A Mumbai-based lawyer couple was unable to conceive for over four years. The couple Asma and Mihir (name changed on request) got married in their early 30s. Four years into their marriage, they decided to have a baby. After several unsuccessful tries and treatments, they opted for in vitro fertilization (IVF) and Asma successfully gave birth to twins, a girl and a boy in 2017.
What is in vitro fertilization?
“In vitro fertilization is an assisted reproductive procedure done when a couple is unable to conceive naturally or with other relatively simpler, less expensive fertility treatments,” says Dr Raajam Murali, senior consultant, reproductive medicine, Milann Fertility Centre, Bangalore.
In vitro means outside the body. In IVF, the sperm and egg are fertilized in a laboratory. The embryo formed after fertilization is transferred into the mother’s uterus which can lead to pregnancy, explains Dr Raajam.
Babies born through the IVF process are called test tube babies.
What happens during the IVF process?
Dr Raajam says that the IVF process lasts for two weeks, starting on day 2 or 3 of the menstrual cycle and involves the following steps:
Blood tests and scans: The woman’s uterine features, the number and quality of eggs are gauged through blood tests and ultrasounds.
Hormone injections: The woman is given gonadotropin hormone injections for 10 to 12 days to stimulate ovulation, triggering the release of multiple eggs, instead of one which increases the chances of pregnancy.
Egg retrieval: Mature eggs are retrieved through a transvaginal procedure using an ultrasound probe, under sedation. The same day, the partner’s/donor’s semen sample is collected.
Fertilization: The sperm is injected into the egg in a process called intracytoplasmic sperm injection (ISI). Once the egg is fertilized, it divides to form an embryo. The embryo is cultured in the lab for five days until it reaches the blastocyst stage, which is a ball of cells formed from rapid cell division.
Embryo Transfer: The embryo is transferred into the mother’s uterus, in a transvaginal procedure that takes 15-20 minutes.
Causes of infertility
“On evaluation, it was found that Asma’s trouble getting pregnant was due to a septate uterus (tissue growth in the middle of the uterus) and uterine polyps (growth in the inner lining of the uterus). They were surgically removed,” says Dr Kiran Coelho, HOD of Gynaecology and their treating doctor at Leelavati Hospital & Research Centre, Mumbai.
According to Dr Coelho, when a couple is unable to conceive naturally, despite several attempts for about six months to one year, they should consult an infertility specialist,” says Dr Kiran Coelho.
Some of the causes of infertility
- Presence of uterine fibroids and polyps
- Endometriosis, where tissues similar to that of uterus lining grows outside the uterus
- Blocked fallopian tubes.
- Absence of ovulation
- Poor sperm quality, motility, or count.
- Unexplained causes
IVF is not the first option
“When the couple couldn’t conceive despite removing the septum and polyps, intrauterine insemination (IUI) was opted for, where the sperm is directly placed in the uterus to increase the chances of fertilization. When 4 cycles of IUI also proved futile, in vitro fertilization was deemed the final option,” says Dr Coelho.
Dr Coelho says that IVF is often the last treatment option. The couples will initially undergo several tests to probe the cause of infertility based on which a suitable treatment is chosen.
According to Dr Coelho, if corrective treatments don’t result in pregnancy, the IUI procedure is done and if that is unsuccessful, IVF is deemed as the last resort.
“In case of irrevocably blocked fallopian tubes, advanced maternal age, unexplained infertility, multiple failed pregnancies, IVF is the first choice,” says Dr Coelho.
IVF can also be done with a donor’s sperm and eggs. The donor’s sperm is used to fertilize the egg. If the woman’s ovarian reserve is low, donor eggs can be used, where the donor’s egg is fertilized with the male partner’s sperm and implanted in the woman’s uterus.
How successful is in vitro fertilization?
“The incidence of IVF resulting in pregnancy is 50-60%. However, IVF that results in live births is 25-30%, as there are chances of ectopic pregnancies, abortions, preterm deliveries, despite successful conception,” says Dr Raajam.
According to Dr Raajam, the most important factor that influences the success of IVF is maternal age, as the quality of eggs reduces with age. The number of eggs retrieved during the IVF cycle, the egg reserve, quality, uterine conditions, sperm quality and sperm count are also contributing factors.
Dr Raajam adds that the success of IVF can be enhanced by pre-implantation genetic testing (PGT), where the genetic profile of the embryo is tested before implanting into the uterus, increasing the chances of a healthy baby.
Why Is IVF on the rise?
Experts say that both male infertility and female infertility can contribute to the increase in in vitro fertilisation. IVF clinics are mushrooming in all tier-2 and tier-3 cities of India. Dr Coelho adds that the causes for the rise in IVF over the years are late marriages, nuclear families – which can delay childbearing and pose roadblocks in natural conception. As there is a high demand, the number of service providers have also increased.
Dr Raajam mentions maternal age and lifestyle factors. “Women tend to delay pregnancy due to career and financial stability. Fertility reduces with age.”
“A sedentary lifestyle, stress, circadian disturbances due to poor sleep, alcohol, smoking, can also affect fertility,” she adds.
Does IVF have risks?
“The overstimulation of the ovary due to hormone injections can cause ovarian hyperstimulation syndrome (OHSS), a condition where the ovaries swell and become painful,” says Dr Coelho. Other side effects include bloating and hormonal mood swings.
Dr Coelho adds that these symptoms are temporary and don’t affect the foetus. IVF pregnancies also have a greater chance of miscarriage, preterm labour and multiple pregnancies
- In in vitro fertilization (IVF), the sperm and egg are fertilized in a laboratory and implanted into the uterus.
- The quality of the egg and sperm plays a major role in the success of IVF.
- Delayed pregnancy, sedentary lifestyle and stress play a role in infertility.