IVF – the term has become familiar to almost all of us over the last few years. With more and more women facing fertility issues, IVF or In Vitro Fertilization is that ray of hope that makes dreams come true for millions of women worldwide.

Although we have heard about it, many of us are not familiar with exactly what it is. Today, in this article, we will explore different aspects of IVF so that you can get a clear idea about the entire process.

Why is IVF Done?

IVF is done for many reasons, the foremost among which is infertility issues or one partner having some health condition. Many people try IVF after other fertility methods have failed or if they are in older than 35.

Your doctor may suggest IVF if you or your partner has:

• Endometriosis, where a tissue like the uterus lining grows outside the uterus. You can read our article about endometriosis to learn more about this issue.
• Issues with ovulation – In many cases, ovulation does not happen normally or does not occur as often as it should. Or sometimes fewer eggs are available for fertilization by sperm.
• Damaged or blocked fallopian tubes – The fallopian tubes are the organs through which eggs move from the ovaries to the uterus. Damage or blockage of both the fallopian tubes can make it hard for an egg to be fertilised or for an embryo to travel to the uterus.
• Uterine fibroids – Tumours that grow inside or outside the uterus which may or may not be cancerous. They are common in people in their 30s and 40s. Due to fibroids, there can be trouble with fertilised eggs getting attached to the lining of the uterus.
• Low sperm count or other sperm impairments – Low sperm count or unusual changes in their size, shape or movement can make it hard for sperm to fertilize eggs. In case medical tests reveal that there are issues with the sperm, a visit to an infertility specialist may be useful.
• Preserving fertility due to cancer or other health conditions – Some treatments for cancer such as chemotherapy or radiation can harm fertility. For women going through cancer treatment, IVF can be a way to have a baby in the future. Eggs harvested from the ovaries can be frozen for later use. Sometimes the eggs can be fertilized and the embryos are frozen for future use.
• An earlier surgery preventing pregnancy – A surgery called tubal ligation involves the cutting of the fallopian tubes and blocking them. This can prevent a woman from getting pregnant. Women wishing to conceive after tubal ligation have the option of going for IVF. IVF is preferred by women who do not want to go through another surgery to reverse tubal ligation.
• A genetic disorder – When there’s a risk of passing a genetic disorder to your child from you or your partner, the health team might recommend a procedure that involves IVF. This is called preimplantation genetic testing. Post-harvesting and fertilizing the eggs, they are checked for some genetic problems. Embryos without genetic problems can be placed in the uterus through IVF.
• Polycystic ovarian syndrome or PCOS
• Opting for an egg from a donor or a gestational surrogate
• Issues with the uterus
• Unexplained infertility – When no reason for someone’s infertility is found through tests.

IVF – The Entire Process

Let’s under the step-by-step process involved in IVF. But first, let’s talk about the normal process of conception and the birth of the babies. Once an egg is fertilised, it attaches to the lining of the womb. The embryo continues to grow for the next nine months and a baby is born. This is a natural or unassisted conception.

IVF is a kind of assisted reproductive technology which means that a woman gets pregnant with the help of special medical techniques. It is usually tried when less expensive fertility techniques have failed. Normally, an in-vitro fertilization involves five steps:

Step 1: Super Ovulation or Stimulation

Medicines, known as fertility drugs, are given to a woman to improve egg production. Usually, a woman produces one egg every month. Fertility drugs are used to send signal to the ovaries to produce more than one egg. During this step, regular transvaginal ultrasounds are conducted on the woman to examine the ovaries and blood tests are done to check hormone levels.

Step 2: Retrieval of the Egg

During this step, a minor surgery, known as follicular aspiration, is done to remove eggs from the woman’s body. During the surgery, the woman is given medicines so that she does not feel pain during the procedure.

Step 3: Insemination and Fertilization

During this step, the man’s sperm is placed with the best quality eggs and stored in an environmentally controlled chamber. This process is known as insemination. In most cases, the sperm fertilizes an egg a few hours after insemination.

If the doctor feels there’s less chance of fertilization, the sperm may be injected directly into the egg. This is known as intracytoplasmic sperm injection (ICSI). In many fertility programs, ICSI is done regularly on some eggs, even if things appear normal.

Step 4: Embryo Culture

Once an egg is fertilized, it divides and becomes an embryo. The embryo is checked regularly by the laboratory staff to see if it is growing properly. In about 5 days, a normal embryo has several actively dividing cells.

When there’s a higher risk of passing on some genetic (hereditary) disorder, then the doctor may suggest a pre-implantation genetic diagnosis. This procedure is usually done within 3 to 5 days of fertilization. During this procedure, cells are removed from each embryo by a laboratory scientist and screened for specific genetic disorders.

Step 5: Embryo Transfer

In the final step, embryos are placed in the woman’s womb 3 to 5 days after egg retrieval and fertilization. This procedure is done in the doctor’s office while the woman is awake. A thin tube called a catheter with the embryos into the woman’s vagina up into the womb. If the embryo gets implanted in the lining of the woman and grows, the woman gets pregnant.

Usually, more than one embryo is placed into the womb at the same time and that’s why often IVF leads to conceiving twins, triplets or more. The exact number of embryos transferred depends on many factors including a woman’s age. Unused embryos are frozen for implantation at a later date or are donated to other couples.

Risks of In Vitro Fertilization

IVF is not without risk. Some of the short and long-term risks of IVF include:

• Stress: IVF can be a stressful experience not only for the body but for the mind too. And finances too! Seek support from family, friends and professional counsellors. Both partners have to work together to have a smoother experience during this journey.
• Complications related to the procedure to retrieve eggs: After medicines are given to spur the growth of sacs that contain eggs in the ovaries, a procedure is done to collect the eggs. This is known as egg retrieval. A thin, long needle is inserted through the vagina and into the sacs, being guided by ultrasound images, to harvest the eggs. The needle can lead to bleeding, infection or damage to a blood vessel, bowel or bladder. There are also risks associated with the medications given to help the woman sleep and prevent pain during the procedure.
• Ovarian hyperstimulation syndrome: This condition can be very painful and the ovaries can get swollen. This can be due to shots of fertility medicines such as human chorionic gonadotropin (HCG) which trigger ovulation. Symptoms from this procedure can last up to a week. These symptoms include mild belly pain, upset stomach, vomiting, diarrhoea and bloating. Some women may get a form of ovarian hyperstimulation syndrome, but it is quite rare. This can cause shortness of breath and rapid weight gain.
• Ectopic Pregnancy: A fertilised egg attaches to tissue outside the uterus, often in a fallopian tube, during this kind of pregnancy. As the embryo cannot survive outside the uterus, the pregnancy doesn’t go forward. The percentage of women who experience ectopic pregnancy after surgery is quite small.
• Miscarriage: Some women have miscarriages after conceiving through IVF. However, the percentage of women who experience this is similar to those who conceive naturally.
• Multiple Pregnancy: IVF raises the chances of multiple pregnancies as multiple embryos are implanted in a woman. Getting pregnant with multiple babies contains a higher risk of pregnancy-related diabetes and hypertension, early labour and delivery, low birth weight and birth defects compared to being pregnant with a single baby.
• Birth Defects: A major risk factor for birth defects is the age of the mother, irrespective of how the child is conceived. However, assisted reproductive technologies, such as IVF, increase the risk slightly.
• Cancer: Certain medications used to stimulate egg growth are believed to increase the risk of getting a specific type of ovarian tumour.
• Premature Birth and Low Birth Weight: IVF raises the risk of the baby being born early or with low birth weight slightly.

How to Prepare for an IVF Treatment?

Thinking of getting an IVF treatment? Here’s how you can prepare for it. To begin with, you will need thorough fertility tests and medical exams. Your partner will be tested too. Some of the preparations include:

What to Expect from an IVF Treatment?

You might experience a few mild symptoms after the embryo transfer such as:

• Tenderness in the breast from high oestrogen levels.
• Mild cramping and bloating
• Constipation
• Spotting

Most women return to normal activities after the egg retrieval procedure. However, if there’s a procedure involving anaesthesia, then you should not drive within 24 hours of going through that. You will be asked to return to the clinic for a pregnancy test, 9 to 14 days after the embryos are transferred.

Sources:

• https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about
• https://medlineplus.gov/ency/article
• https://my.clevelandclinic.org/health/treatments/ivf
• https://www.plannedparenthood.org/learn/pregnancy/fertility-treatments/what-ivf
• https://www.healthline.com/health/in-vitro-fertilization-ivf