In vitro fertilisation (IVF) is a form of assisted reproductive technology which helps a couple conceive a baby. In vitro means outside the body, IVF is the process of fertilising a woman’s egg with a sperm from a man outside the human body, in a lab. Approximately 1.7% of infants are born with the help of assisted reproductive technology every year in USA. In 2016 263,577 ART cycles were performed in USA resulting in 65,996 live births and 76,930 infants.
There are five basic steps to one cycle. They are
Induction of ovulation
Retrieval of egg
This is a procedure for removal of mature eggs from the body. It is performed on an outpatient basis. For this procedure you will be given pain medications and sedation. Your doctor will insert an ultrasound probe into the vagina. Under ultrasound guidance a needle will be inserted into the ovary via the vagina. The needle is attached to a suction device which helps in collecting the eggs in a nutrition media for transport to the lab. In rare cases a laparoscopic procedure is required for egg retrieval.
Insemination and fertilisation
The sperm and egg are placed together in a controlled environment for the fusion of sperm and egg to occur, leading to the formation of a zygote. When the sperm cannot enter the egg, it can be injected into the egg artificially by a process called intra cytoplasmic sperm injection (ICSI).
Embryo culture
The fertilised egg divided to form an embryo. Within five days, a normal embryo has several, actively dividing cells. For couples with risk of transferring genetic disorders, a pre- implantation genetic diagnosis (PGD) is offered. With the help of PGD it is possible to identify the embryos with minimal chances of being born with a genetic disorder.
Embryo transfer
The embryo is placed into the womb 3-5 days after fertilisation. This procedure is done on an out patient basis. You will be awake during the procedure. Your doctor will introduce a thing tube called a catheter into your uterus via your cervix and vagina. The embryo is placed onto the uterine lining. More than one embryo is transferred at a time, hence it may lead to a multiple pregnancy.
IVF is indicated for couples with infertility or genetic problems. Infertility is defined as inability to conceive after one year of unprotected intercourse. IVF may be an option if you or your partner has:
To prepare for IVF your doctor will first like to record a history of the present and past medical conditions of you and your partner. Both of you will be requested to undergo various screening tests before an IVF cycle:
Before the procedure your doctor will also discuss about what to do with the multiple fertilised eggs. You may choose to preserve them for later use. Your doctor will also help you decide the number of embryos that can be safely implanted in one cycle.
IVF is a long procedure which requires large amount of time, physical and emotional energy. All steps in IVF come with their own set of complications.
You will have an appointment with your doctor 12 days or 2 weeks after embryo transfer to confirm the pregnancy. If you are pregnant you will be referred to an obstetrician who will guide you through your pregnancy. Women undergoing IVF are prescribed progesterone pill or shots for 8-10 weeks after embryo transfer. Progesterone is a hormone responsible for maintaining the inner lining of the uterus, too little progesterone may lead to a miscarriage.