IVF
INTRODUCTION
WHAT IS IVF ?
In vitro fertilization is a process by which an egg is fertilized by sperm outside the body : IN VITRO
Baby concieve as the result of IVF are termed as TEST TUBE BABIES.
WHO need IVF…?
IVF is recommended to those infertile patients who fail to conceive despite all treatment options that is available for infertility management i.e. either by normal conception | ovulation indution | IUI | failure. However there are several indications for IVF.
1) OVULATORY DISORDERS
Such females either do not ovulate or the quality of egg that forms is of poor quality , such conditions are mainly seen in
1) Female with advance age > 35 years
2) With very low AMH count <0.5
3) PCOS (poly cystic ovarian syndrome) with failed OI+IUI ( ovulation induction & intrauterine insemination)
2) Blocked fallopion tube or hydrosalpinx with history of genital TB or pelvic inflammatory disease.
3) ENDOMETRIOSIS
Abnormal ectopic growth of endometrial tissues & glands other than utero i.e. ovary, fallopion tube bowel, bladder, leading to menstural irregularity & severe dysmenorrhea, this hormonal imbalance leads to infertility.
4)UTERINE FIBROID / ADENOMYOSIS
Fibroid is a benign tumor of the uteruo which can distort the shape of endometrial cavily – this leads to infertility & abortion & pretern labour.
5)UNEXPLAINED INFERTILITY
when the reason for infertility can not be explained i.e. all fertility test & parameters are normal still patient is unable to concieve.
6) MALE INFERTILITY/ Poor quality and quantity of sperm in semen analysis report
In such PATIENTS, IVF – ICSI is done.
7) Some known genetic/ Congenital disorder
If there is history of some congenital anamoly or genetic disorder then IVF is a good solution for such couple as we can detect such things by pregestational genetic testing of embryos.
It depends on the age of female
AGE SUCCESS RATE
< 35 years 30-35%
35- 37 years 25%
38-39 years 19%
40-42 years 11%
43 -44 years 5%
>44 years 4%
Process Success Rate
1st cycle of IVF 35 %
2nd cycle of IVF 40-45 %
3rd cycle of IVF 45- 50 %
In IVF, eggs are retrieved by a process known as ovum pickup. Embryos are prepared in vitro & frozen (preseved) depending on how much eggs are prepared.
1st cycle in transfer of this embryo for thr first time.
2nd cycle is embryo for 2nd time.
3rd cycle is embryo transfer for 3rd time.
Atleast 4 to 6 week interval is recommended.
It depends on age of the patient & stimulation protocol which has been used & AMH value.
Almost all eggs that develop after stimulation are retrived during pickup.
1) If risk of OHSS is there ovarian hyperstimulation syndrome
2) Endometriosis/ adenomyosis.
3) If there is need of pregestational diagnosis test.
1st cycle :- 1 to 1.5 lakh
2nd cycle :- 1.5 to 2 lakh
3rd cycle :- 2 to 2.5 lakh
1) Change your life style first.
2) Balance diet
3) drink plenty of water & include plenty of green leafy vegetables & seasonal fruits in your diet
4) Take adequate sleep
5) Do not do heavy exercise, but go for half and hour yoga /meditation/ walk.
6) Avoid cigarette, alcohol, any drug condition
7) Stay away from junk food, artificial beverage, colouring agent packed food.
8) Avoid stress & take help from your doctor/friend or relative.
For Male — Husband semen analysis–If abnormal
Hormonal testing eg :- testesterone, semen, LH, FSH, TSH, Blood suger
Trans rectual ultrasound
Testiculaer biopsy
Genetic test
DF – DNA Fragmentation index.
For Females :- Ovulation test
Pelvic ultrasound
Hormones Assay :- Day 2 LH, FSH, AMH, Estrodial, prolactin test, S, TSH, RBS
Hysteroscopy & laparosocopy
1) It is just like boon for the infertile couple.
2) It gives you an option to become parents even in advance age.
3) There is possibility to become patient via donor sperm/ovum if there is an abnormality of ovary/sperm of your own.
4) IVF is a better option surrogacy.
5) Good quality of egg & sperm are selected for IVF, so there is high probability of conception & danger of abortion. There is increase chance of giving birth to a healthy baby.
6) There is a freedom to cruicle time when to get pregnant in IVF treatment
1) Risk of multiple pragnancy
2) OHSS, ovarian torsion risk increase
3) Psychological & emotional inbalance
4) Stress, constipation & cramps
5) Increase risk of premature birth
6) Increase risk of ectopic pregnancy & heavy bleeding
7) Costly treatment
1) Ovuarian stimulation
we need around 10 to 15 eggs from each ovary during IVF treatment for this, Hormones injuction are given for 10 to 15 days. there injuctions stimulate ovaries & increases multifollicular development of ovum. TVS transvaginal sonography monitoring of egg formation are done till eggs attain size of around 18 to 20 mm.
2) Trigger injuction
Trigger of hormone injuction is given which help eggs to mature.
3) Ovum pickup
A 33 to 36 hours of trigger injuction ovum pickup is done on OT under anesthesia. It takes 20 to 30 minutes.
4) Sperm selection
IVF treatment sperm is collected from husband from same day of ovum pickup for which a dedicated room in there. Husband collects his semen in a semen collection jar via masturbation.
Semen wash is done to increase the quality of sperm.
In case of doner sperm / frozen sperm. semen is already washed & prepared in IVF lab.
5)In vitro fertilization
Eggs & sperm are kept in an incubators for fertilization.
6) Embryo development for IVF
Eggs develop into an embryo after fertilization which is kept in a separate incubators for development for 3 to 5 days
7) Eembryo transfer
Embryo is transfered for implantation in endrometrium through ET catheter under USH guidance. It takes 10 to 15 minutes for ET. patients can go to home after few hours of embryo transfer.
8) Pregnancy test
Blood/semen HCG test is advised after 2 weeks of IVF treatment to detect pragnancy. if it comes positive, pragnancy support & regular ANC checkup is advised.
1) AVOID SEX
2) AVOID HEAVY WEIGHT LIFTING
3) STAY AWAY FROM DRUG/ALCOHOL/CIGRATTE
4) TAKE YOUR MEDICATION REGULARLY & TIMELY.
5) TAKE BALANCE DIET.
6) AVOID STRESS
7) HEALTHY DIET
8) STAY HAPPY & FRESH
In case of any doubt or broblem consult freely with your treating doctor.