1. What do IVF, ET and ovum donation mean?

IVF means In-Vitro Fertilization commonly known as Test Tube Baby. Here the patient is given injections for the growth of multiple follicles and eggs which are retrieved from the patients ovaries and inseminated with the husband’s semen in our incubators for 2-3 days and once the fertilization has taken place, they are transferred back into the patients uterus. This procedure is called ET or Embryo Transfer.

Ovum Donation
When a patient cannot make her own eggs that is after menopause or in some cases even before menopause, we have to go in for ovum donation programs. Here the donor (brought in by the patient or an unknown donor from outside ) is given injections for the stimulation of the ovaries. The eggs are retrieved and incubated with the husband’s semen. The fertilized eggs or embryos are transferred into the patient’s uterus after 2-3 days.

Donors should be young ladies below the age of 32 years with healthy children screened for various illnesses prior to selection. It is advisable to try at least for 3-4 cycles before labelling it as failed IVF.

2. What is the age limit?

Generally ladies below 35 years – 38 years whose ovaries are well functioning can respond to IVF treatment.

If there is no response in the first attempt i.e. no or poor egg formation they are advised to go for a donor program.

3. Which tests are required before undergoing these procedures?

The tests before an IVF program are conducted both on the male and female partner. Some tests usually conducted are provided below.

  • Complete basic Blood Profile.
  • Blood group / VDRL / Hbs Ag / HIV I & II
  • Hormonal Estimation on 2nd or 3rd day of Period
    • Sr. FSH- Follicle Stimulating Hormone
    • Sr. LH- Luterizing Hormone
    • Sr. Prolactin
    • Sr. TSH- Thyroid Stimulating Hormone
    • Sr. Estraduol
    • Sr. Progesteron
  • Complete Semen Analysis in the male along with HIV, Hbs Ag
  • Transvaginal Ultrasound to see the uterus size, shape and the presence of fibroids to visualize the endometrial lining which should be of a particular trilinear pattern in the 1st half of the menstrual cycle with no polyps or deviation of the central echo.

4. How much time the couple has to spend at the clinic?

The couple needs to come for detailing the IVF program 2-3 months prior to IVF if this regime is new to them. Some, if too far away can communicate on the e-mail.

Hospitalization on the day of IVF or ovum picking is for 4-5 hours as the patient requires general Anaesthesed.

The patient does not need Anaesthesia on the day of ET or Embryo Transfer but is required to stay at our center for 2-3 hours.

5. When is semen required? How much abstinence is required?

Semen is generally required ion the day of the ovum pick up. Just prior to or after the pick-up as informed by the doctor. There should be an abstinence of 3-4 days prior to semen collection.

In a few cases if the husband is abroad, the sperms are frozen twice before the IVF cycle.

Semen is always collected at the center after explaining the method of collection. Complete aseptic precautions are required for collection.

6. Whose sperms are taken?

Sperms are generally of the husband but if his count is nil or inadequate as investigated earlier. Consent is taken for Donor sperms.

7. Does the women require extra rest?

Actually no extra rest is required but due to the anxiety on the part of the patients we do advise restriction of heavy work.

8. When does one come to know about pregnancy?

14 days after the embryo transfer, a blood test called Beta HCG is carried out which confirms pregnancy.

Even after that a rising Blood litre is important to see the growth of the embryo. An ultrasound is generally done 3 – 3 1/2 weeks after the ET.

9. What is the success rate?

The success rate is 35-40% with a take home baby rate of 30-35%.

Few cycles can result in abortions as in normal pregnancies.

10. What are the major reasons for failure?

Generally healthy Grade I.II embryos are transferred. Inability of the embryos to pick up growth or implantation failure can result in failure of IVF – ET.

11. What are the major problems?

We do encounter a few patients who are labelled a Poor Responders i.e. they do not have enough follicles even after a good stimulation.

Some patients have a large recruitment of follicles which increases rapidly resulting in OHSS i.e. Ovarian Hyper Stimulation Syndrome. This is one problem which can pose a problem.

Early diagnosis is very important in freezing of excess embryos or ovules.

12. What is the cost of one cycle?

One cycle costs approximately Rs. 30,000/-.

Hormones and injections cost anywhere between 30,000 – 35,000 depends on response of patient to patient.

13. What are PESA, MESA & TESE?

PESA, MESA and TESE are ways of retrieving sperms from the testes which are further used in ICSI.

This is done in cases of very low sperm counts or nil sperms due to blockage in the transport of sperms to the outside.

14. Who can donate the ova?

Young, married ladies below age of 32 – 35 years can donate their eggs for patients who have failure in egg formation.

15. Is the Ovum Pick Up (OPU) procedure same in ovum donors as that for IVF case?

OPU procedure is same in Ovum Donors.

They are stimulated with hormones and once the follicles are mature the eggs are aspirated.

16. How many times the egg donor has to come to the clinic?

The Ovum Donor has to come to clinic for her injections daily. If she can have other reliable arrangement for giving the injections, she needs to come only 7-8 times to the clinic.

17. What are the risks for ovum donor?

The Ovum Donor has to come to clinic for her injections daily. If she can have other reliable arrangement for giving the injections, she needs to come only 7-8 times to the clinic.

18. Will the IVF technique damage my ovaries?

There is no evidence to suggest that either normal laparoscopy or ultrasound egg retrieval damages the ovaries. In fact, some reports in the medical literature suggest that following ovarian biopsy, pregnancies occur in couples with a long-term history of infertility.

19. Will scar tissue around my ovaries make it impossible to retrieve the eggs?

Not ordinarily. The surgeon must be able to see the follicles in order to guide the needle to the proper spot for retrieval of the eggs whether by sonographic (ultrasound) or surgical methods.

20. What if I ovulate before oocyte (also called egg or ovum) retrieval?

Once ovulation has occurred it is impossible to retrieve the eggs. The entire team of physician, nurses and embryologist will monitor your cycle very carefully to avoid premature ovulation.

21. If the technique does not produce a pregnancy on the first attempt, how soon can the procedure be repeated?

This depends on the individual. The primary reason for delay is to allow the patient’s normal menstrual cycle to resume, which may take 2-3 cycles.

22. How many times will IVF be repeated per couple?

There is no specific number. This is determined by the couple together with the physician.

23. Can we have intercourse during a two-week period before a IVF procedure is performed?

Most definitely. We recommend that the husband refrain from ejaculation for at least 48 hours, but for no more than 3 to 4 days preceding egg retrieval. This precaution assures that the semen sample obtained for IVF will contain a maximum number of healthy, motile sperm.

24. After the IVF procedure, how long must we wait to have intercourse?

Although a definite time of abstinence to avoid damage to the pre-embryo has not been determined, most experts recommend abstinence for 2 to 3 weeks. Theoretically, the uterine contractions associated with orgasm could interfere with the early stages of implantation. However, intercourse the night before pre-embryo transfer is acceptable.

25. What about other activities? How soon can I resume my normal routine?

The IVF team recommends that the patient be sedentary for a full 24 hours following pre-embryo placement in the uterus. Strenuous exercises such as jogging, horseback riding, swimming, etc. should be avoided until pregnancy is confirmed. Otherwise, the patient is free to return to her regular activities.

26. How soon will I know if I am pregnant?

Pregnancy can be confirmed using blood tests about 14 days after egg aspiration. Pregnancy can be confirmed by ultrasound 30 t0 40 days after aspiration.

27. I had my tubes tied (tubal ligation) several years ago. Would I be a candidate for IVF?

Perhaps, in certain situations. IVF may be cheaper and physically less demanding than surgery to repair you fallopian tubes.

28. What drugs are given to stimulate the ovarian follicles and to maintain the lining of the uterus prior to implantation of the pre-embryo?

Four to five medications normally are given:

  • Leuprolide acetate or Brucerelin ( Lupron ), an injectable drug that blocks secretions of the pituitary gland, thereby the number of oocytes retrieved. Given for 15-20 days
  • Human menopausal gonadotropin (HMG) or Follicle Stimulating Hormone (FSH), hormones that stimulates ovarian activity, are injected daily for about 8 to 10 days prior to the procedure.
  • Human chorionic gonadotropin (HCG), a hormone that mimics the action of the hormone which naturally induces ovulation, is injected 34 to 36 hours before retrieval and may be used after retrieval to supplement natural progesterone production.
  • Progesterone, a natural hormone that enables the uterus to support pregnancy, may be used as a daily injection after egg retrieval
  • Other drugs are added according to the patients requirements.

29. What side effects, if any, can these drugs cause?

No pronounced side effects have been associated with any of these drugs. However, the patient should inform the physician of any allergies she has or of any previous adverse reactions to drugs.

30. Will I have an egg in every follicle?

It varies from patient to patient. As many as half of the follicles may not contain an egg in some patients.

31. Is there a possibility of multiple births with IVF?

Yes, when multiple pre-embryos are transferred. 25% of pregnancies with IVF are twins. (In normal population, the rate is one set of twins per 80 births). Triplets are seen in approximately 2-3% of pregnancies.

32. Is there an increased chance of birth defects if I become pregnant through IVF?

There are no known ill effects. Abnormal pre-embryos, even those produced through normal fertilization, do not seem to mature.

33. How much time does the entire procedure require?

Approximately three weeks ( all as an outpatient ). Fertility drugs are administered to stimulate the ovaries. Then during the four to six days prior to ovulation, the patient is monitored by ultrasound as well as by hormone levels.

34. What happens to any extra pre-embryo?

A maximum of 3 pre-embryos will be transferred to the uterus for possible implantation. Patients will have several other options regarding the disposition of the remaining pre-embryos. One option is to freeze pre-embryos for later use. Other option is to donate

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