Challenges of Fertility and how to overcome to achieve parenthood-Part 7

In Vitro Fertilization (IVF) treatment is a multi-stage fertility treatment which may take around two months to complete. Although it is one of the best fertility treatments available, many couples find that it is also the most stressful. As women, we have to be prepared to get a number of tests, for example, ultrasound exams, so that the doctors can monitor the progress and implement each stage of the process at the optimal time.

There are 5 important stages for IVF:

1. (Ovulation Induction) – Stimulate and monitor the development of egg(s) in the ovaries.
2. (Egg Retrieval) - Collect the eggs.
3. Collecting and preparing the sperm.
4. (Insemination, Fertilization and Embryo Culture) - Combine the eggs and sperm together in the laboratory and
provide the appropriate environment for fertilization and early embryo growth.
5. Embryo Transfer – Transfer the embryos into the uterus.

We have already seen in length about Ovulation induction using Clomid and Injectables in the previous write-ups.

For IVF, doctors usually prescribe Injectables, mostly using the Lupron protocol(which might take upto a month). Once your period starts on Lupron, you will be asked to take the Injectable gonadotropins. You will be constantly monitored using blood tests and Ultrasound for the developments of the eggs in the ovaries. Once your doctor determines that the follicles are mature and ready (usually around 16-19mm), you will be asked to come for egg retrieval. Egg Retrievals are usually performed in your fertility clinic or in a hospital that your clinic is affliated to. You will be given general anesthesia, and given an IV, and the eggs will be removed from your ovaries using a procedure called follicular aspiration. Since you will be under the effect of anesthetic, you will not feel any pain.

Once the follicles are aspired, they are observed under a microscope to see if they have a viable egg, and then place in an incubator. The entire process takes about 20 minutes to an hour.

Depending on your age and the dosage of fertility medications, you might have around 5-20 eggs removed. You might feel tired because of the anasthetic and tender in your abdomen. Don’t eat anything spicy for the next 2-3 hours. Have very light foods like idlis, toast and yoghurt. Drink fluids if possible and take rest. If you work, take off the entire week
and be on bed rest starting from the day of retrieval to three days after embryo transfer. You might have spotting, but there is nothing to worry about. You might be prescribed some antibiotics to prevent infection.

After the egg retrieval, all viable eggs will be mixed with a sperm sample provided by your partner. In a process called insemination, the sperm and eggs are placed in incubators located in the laboratory which enables fertilization to occur. In some cases where fertilization is suspected to be low, intracytoplasmic 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.

The next stage of IVF treatment can begin: Embryo Transfer.

Embryo transfer is one of the most important parts of the IVF process. It is during this final stage of the IVF procedure that your embryos will be transferred into your uterus, in the hopes that you will become pregnant. Embryo transfer is completed after your eggs have been fertilized by your husband's sperm and they have been through the embryo culture
process.

It is vital that the embryo transfer procedure be performed by a skilled doc. If mistakes are made during the embryo transfer process, it can affect your chances of pregnancy.

Timing of Embryo Transfer:

Embryo transfer is usually performed once your embryos have been cultured to the right stage. Typically, there are two
types of embryo transfers:

Day 3 Embryo Transfer: The Day 3 embryo transfer is performed 72 hours after egg retrieval. Your eggs will be mixed with your partner's sperm and then allowed to develop for three days. At this point in time, your embryos will be transferred into your uterus where, hopefully, they will implant.

Blastocyst Transfer: Blastocyst transfer occurs when your embryos have reached the blastocyst stage. This occurs after five days of culturing. Some fertility specialists prefer doing blastocyst transfers because it is easier to choose a healthy embryo for transfer at this stage.

Number of Embryos transferred:

Generally, between two and four embryos are transferred during each IVF cycle. The exact number of embryos that you have transferred will depend upon a number of factors, including:

-the number of embryos that were formed after egg retrieval
-the health of your embryos
-your age
-your risk level for multiple pregnancy

The greater the number of embryos that are transferred into your uterus, the higher your risk of having a multiple pregnancy. When multiple pregnancies form, this can seriously affect the health of both you and your baby, so every effort to minimize multiple pregnancies must be taken by fertility clinics. In some countries, such as the UK, there is a limit of
two embryos that can be transferred per IVF cycle.

How Is Embryo Transfer Performed?

Your embryo transfer will likely be performed at your local fertility clinic or the hospital your clinic is affliated to. It is a completely painless procedure, so you will not have to receive any type of anesthesia during the transfer.You and your husband will be asked to come in a few hours prior to the transfer procedure. At this time you will be asked to drink a lot of fluids in order to increase the size of your bladder. This is needed in order to help your doctor see your uterus more clearly during the ultrasound portion of the embryo transfer. Your embryologist will
also discuss with you which embryos are the healthiest to have transferred into your uterus and how many embryos should be
transferred. You and your husband will be able to see pictures of your embryos or view them under the microscope before the
procedure begins.

Your physician will perform an abdominal ultrasound in order to determine the best place inside of your uterus to deposit your embryos. This is usually in the space at the very top of your uterus. Once this location has been found, the embryos will be pushed out of the catheter and into your uterine lining.

After the Embryo Transfer:

After the transfer procedure has taken place, you will be asked to lie down for two hours. You may experience some cramping, however you shouldn't experience any other side effects. After two hours, you and your husband can go home. It is usually recommended that you take it easy for a couple of days after the transfer. After 48 hours though, you can resume your normal activities these will not affect implantation in anyway. You may have to give yourself shots of hCG or progesterone, however, this will be determined by your physician. In 12 days, you and your husband will return for a blood test to find out if your are pregnant.

Remaining Embryos

Typically, most couples have leftover embryos remaining from the IVF process. You and your husband will need to decide what you would like to do with your embryos. There are a number of available options, including embryo cryopreservation and embryo donation. These options allow you to store your embryos for your own future use or to help other couples who are suffering from infertility to conceive.

All the above is fairly common knowledge, one can find it on the Internet. What makes the difference between a successful IVF and an unsuccessful waste of time and money ? In my opinion it comes to these factors:

• Age of the woman – best chances are for women under 35, exceptions exist.
• Ovarian reserve – measured by FSH levels, lower the better.
• Skill of the doctor - though IVF clinics have mushroomed like a cottage industry, doctor skill counts for a lot.
From deciding injectible dosage to determining when the eggs are "ripe" to be aspirated, a seasoned doc makes all the
difference.
• Facilities for IVF - IVF needs expensive lab equipment and a fair degree of trained technicians.

Very important: Make sure you have had a laparoscopy performed by an expert surgeon before you go for IVF. Without a laparoscopy and treatment to correct whatever the laparoscopy finds, IVF is a shot in the dark. An expert in laparoscopy is someone who has performed this procedure atleast a few thousand times.

Furthermore, if you are getting IVF done in the US, check out the clinic's success rates using the CDC website ( by law every IVF clinic has to report their success rates).

If you are getting it done in India, do ask around ( perhaps right here on IL ) about others' experience with that doctor.

 

Hi Malar,

Yes, the General anesthesia is similar to the one that is given during Laparoscopy. During the egg retrieval, they usually do a routine blood test (measure HCG/LH etc). You are asked to change into a hospital gown, and then you are started on IV. You will be wheeled into the Procedure room and asked to lie down on the operating table. You will be started on the anesthetic and asked to count till 10. I don't remember counting till 4.

You will not be aware of anything happening. Once you regain consciousness, the doctors will let you know how many viable eggs have been retrieved. You might feel groggy because of the anesthetic. Your husband will be let in and you will be asked to change into your normal clothes after 15-20 minutes.

Your stomach will feel soft and sensitive. Like I mentioned, have very light food after an hour or so and be on bed rest as much as possible.

Let me know if you have more questions.

Regards
Vidya

 

Hi Malar,

Yes, some IUI cycles are cancelled because of the risk of higher order multiples. I think your doctor did the right thing by cancelling it. I know it is very disappointing and heartbreaking, but it is better to cancel the cycle rather than go for a selective reduction after conceiving or be in a high risk pregnancy involoving significant mental and physical stress.

-Vidya