In vitro fertilization (IVF)
is a process of fertilization where an egg is combined with sperm outside the body, in vitro (“in glass”). The process involves monitoring and stimulating a woman’s ovulatory process, extracting ova, retrieving a sperm sample and then manually combining an egg and sperm in a laboratory dish. After the fertilized egg (zygote) undergoes embryo culture for 2–6 days, it is implanted in the same or another woman’s uterus, with the intention of establishing a successful pregnancy.
Why IVF is Used?
- Blocked or damaged fallopian tubes
- Male factor infertility including low sperm count or poor sperm motility
- Women with ovulation disorders, premature ovarian failure, uterine fibroids, endometriosis.
- Women who have had their fallopian tubes removed.
- Individuals with a genetic disorder
- Unexplained infertility
- IUI failures
- Immunological problems
Steps involved with in-vitro Fertilization
There are 6 basic steps involved in the IVF and embryo transfer process:
- Step 1 – Preparatory tests: these depend on both male and female partner’s age and history. These include: basic evaluation mentioned above. In addition to these, routine blood reports to check the physical fitness and extra test to check the hormone levels may be advised.
- Step 2 – Ovarian hyper-stimulation: It is the stimulation to induce development of multiple follicles of the ovaries. It should start with response prediction by e.g. age, antral follicle count and level of anti-Müllerian hormone. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. A transvaginal ultrasound is used to examine the ovaries, and blood test samples are taken to check hormone levels.
- Step 3 – Ovum Pick up: Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity to remove the eggs from the ovarian follicles under mild anaesthesia or intravenous sedation. Medication is provided to reduce and remove potential discomfort.
- Step 4 – Semen preparation: The male is asked to produce the semen sample, which is prepared through any of the sperm preparation techniques (swim up, swim and wash, or density gradient) for combining with the eggs.
- Step 5 – Insemination: In this step, the sperm and eggs are left together in a laboratory dish to encourage fertilization. In some cases where there is a lower probability of fertilization, intra-cytoplasmic sperm injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.
- Step 6 – Embryo transfer: The eggs fertilized in the laboratory are implanted into a woman’s uterus three to five days following egg retrieval and fertilization with the help of an ET catheter. This procedure is painless for most women, although some may experience mild cramping. If the procedure is successful, implantation typically occurs around six to ten days following egg retrieval.
Advantages of IVF
IVF helps many patients who would be otherwise unable to conceive. The ultimate advantage of IVF is achieving a successful pregnancy and a healthy baby. IVF can make this a reality for people who would be unable to have a baby otherwise:
Blocked Tubes: For women with blocked or damaged fallopian tubes, IVF provides the best opportunity of having a child using their own eggs.
Older Patients/ Patients with a Low Ovarian Reserve: IVF can be used to maximise the chance of older patients conceiving. We have great experience with older women and those with low ovarian reserve. We use Natural IVF to focus on quality of eggs, rather than quantity.
Male Infertility: Couples with a male infertility problem will have a much higher chance of conceiving with IVF than conceiving naturally. We have a number of laboratory techniques to facilitate this including intra-cytoplasmic sperm injection (ICSI). We also have an experienced consultant urologist to advise men with fertility problems.
Unexplained Infertility: 1 in 6 couples will suffer fertility problems and sometimes these remain undiagnosed after investigation. These patients may benefit from intervention.
PCOS: Polycystic ovary syndrome is common condition in which there is a hormone imbalance leading to irregular menstrual cycles. IVF has proved very successful in patients with PCOS, who will not conceive with ovulation induction.
Endometriosis: Patients with endometriosis, where parts of the womb lining grow outside the womb, may like to try IVF, as it has proved successful in this group.
Premature Ovarian Failure: Women with premature ovarian failure or menopause can have IVF treatment using donor eggs, which typically has high success rates.