add in the subsequent cycle.

What is the success rate of IVF (in vitro fertilization)?

See IVF Success Rates

Why Delhi?

Delhi is the capital of India and one of the most modern cities. Delhi boasts world class medical schools and hospitals. The medical facilities in Delhi are the best in Asia. Here you can take advantage of the cheaper services cost and superior doctors.

I want to understand in detail what the procedure for IVF involves.

IVF (invitro fertilisation) procedure step by step involves : -

The body neeeds to be prepared by a series of subcutaneous injections (this is a type of injection which are quite painless). This preperation can be done in two ways, the long/ agonist protocol (which begins on day 21 of the previous month) or the antagonist protocol which begins on the day the periods start. Both the protocols have their individual advantages and it for the Infertiltiy and IVF (invitro fertilisation) specialist to decide which is the best treatment for you.

Once the periods have arrived, you will need to take a series of injections (gonadotropins) which will help the ovaries to produce multiple eggs. (normally each ovary producwes one egg a month only, here under the influence of the injections you can produce as many as 10 to 20 eggs.

The progress of these eggs (follicles) is monitored by a series of ultrasoounds (folliculometry) and the measurement of hormones (S. Estradiol)levels in the body.

Once the eggs are ready, you will receive an injection for ovulation trigger.

34 hours after the trigger, your eggs are ready for collection (Ovum Pickup)

For Ovum pickup, you need a short admission to the IVF (invitro fertilisation) Hospital. You need to be 6 hours fasting. You will be given a very short general anaesthesia (which basically means that you will get an injection in your hand after which you will become totally unconscious and you will not feel any pain). The eggs are collected by passing a needle through your vagina, under ultrasound guidance.

The same day, your husband will deposit his sperm in the hospital.

The eggs are fertilised by either IVF (Invitro fertilisation) or by ICSI(intracytoplasmic sperm injection). Both these techniques have their inherent advantages and here again, it is for your IVF (Invitro fertilisation) Specialist to decide which method is to be used.

After Ovum Pickup, you are discharged from the IVF (Invitro fertilisation) Hospital in about 2 to 3 hours time.

You will be readmitted after 2 days for Embryo Transfer. The embryos which have been formed using your eggs and your husbands sperms are now 48 hour old and are ready to be transferred into your uterus. Embryo Transfer is a painless procedure and you are totally awake during the procedure. This means that you do not receive any anaesthesia for this procedure. You can go home after 1-2 hours of Embryo Transfer.

After IVF (Invitro fertilisation),the endometrium is supported with hCG injections or progesterone.

Beta HCG (the pregnancy hormone in your blood) is checked after 17 days to determine your pregnancy.

Questions to Dr. Richa Katiyar about IVF:

Dear Dr Richa,

Thank you so much for your concern and personalized assistance.
On related issues, I would like to extend few more questions regarding the ivf 
(test tube baby) procedures.
1- on the ovarian stimulating process, which protocol do you use? Long or short protocol?
2- do you provide assisted hatching and frozen Embryo transfer services?
3- DO you have PDG-fish (gender selection) Pdg 5 probes (chromosome x,y, 13, 18, 21 & ACGH 24 chromosomes tests?
4- on collecting the mature eggs, the only available option is to take a general anesthesia? or local anesthesia like pethedin is also available?
5- is it possible to get assistance from your stuff , about finding information for accommodation around your clinic area and visa processing letter from your clinic ?

Will be waiting to hear from you.
Regards

Dear Guest,

To reply to your queries,
1. I prefer to do long protocol if your schedule permits, else short protocol.
2. We do provide assisted hatching (at no extra cost) and frozen embryo transfer.
3. Gender selection of any type is illegal in India.
4. Prefer to use general anaesthesia but local can be given for egg collectio
5. Can help with processing of visa by sending across necessary documents and arranging accomodation.

Regards,

Dr. Richa


Dear Dr.Richa

As per below mail said my hysteroscopy has been done on 1st of Jan'2014. Report was ok . And my Doctor suggested me to take progayonova 2mg for 10days with meprate also and R-Cinix to be continue for at least 6months today I got my periods I will to clinic on 23rd and my LIT Therapy is continue till IVF. This time my doctor planned for short protocall IVF. Last time she did Long Protocall IVF But is was failed. I Don't know when my tubes are ok utres is ok and with the help of injection eggs also ok then what is wrong in my body why I am not getting concive.
pls advice me that I will go for short protocall ivf and it will be definitely success.

rgds,

Devika