Specialised IVF clinic at the centre primarily focuses on IVF and ICSI treatments. In Vitro Fertilisation (IVF) and Intra-Cytoplasmic Sperm Injection (ICSI) are recognized treatments for subfertility. While IVF and ICSI have been originally recommended for subfertility associated with tubal problems and sperm problems respectively, these have now become the choice, if all other fertility treatments have proven unsuccessful. Through these procedures, many couples with otherwise untreatable subfertility have given birth to healthy babies and so far over five million babies have born world-wide.
- Ovarian Stimulation
This is aimed to stimulate multiple eggs to grow in the ovaries rather than the single egg that normally develops each month. Multiple eggs are stimulated during a routine IVF/ ICSI treatment cycle. If we obtain multiple eggs, the chance of getting one or two good quality embryos for transfer is quite high. “Fertility drugs”, commonly hormonal injections, are used for ovarian stimulation. The commonly used hormonal drugs are human menopausal gonadotropins (HMG), Follicle stimulating hormone (FSH), luteinizing hormone (LH) and human chorionic gonadotropins (hCG). Woman’s cycles are monitored using ultra sound to examine the ovaries and blood samples are collected to check the hormone level.
- Egg Collection (Ovum Pickup)
Egg collection is a minor procedure using ultrasound guidance. Some form of pain medication (sedation) or anaesthesia is generally given so that women do not feel any pain during the procedure. A vaginal ultrasound scan is performed to identify the follicles and then, a needle is guided through the vagina into the follicles. The fluid with eggs is aspirated from the follicles through the needle connected to a suction device. The procedure of egg collection is completed in 15-20 minutes. The recovery after the procedure is quick and women should be able to go home generally in about 3-4 hours’ time. Some women experience pain on the day of the retrieval, but this sensation usually subsides by the next day.
Once eggs are collected, the embryologists in the laboratory examine them for maturity and quality prior to performing IVF and ICSI. Before inseminating the eggs for fertilization, good quality sperm are separated from the whole semen usually obtained by masturbation. In men, whose semen has no sperm (azoospermia) sperm may be obtained surgically from the testis or epididymis by using needle aspiration (PESA and TESA) or by biopsy.
- Fertilization And Embryo Culture
Fertilization is achieved by insemination (IVF), where motile sperm are placed together with the oocytes and incubated overnight or by Intra-Cytoplasmic Sperm Injection (ICSI), where a single sperm is directly injected into each mature egg. ICSI is usually performed when there is a likelihood of reduced fertilization, e.g., low sperm count, poor sperm quality, history of failed or low fertilization in a prior IVF cycle. Overall, pregnancy and delivery rates with ICSI are similar to the rates seen with traditional IVF.
- Embryo Transfer
One of the key steps during IVF/ ICSI treatment is the embryo transfer. Generally the procedure is done without any anaesthesia. The doctor uses a vaginal speculum to visualize the cervix. One or more embryos suspended in a drop of culture medium are drawn into a transfer catheter and places the fluid containing the embryos into the uterus. The procedure is painless and is guided with the help of ultrasound.
- Cryopreservation [Freezing of Embryos)
Surplus good quality embryos remaining after the transfer may be frozen for the future treatment. Once frozen, embryos may be stored for a long period of time. The success rate is not dependent on how long the embryos have been stored.
Psychological stress is quite common during and after IVF treatment, which involve significant physical, financial, and emotional commitments on the part of the couple. While there are high expectations during each treatment cycle, unfortunately just over 50% of IVF treatment cycles are unsuccessful. Pregnancy rates, and more importantly live birth rates, are influenced by a number of factors, especially the woman’s age. The chance for pregnancy in consecutive IVF cycles remains similar in up to first 3 to 4 cycles. Many times, the first IVF cycle will give some extra information about the potential cause of the couple’s subfertility and their treatment response. This extra information may help the doctor and embryologist to modify treatment protocol subsequently to aim for a better response and better success in the subsequent cycles.
Preparation for IVF
Preparation for IVF procedure is as important as the procedure itself. Testing for ovarian reserve (egg reserve) by estimating AMH and AFC is generally recommended in order to predict how the ovaries will respond to ovarian stimulation injections. The chance of success may be low if tests demonstrate low ovarian reserve. A detailed ultrasound scan is advised prior to IVF treatment. Any abnormalities in the uterus (fibroids, polyps, or a septum) or in the tube (hydrosalpinx) can be identified on ultrasound scan. If any of these abnormalities are found, the doctor may advise to treat them in order to improve the chances of IVF success.
A detailed semen analysis is also performed prior to IVF treatment if not already done. Further hormonal blood tests or chromosomal tests may also be advised if there are severe sperm abnormalities. Lifestyle issues such as smoking, alcohol and body weight should be addressed before IVF treatment. Achieving an optimal weight particularly in women prior to undergoing IVF is appropriate. Women should be taking folic acid (400 micrograms) before starting treatment, if not already taking.
While most IVF treatment cycles are safe and straightforward, some recognized complication may occur occasionally despite precautions. Ovarian stimulation carries a risk of ovarian hyperstimulation syndrome (OHSS), where the ovaries become swollen and painful. Fluid may accumulate in the tummy and rarely in the chest, and the woman may feel bloated, nauseated, and experience vomiting or lack of appetite. The chance of multiple pregnancy is increased in all IVF cycles when more than one embryo is transferred. While some would consider twins as a happy result, multiple pregnancies are associated with pregnancy complications like miscarriage, pre-term deliveries, low birth weight and blood pressure problems.
There are risks associated with egg collection procedure although very rare. It includes a small risk of bleeding, infection, and even rarely damage to the bowel, bladder, or a blood vessel. Psychological stress is quite common during and after IVF treatment which involve significant physical, financial, and emotional commitments on the part of the couple.