IVF Procedure

IVF Procedure

In Vitro Fertilisation (IVF) is one of several techniques available to help people with fertility issues. This procedure involves removing an egg from the woman’s ovaries and fertilizing it with a sperm in the laboratory. The fertilised egg called an embryo is then returned to the woman’s womb to grow and develop. The procedure is carried out using the woman’s eggs and her partner’s sperm or eggs and/or sperm from donors.

IVF is a popular and tested treatment option that works for thousands of couples. It can grant people their wish of becoming parents when most other approaches have failed. The truth however is that IVF doesn’t always work and for most at least not at the first attempt. There are many couples out there that have to go through more than one cycle of IVF before getting pregnant. It can be very hard to accept when your IVF treatment does not work and it can be very difficult to understand why.

1) Female age
2) Embryo quality
3) Ovarian response
4) Implantation issues
5) Sperm Quality and Sperm DNA

Your likelihood of getting pregnant decreases over time. Since each woman is born with a certain number of eggs, as you age you use those eggs up. Your likelihood of a live birth after IVF is greater the younger you are. Some studies show that the likelihood of a live birth after IVF for a woman age 35 is around 32%, but only 16% for a woman who is 40. Of course, this is not a guarantee that IVF won’t work in specific cases.

Quality of the embryo can be another contributing factor to IVF failure. Some embryos have genetic or chromosomal abnormalities that can make them too weak to work for IVF. Other embryos don’t have enough cells to survive and are less likely to fertilize. There are quite a few things that can contribute to embryo quality, which can eventually lead to IVF failure.

Sometimes a woman’s ovaries just do not respond properly to the IVF medications that try to get the ovaries to produce multiple eggs. If you already have a reduced number of eggs, are over 35 or 37 or have elevated FSH levels, it might be harder for your body to respond properly to IVF medications. In short, if your body listens to the medication and produces more eggs, your IVF is likely to be successful. If it doesn’t then the chances of failure of IVF will be greater.

Implantation issues are probably the most common reasons behind the failure of IVF treatment. Most times implantation issues occur simply because the embryo just stops growing for no reason in particular. Polyps in uterus or cysts on ovaries could also be a contributing factor to implantation issues. Some research even suggests that chromosomal abnormalities that can cause implantation issues in embryos can be present in as many as 50% of cases!

This equation can illustrate the implantation process:

Embryo quality + receptivity of uterine lining = chance for implantation and pregnancy

Increasing sperm DNA fragmentation or damage is associated with:

1) Poorer fertilization
2) Poorer embryo quality
3) Poorer pregnancy rates
4) Increased risk of miscarriage

These are the five most common reasons for IVF treatment to fail. Just because you experience a failed IVF attempt doesn’t meant that you should give up trying to get pregnant. That is not the case at all. Talk candidly with your doctor about what he or she thinks might have gone wrong and if there is anything that you or your partner could do to help things go smoothly the next time around. The most important thing is to stay positive and not give up!

Chromosomal abnormalities in human embryos are the major cause of IVF failure. As women age the incidence of chromosomal abnormalities in mature eggs increases significantly. Studies have shown that starting in the early 30s the rate of chromosomal abnormalities in human eggs (and therefore in human embryos) starts to increase significantly.

The rate continues to increase with advancing female age so that by the mid-40s a very high percentage of human embryos are chromosomally abnormal (over 75%). It is believed that this is mainly due to problems with the spindle apparatus in the egg nucleus. The spindle is involved with properly lining up and segregating the chromosomes as the egg matures at the time of ovulation.

Older eggs have an inefficient spindle apparatus that does not line up the chromosome pairs properly and “mistakes” are made when splitting pairs of chromosomes. This leads to eggs that do not have the proper balance of 23 chromosomes – and will result in a chromosomally abnormal embryo if fertilized. It has been shown that about 30% to 40% of human sperm are chromosomally abnormal on the average – as compared to about 20% to 90% of human eggs (depending on female age).

In Vitro Fertilisation (IVF) is one of several techniques available to help people with fertility issues. This procedure involves removing an egg from the woman’s ovaries and fertilizing it with a sperm in the laboratory. The fertilised egg called an embryo is then returned to the woman’s womb to grow and develop. The procedure is carried out using the woman’s eggs and her partner’s sperm or eggs and/or sperm from donors.

IVF is a popular and tested treatment option that works for thousands of couples. It can grant people their wish of becoming parents when most other approaches have failed. The truth however is that IVF doesn’t always work and for most at least not at the first attempt. There are many couples out there that have to go through more than one cycle of IVF before getting pregnant. It can be very hard to accept when your IVF treatment does not work and it can be very difficult to understand why.

1) Female age
2) Embryo quality
3) Ovarian response
4) Implantation issues
5) Sperm quality and sperm DNA

Your likelihood of getting pregnant decreases over time. Since each woman is born with a certain number of eggs, as you age, you use those eggs up. Your likelihood of a live birth after IVF is greater the younger you are. Some studies show that the likelihood of a live birth after IVF for a woman aged 35 is around 32%, and is only 16% for a woman who is 40. Of course, this is not a guarantee that IVF won’t work in specific cases.

Quality of the embryo can be another contributing factor to IVF failure. Some embryos have genetic or chromosomal abnormalities that can make them too weak to work for IVF. Other embryos don’t have enough cells to survive and are less likely to fertilize. There are quite a few things that can contribute to embryo quality, which can eventually lead to IVF failure.

Sometimes a woman’s ovaries just do not respond properly to the IVF medications that try to get the ovaries to produce multiple eggs. If you already have a reduced number of eggs, are over 35 or 37 or have elevated FSH levels, it might be harder for your body to respond properly to IVF medications. In short, if your body listens to the medication and produces more eggs, your IVF is likely to be successful. If it doesn’t, then the chances of failure of IVF will be greater.

Implantation issues are probably the most common reasons behind the failure of IVF treatment. Most times, implantation issues occur simply because the embryo just stops growing for no reason in particular. Polyps in uterus or cysts in ovaries could also be a contributing factor to implantation issues. Some researches even suggest that chromosomal abnormalities that can cause implantation issues in embryos can be present in as many as 50% of cases!

This equation can illustrate the implantation process:

Sperm Quality and DNA

Increasing sperm DNA fragmentation or damage is associated with:

1) Poorer fertilization
2) Poorer embryo quality
3) Poorer pregnancy rates
4) Increased risk of miscarriage

These are the five most common reasons for IVF treatment to fail. Just because you experience a failed IVF attempt doesn’t meant that you should give up trying to get pregnant. That is not the case at all. Talk candidly to your doctor about what he or she thinks might have gone wrong and if there is anything that you or your partner could do to help things go smoothly the next time around. The most important thing is to stay positive and not give up!

Chromosomal abnormalities in human embryos are the major cause of IVF failure. As women age, incidences of chromosomal abnormalities in mature eggs increase significantly. Studies have shown that starting in the early 30s, the rate of chromosomal abnormalities in human eggs (and therefore in human embryos) starts to increase significantly.

The rate continues to increase with advancing female age so that by the mid-40s a very high percentage of human embryos are chromosomally abnormal (over 75%). It is believed that this is mainly due to problems with the spindle apparatus in the egg nucleus. The spindle is involved with properly lining up and segregating the chromosomes as the egg matures at the time of ovulation.

Older eggs have an inefficient spindle apparatus that does not line up the chromosome pairs properly and “mistakes” are made when splitting pairs of chromosomes. This leads to eggs that do not have the proper balance of 23 chromosomes – and will result in a chromosomally abnormal embryo, if fertilized. It has been shown that about 30% to 40% of human sperms are chromosomally abnormal on the average – as compared to about 20% to 90% of human eggs (depending on female age).

    The cycle before the treatment

    Step 1: The cycle before the actual IVF treatment begins you may be put on medications to control your menstrual cycle and depending on the protocol you may be required to take injections.

    Step 2: When you get your cycles, on the second day of your period, you will undergo an Ultrasound to check the ovaries and look for ovarian cysts and start the treatment.

    Step 3: Ovarian stimulation will be done with gonadotropin injections and frequent monitoring will be done with ultrasound to look in to the follicular growth and development. There may be need to do blood tests to evaluate the estrogen levels and progesterone to rule out premature leutanization. Once the follicles attain the dominant size, egg retrieval will be scheduled after 36 hours of HCG trigger.

    Step 4: Egg retrieval or ovum pick up is planned under general anesthesia, transvaginal USS guided oocyte retrieval is preferred, a needle is used to gently aspirate the follicle and then transferred to the Embryology lab for assessment of oocytes.After the procedure you will be monitored for few hours and then discharged, light spotting and abdominal cramps is common after ovum pick up.

    Step 5: Fertilization: On the day of egg retrieval husbands semen sample will be collected, sperms from washed and processed sample will be selected for doing ICSI of the mature oocytes. The fertilization will be checked 16-18 hours after doing ICSI and the embryos allowed growing in the lab for few more days.

    Step 6: Embryo transfer: The fertilized eggs now termed as the embryos are then transferred in to the uterus after 3 – 5 days using an embryo transfer catheter. The number of embryos transferred will depend on the quality of the embryos and also the age of the patient. Post the transfer you will be given rest for 3 hours and then discharged.

    Blastocyst Culture

    Blastocyst is an embryo that has developed for five days after fertilization.
    Most of Embryo transfers are performed on day 2 or day 3. Recently, improvement in embryo culture condition has allowed sustained embryo development to the blastocyst stage. It is stage at which embryo naturally arrives to the uterine cavity and implantation occurs. Preliminary studies with new media and age in good responder woman have shown that ~50% of the fertilized eggs reach blastocyst stage.

    Advantages of blastocyst culture :-
    Better selection of the embryos to be transferred
    Better selection of the embryos to be transferred
    Limit the number of embryos to be transferred
    Eliminate the risk of multiple pregnancy
    Better implantation rate

    Disadvantages of Blastocyst culture:-
    Longer time interval between retrieval and transfer
    No embryos or fewer embryos for freezing
    Risk of embryo arrest

    Candidate for blastocyst transfer:-
    Woman with at least six number of good quality embryos on day II after oocyte pick up
    Woman under age 35
    Oocyte recipients who receives young oocytes from donor

    Step 7: Luteal support: This is started soon after your egg retrieval is done, progesterone injections are given daily and estrogen supplements started to prepare the uterus to receive the pregnancy. Post embryo transfer also this support is continued till the pregnancy test is done.

    Step 8: Pregnancy test and follow up: After 15 days of embryo transfer, pregnancy test is done, this will usually be a blood test, if the test is positive the progesterone support is continued for few more weeks.

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    How long does an egg retrieval take?

    Egg retrieval is a fairly rapid procedure. The length of the procedure depends on how many follicles are present. Also the accessibility of the ovaries will determine how long the procedure will take. Accessibility means how easy is it to reach the ovaries with the ultrasound probe, whether they have a tendency to move away from the probe and so on. The typical egg retrieval will take from 20-30 minutes.

    Is the egg retrieval painful?

    We do our egg retrievals under anesthesia; our patients are asleep. Our anesthesia specialists use medications which heavily sedate you. You will be “asleep” however; you will not require a breathing tube. The beauty of this approach is that you will feel absolutely nothing, remember absolutely nothing, and will have few of or none of the typical side effects of anesthesia such as nausea and vomiting.

    Will the egg retrieval damage my ovaries?

    The data we have available tells us that it does not. There have been many women who have undergone multiple egg retrievals. The fact that they have responded to stimulation on subsequent occasions and produced eggs and pregnancies on these occasions implies that the ovaries are OK after egg retrieval. There have been some limited studies looking at the appearance of the ovaries in women who have had egg retrievals and subsequent laparoscopic surgery. In those patients, the findings were normal.

    Is bleeding expected after the egg retrieval?

    Vaginal bleeding is not uncommon after an egg retrieval. Usually this bleeding is from the needle puncture sites in the vaginal wall. It is usually minor and similar to a period or less. The bleeding experienced is analogous to the bleeding that will take place from an IV or from the arm after blood has been drawn.

The video describes a procedure known as In-Vitro Fertilisation which is a form of assisted pregnancy for those who may not be able to conceive. The video begins by describing the structure and parts of the female reproductive system and goes on to describe the ovulation process from the ovary to the fallopian tube. The conditions for pregnancy are then discussed along with the fertilisation process where the sperm and ovum unite. The embryo then travels to the uterus where implantation takes place and forms the placenta that acts as the bridge between the mother and child. The conditions for IVF to be used are listed with some of them being infertility, single parenthood etc.

The steps involved with IVF include fertility medication, a semen sample and then a set of 3 processes: follicle aspiration where eggs are harvested from the ovaries using a suction device connected to a needle, fertilisation where the eggs are placed in a petri-dish and artificially inseminated using the semen sample collected and embryo transfer where the fertilized egg is transferred to the uterus which is subjected to hormone therapy to facilitate implantation.

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