Dr. Aruna Ashok MBBS, MS OG, DNB OG
- Clinical Director
Aruna Ashok | 25 Sep 2023
In vitro fertilization (IVF) is one of the artificial reproductive techniques (ARTs) used in fertility treatment. The techniques used in the process of IVF (test tube baby) have been developed dramatically since the 19th century. So, what is IVF? In simple terms, IVF is an advanced fertility technique, which is used to fertilize the sperm and egg outside the uterus, escalating the natural process of conception.
The procedure is generally considered a boon among many couples who are struggling to achieve conception naturally quite for a long time.
In this blog, let’s see the detailed breakdown of who requires this procedure, the steps involved in it and its success rate.
Your fertility specialist may suggest IVF or test tube baby in either of the scenarios:
This IVF process can be a good option for couples with the following conditions:
In general, the natural conception can indeed take place in the fallopian tubes. During ovulation, the released eggs travel through the fallopian tubes and then reach the uterus, either fertilized or unfertilized. If fertilization takes place, the egg eventually moves to the uterus and gets implanted. This may be marked as a successful way of achieving pregnancy.
In cases of damaged or blocked fallopian tubes, an egg that is released during ovulation cannot pass through the fallopian tubes. Even if it passes and is fertilized with the sperm, it cannot travel to reach the uterus for implantation. This is because of the blockage or interruption in the fallopian tubes. Hence, the pregnancy is delayed or interrupted.
Sperm is considered a crucial factor when it comes to achieving conception. The disorder in sperm quality and numbers may certainly disturb this natural process.
Age-related fertility decline may primarily interrupt the natural conception process. This is because the ovaries may tend to produce diminished quality eggs in low numbers as women age. Similarly, men too may tend to produce diminished quality sperm in low numbers as they age. Hence, conception is predominantly affected.
Women with ovulation disorders may need IVF treatment as it disrupts the natural process of ovaries. This disorder may cause either absent or infrequent ovulation, which is significant for achieving pregnancy. This may also lead to cause irregular menstrual cycle. Hence, the chances of achieving pregnancy are significantly minimized.
The presence of endometriosis may negatively affect reproductive function and other organs. This may also develop scar tissue, adhesions, ovarian cysts, and inflammation, which potentially impacts fertility.
In general, the fertility specialist may prepare the appropriate treatment plan if the underlying cause of infertility is diagnosed. What if the cause is unable to be identified? There are scenarios where the cause of infertility is unable to be diagnosed, even by standard fertility testing. In such cases, IVF or test tube babies may be suggested by the fertility expert to enhance the better outcomes.
If either one of you is identified with a genetic disorder, there are significant possibilities that it can be transferred to your offspring. Your fertility specialist may suggest the IVF procedure with PGT (preimplantation genetic testing) to alleviate the issue. This can be deviated as the PGT testing involves analysing embryos developed through IVF for any potential genetic abnormalities. After the analysis, only the healthy ones are preferred to be placed in the partner’s uterus.
The test tube baby process involves several steps like collecting the eggs and sperm from the couple or a donor by inducing hormonal medications. The retrieved sperm and eggs are brought together to get fertilized outside the woman’s body, typically in regulated laboratory conditions. Once fertilized, they are then located back into the uterus for implantation. The successful implantation may denote a successful pregnancy.
However, listed below is a detailed description of how the process works.
During the consultation, the fertility expert may completely evaluate both of your medical history and suggest particular tests like ultrasound, blood tests, semen analysis, ovarian reserve and more. Based on the reports, the fertility treatment plan may be personalized.
After the complete diagnosis, the fertility specialist may start with the treatment. The initial step of the treatment might be ovarian stimulation.
Ovarian stimulation involves a series of hormonal medications and injections. They are used in order to stimulate the progress of multiple mature eggs in the ovaries. The growth is closely monitored through blood tests and ultrasounds. The dosage of the injections or medications may be modified according to the results. This is done to ensure the woman’s body response to the medications, thus reducing complications.
After ovarian stimulation, the retrieval of matured eggs takes place. This may be done by giving a trigger shot of human chorionic gonadotropin (hCG) to induce ovulation. It may usually take 36 to 38 hours for the ovaries to respond to the injection and start to ovulate. Hence, within this specific time period, egg retrieval is planned.
The procedure is widely known as follicular aspiration. This is performed by giving medicines so that the woman does not feel any pain during the process. A thin needle may be injected into the ovary through the uterus. A suction device is connected to the needle to aspirate the matured eggs from the ovary. The procedure is done by the fertility specialist using the ultrasound guidance. The process is repeated to the other side of the ovary as well.
The whole procedure might take about 30 to 45 minutes to complete. In addition, your healthcare specialist may also recommend you to stay for a few more hours in the hospital before leaving.
On the very same day of the egg retrieval, your male partner is also recommended to provide his sperm sample. The fertilization may take place as soon as the samples are collected from both of the couples. This is just because the fresh sperm and egg can enhance the probability of successful fertilization than the frozen ones.
The collected eggs and sperm are put together in the petri dish for fertilization to happen naturally. This is done under-regulated laboratory conditions. If there are any disruptions in fertilization like issues with the sperm quality or so, the process might be facilitated through intracytoplasmic sperm injection (ICSI). ICSI is a technique that involves inserting a healthy single sperm directly into the egg. This is repeated with every single healthy sperm.
The very next day after fertilization, which is typically considered as Day 1 of embryo development, its growth is examined by the embryologist. Using microscopes, the embryologist assesses the embryo’s cell shape, appearance and more. This will ensure its potential for further development. They are then allowed for more growth until Day 5. The Day 5 embryos are widely known as blastocysts. Blastocysts are the appropriate phase of the embryos, which are more likely to be implanted into the uterus.
Note that if multiple blastocysts are developed in the process, the more viable ones are predominantly frozen for future use.
At this stage, a healthy blastocyst is placed inside the partner’s uterus. The procedure is done by inserting the thin-sized catheter into the woman’s uterus. The blastocyst may be transferred through it until it reaches the uterus.
Note that the number of blastocysts to be transferred is suggested by your fertility specialist depending on the woman’s age and medical history.
Once the blastocyst is transferred into the uterus, it may tend to attach itself to the uterine lining (endometrium). The successful attachment is the beginning of a successful pregnancy. As soon as it is attached, the placenta may start to develop. This might approximately take 2 to 3 days of embryo transfer. Later on, the levels of human chorionic gonadotropin (hCG) hormone may increase gradually to help support the developing baby. The presence of hCG hormone is what a pregnancy blood test is performed to detect.
Your fertility specialist may suggest you wait for 2 weeks before performing the pregnancy test. The specified waiting time is given to allow the hCG hormone in the maternal body to produce enough to get detected in the pregnancy test.
The success rates of the test tube baby (IVF) may widely vary depending on numerous factors. The factors may include women’s age, quality of egg and sperm, quantity of egg and sperm, underlying cause of infertility, and more.
However, a recent study shows that the success rate of IVF globally stands out to be 40% for women under the age of 35. In India, the success rates are projected to be around 35 and 40% on the other hand.
While the success rates are predominantly influenced by the quality of the eggs retrieved from the woman, the fertility clinic you choose and the techniques used like ICSI also play a major role.
Even though in vitro fertilization (IVF) is a complex procedure, it gives hope to many couples who are struggling to achieve a healthy conception. It is essential to understand that the procedure involves both financial and emotional commitment. Hence, choosing the right fertility clinic plays a key role, and can provide you with proper guidance and support all through the process.
1. Is the IVF procedure more difficult?
There is no direct answer to the question. When it comes to the physical aspect, the procedure can cause distress and discomfort. However, IVF can certainly cause emotional distress as it involves several hormonal medications. Furthermore, the financial aspect also can be difficult with the procedure.
2. Why did most of the first IVF cycle become unsuccessful?
A recent study shows that almost 50% of the first IVF cycle becomes unsuccessful. The reason may range from lifestyle factors to chromosomal or genetic abnormalities. Your fertility specialist may initially not recognise how well your body responds to these fertility drugs. This is because the responses may differ from woman to woman. After analysing the first cycle, a better understanding of the woman’s sensitivity may significantly help the healthcare provider to customize the treatment plan accordingly in the subsequent cycles. Hence, you can see positive outcomes in the second or following cycles.
3. Can stress impact test tube baby or IVF procedure?
The answer to the question is yes. Studies show that stress can certainly impact the reproductive hormones, which reduces the chances of pregnancy. Stress may potentially disrupt the medications used in the procedure as well as the embryo implantation. Hence, disrupting the outcome.
4. How many times can I try an IVF procedure to conceive the baby?
Even though there are no specific limitations to trying IVF, many experts in fertility treatment suggest trying a maximum of 3 to 6 cycles. However, the number of cycles depends on the woman’s age, overall health, and more.
5. What are the guidelines to follow after embryo transfer?
Once the embryo is transferred, it is suggested to avoid stressful situations and strenuous activities. Also, it is essential to follow the physician’s guidelines on medications. Avoiding long travels and extreme temperatures can also be beneficial.
