In Vitro Fertilization (IVF)

Overview

In Vitro Fertilization (IVF) is a type of Assisted Reproductive Technology (ART) that involves fertilizing eggs with sperm outside the body. The procedure starts with collecting eggs from the ovaries, which are then fertilized with sperm in a lab. After a few days, these fertilized eggs, now called embryos, are placed into the uterus. A successful pregnancy is achieved if one of the embryos embeds itself in the uterine lining.

Throughout an IVF cycle, patients are given hormone injections to encourage the simultaneous maturation of several eggs. The treatment plan, including the choice of medications, their dosages, and how often they’re administered, is customized by healthcare providers based on the patient’s age, medical background, hormone levels, and their reactions to any past IVF attempts. Generally, the fertility drugs are given for a period ranging from about 8 to 14 days.

Medications used in IVF

Various medications can be utilized throughout an IVF cycle, with some taken orally and others administered through injection, absorbed through the skin, or placed in the vagina. Your doctor will specify the precise dosage and timing based on your treatment plan.

During the ovarian stimulation phase, you can anticipate receiving injectable hormones:

• Follicle Stimulating Hormone (FSH): These hormones function to induce the production of eggs in your ovaries. You may receive either one or a combination of both during your treatment, typically administered over a duration of approximately eight to 14 days.
• Human Chorionic Gonadotropin (hCG): Typically administered as a single final injection to prompt the maturation of your eggs and initiate ovulation.
• Leuprolide acetate: An injectable form of Gonadotropin-Releasing Hormone (GnRH) agonist, which induces a response. It can assist in regulating the stimulation process or serve as a trigger shot.

Prior to starting IVF treatment, patients may be prescribed birth control pills or injections to facilitate cycle control and synchronize the development of their eggs. Estrogen supplements are often prescribed before and after embryo transfer to support the thickening of the uterine lining. Furthermore, progesterone is administered to improve the chances of successful embryo implantation and progression to a viable pregnancy. This medication regimen is typically continued throughout the first trimester and can be delivered orally, via injections, transdermally, or vaginally.

Reasons for undergoing the procedure

IVF, or In Vitro Fertilization, serves as a solution for various fertility challenges, catering to a wide range of needs including:
Infertility Issues: Couples facing difficulties in conceiving naturally.

• Health conditions: When one partner suffers from a health issue that affects fertility.
• Previous fertility treatments: Individuals or couples turning to IVF after other methods have not succeeded.
• Age considerations: Those dealing with fertility concerns related to advanced maternal age.

Common reasons for choosing IVF:

• Blocked or damaged fallopian tubes: Hinders the egg and sperm from meeting naturally.
• Endometriosis: A condition where tissue similar to the lining inside the uterus is found outside it, affecting fertility.
• Sperm-related issues: Low sperm count or other impairments that affect the sperm’s ability to fertilize an egg.
• Ovarian conditions: Including Polycystic Ovary Syndrome (PCOS) which can disrupt ovulation.
• Uterine fibroids: Benign tumors in the uterus wall that can interfere with the implantation of the fertilized egg.
• Uterine anomalies: Problems with the structure or health of the uterus.
• Genetic concerns: Risk of transmitting a genetic disorder or disease to the child.
• Unexplained infertility: When no cause for infertility has been identified despite evaluation.

Risks

IVF treatment comes with various risks, including:

• Multiple births: Increases the chances of premature labor.
• Premature delivery: Slightly higher likelihood of early birth or low birth weight.
• Miscarriage: Miscarriage rates are comparable to those in natural conception.
• Ectopic pregnancy: Occurs when the fertilized egg implants outside the uterus.
• Egg retrieval complications: Potential for bleeding, infection, and damage to the bladder, bowel, or reproductive organs.
• Ovarian hyperstimulation syndrome (OHSS): A rare but serious condition causing abdominal pain, nausea, and other symptoms.

Common side effects of IVF

Some individuals may encounter side effects from the fertility medications administered during the ovulation stimulation phase of IVF. These side effects encompass:

• Hot flashes
• Headaches
• Abdominal discomfort
• Expansion of their ovarian size
• Occurrence of bruising due to IVF injections
• Vomiting
• Nausea

Following the embryo transfer, you should be able to resume normal activities, although you may experience some discomfort due to enlarged ovaries. Common side effects after embryo transfer include:

• Bloating
• Spotting
• Cramping
• Constipation
• Tenderness in the breasts (resulting from elevated estrogen levels)

IVF can be challenging, impacting individuals both physically and emotionally. Many undergoing IVF treatment grapple with feelings of depression and anxiety. The challenges of infertility and the IVF journey can lead to a sense of disappointment or overwhelm. It’s crucial to communicate openly with your doctor about your emotions, enabling them to provide the necessary support throughout the process.

Before the procedure

Before embarking on IVF treatment, it’s essential for both you and your partner to undergo comprehensive medical evaluations and fertility assessments. Here’s a structured guide to the preparatory steps involved:

• IVF consultation: Engage in a detailed discussion with healthcare providers about the IVF process.
• Medical examinations and tests:
  • Uterine exam: Includes an up-to-date Pap test; mammogram is required for those over 40.
  • Semen analysis: Evaluates sperm health and viability.
  • Infection screening: Tests for sexually transmitted infections (STIs) and other infectious diseases.
  • Ovarian reserve testing: Assesses the quantity and quality of eggs available for fertilization.
  • Blood and urine tests: Provides a comprehensive health overview.
  • Genetic carrier screening: Identifies potential genetic disorders that could be passed to offspring.
  • Uterine cavity evaluation: Performed via hysteroscopy or saline-infused sonography (SIS) to examine the health of the uterine cavity.
• Fertility medication guidance: Receive instructions on administering fertility medications effectively.
• Consent forms: Review and sign consent forms acknowledging understanding and agreement to the IVF procedures.
• Nutritional supplementation: Start taking folic acid supplements at least three months before the embryo transfer to support healthy development.

This structured approach ensures that both partners are fully prepared for the IVF journey, with a focus on maximizing the chances of a successful outcome

During the procedure

IVF process overview:

• Preparation with birth control pills or estrogen: Prior to starting IVF, healthcare providers may prescribe birth control pills or estrogen to prevent ovarian cysts and regulate the menstrual cycle. This step ensures control over the treatment timeline and maximizes mature egg production. Some may receive a combination of estrogen and progesterone, while others might only take estrogen.
• Ovarian stimulation: Injectable hormone medications are used to stimulate all eggs in the cycle to mature simultaneously, aiming for multiple mature eggs rather than the single egg typically developed in a natural cycle. The type, dosage, and frequency of these medications are personalized based on the individual’s medical history, age, AMH level, and response to past stimulations.
  • Monitoring: Through ultrasounds and blood tests, the development of ovarian follicles (which contain the eggs) is closely monitored. Follicles over 14mm usually indicate mature eggs ready for fertilization.
  • Trigger shot: A hormone injection is administered 36 hours before egg retrieval to finalize egg maturation.
• Egg retrieval: Under mild sedation, a needle guided by ultrasound extracts eggs from the ovaries. The eggs are then placed in a special solution within an incubator.
• Fertilization: Mature eggs undergo ICSI (intracytoplasmic sperm injection), where sperm is directly injected into each egg. Approximately 70% of mature eggs are successfully fertilized. Eggs not fertilized immediately may be frozen for future use.
• Embryo development: Embryos are monitored for five to six days to identify those that reach the blastocyst stage, suitable for uterus transfer. On average, 50% of fertilized embryos reach this stage.
• Embryo transfer: Depending on individual circumstances, either fresh or frozen embryos are transferred to the uterus. The transfer, which is similar to a pelvic exam and doesn’t require anesthesia, involves inserting a catheter through the cervix to place the embryos.
• Pregnancy testing: A blood test is conducted about nine to 14 days after embryo transfer to confirm pregnancy. The same steps apply if donor eggs are used, with the donor undergoing ovarian stimulation and egg retrieval.

Consultation with healthcare providers is crucial for a comprehensive understanding of the IVF process and tailored advice based on individual needs and conditions..

After the procedure

After the embryo transfer, you may encounter some mild symptoms:

• Spotting
• Constipation
• Slight bloating and cramping.
• Tenderness in the breasts due to elevated estrogen levels.

While many individuals resume normal activities immediately after their egg retrieval procedure, it’s important to refrain from driving for 24 hours following anesthesia. Approximately nine to 14 days after the embryo transfer, a return visit to the clinic is scheduled for a pregnancy test, conducted using a blood sample.

Outcome

Age plays a significant role in the success of IVF, with higher chances of pregnancy observed in individuals under 35 years old and lower probabilities for those over 40 years old. The live birth rate correlates closely with age, with approximately a 46% rate for individuals under 35 using their own eggs, compared to around 22% for a 38-year-old using their own eggs.

Following embryo transfer, the pregnancy test typically occurs between nine to 14 days, although the exact timing may vary based on the protocols of the practice or fertility clinic. Doctors commonly use a blood test to assess pregnancy by measuring HCG (human chorionic gonadotropin), the hormone produced by the placenta during pregnancy.