IVF stands for In Vitro Fertilization. Its the most accepted form of artificial reproductive technique for treating sub-fertile couples with a wide range of indications. According to a survey of American Society of Reproductive Medicine more than 5,50,000 IVF babies have been born to date.
Commonly known as “test tube baby” procedure, the patient is given injections for the growth of multiple follicles & eggs which are retrieved from the female’s ovaries & are inseminated with the semen (from husband or donor) in our incubators for 2-3 days. Once the fertilization has taken place, they are transferred back into the female’s uterus. This procedure is generally called Embryo Transfer or ET. For the pregnancy to occur, an egg must be released from the ovary & unite with the sperm. This union or fertilization normally occurs within the fallopian tube.
However, in IVF this union takes place in a laboratory after both eggs & sperm have been collected. The fertilized eggs are then transferred to the uterus for natural growth. There are several steps to the in-vitro fertilization process.
After a baseline screening for the hormonal status of the patient on the second day of the cycle, a complete semen analysis and a transvaginal ultrasound to rule out any ovarian cyst or any uterine pathology the patient is briefed about the procedure of IVF.
Medicines are given to temporarily switch off the messages from the brain forcing the ovaries to produce an egg on a monthly basis. This Down regulation ensures correct timing of ovulation prior to egg collection.
This is generally done with the help of Intranasal Sprays (Naseral) given thrice a day from the 21st day of the period till the day of the periods after which the dose is reduced to twice a day till one day before the pickup. (Alternatively Inj Lupride or Inj suprefact can be given daily ).
To assess the down regulation Serum E2 levels can be done.
Other Protocols for IVF/ICSI
-Short protocol / Ultrashort protocol / With GnRH antagonist.
Stimulation & Follicle Monitoring
On the first day of the periods after down regulation Gonadotrophins are started at a dose of minimum 225iu daily for a period of 5 days and the dose is adjusted thereafter according to the individuals response till the day before the pick-up.. Serial ultrasounds and rising E2 levels decide the day for the Inj HCG which is given 34-36 hours before the pick up.
The Pick-up is done under a short General Anaesthesia and the patient can go home after 3-4 hours.
The oocytes aspirated are washed and inseminated with the semen and incubated in the CO2 incubator. They are viewed after 20 hours to look for fertilization and after changing the media they are further incubated.
Embryos are generally transferred after 48 hours. No anesthesia is required. The patient is required to stay in the hospital for 4 hours after transfer.
Luteal Phase Support
Supplemental progesterone is occasionally used to improve the secretion of progesterone & estrogen during the luteal phase generally for a period of 14-15 days. Luteal support is administered to improve chances of implantation.
Ultrasound & Pregnancy Test
A Serum Beta HCG Test done on the 14 day after the ET will confirm pregnancy. If the test is positive, an ultrasound is conducted with the next 2-3 weeks. If the ultrasound reveals healthy pregnancy, the doctor may offer plans for pregnancy care.