In vitro fertilisation (IVF) is process of achieving success fulfertilization in lab, and the fertilized embryos are transferred into the woman’s uterus.
IVF consist five major steps
1.Follicular stimulation (superovulation)
Naturally the women produce one egg at mid of the menstrual cycle every month, but for invitro fertilization we need multiple number of matured egg, to achieve this, the reproductive specialist will prescribe the follicular stimulating hormones in injection form which is injectable through IM, the patients should take injection everyday at same time, meanwhile at the regular inter-well the doctor will asses the egg growth through transvaginal ultrasound scan and some blood investigations, based on the egg growth doctor may adjust the dose of the hormonal injection either increase or decrease the dose.
2 Final Maturation/Trigger/hcG shot
When the eggs are reached maturity based on ultrasounds and blood test, the doctor will prescribe the final maturation injection usually call it as trigger or hcG shot, after 34hrs of trigger patient ready for the egg retrieval
3 Egg Collection
Timing play a vital role in the process of egg collection. If the egg collected before 34hrs it may not mature enough subsequently the eggs won’t fertilize, if it is done after 36hrs the eggs may have been released spontaneously or may be post mature and will not be useful for the procedure. The eggs are retrieved by an ultrasound-guided-needle aspiration,this procedure is usually performed under short general anaesthesia (short GA). For anaesthesia the patient should come in empty stomach for at-least last 12hr, the surgery generally takes 20mts to 30mts, the patients usually go home a few hours later after the egg collection procedure. Simultaneously the embryologist identify the egg from the follicular fluid, and safeguard the egg in incubator until the further step.
Patient should remember always not all follicle will yield mature good quality egg, it may be immature or post mature or empty zona or poor quality egg, very rare case there is no egg, if this kind of challenges encountered, the doctor will discuss about the possible cause and possible course of future action.In the Fertilization process the male gamete and female gamete will integrate and create a new life by forming pro-nucleus.
After the egg collection the male partner should produce the semen sample, the collected semen sample prepared in laboratory and used for IVF/ICSI
4. Conventional IVF: If the Semen sample has the good count and good forward progressive motility then the conventional IVF procedure is followed. In IVF process a prepared high quality motile sperm is inseminated with the eggs in the glass dish. The major goal in IVF is to attain the natural fertilization and natural selection process will takes place, in some time we may expect low fertilization rate or no fertilization.
5 FERT CHECK AND CULTURE
After 16 to18 hours, of insemination or ICSI the eggs are checked to ensure the fertilization (pronucleus (PN)). Once we confirm the pronucleus the gametes are now embryos, the fertilized embryos are separated and transfer to the fresh culture dish and keep in incubator for further development. The embryologist will monitor the embryos everyday and have the note of embryos growth pattern of like slow growers, fragmented etc, it may help during embryo selection.
Patient should remember not all egg will fertilize, likewise not all fertilized embryos grow well, in rare case we observe no fertilization subsequently no embryos, if this kind of challenges encountered, the doctor and embryologist will discuss about the possible cause and possible course of future action.
Embryo transfer procedure comparatively easy procedure. Its usually take 5mts, the embryo transfer perform under ultrasound guidance,no need of any sedation, but needs full bladder so the doctor may ask you to drink more water. We do transfer either day3 or day5 based on the number of embryo, quality of embryo, previous ivf history etc. For transfer the embryologist and clinician will select the best embryos,the selected embryos loaded by embryologist in a fine catheter with minimum amount of medium and its handed over to the clinician, the clinician gently insert the embryo loaded catheter in to the uterus through cervix, and place the embryo carefully in the uterus.The number of embryos for transfer will be decided jointly by Doctor and couple, based on following major factors like patient age, previous ivf cycle history, patient health condition,embryo quality and patient desire etc. Our goal is to increase the chance of pregnancy with minimal post ET and twin pregnancy complications.
After transfer the patient should lay down in same position for about 15mts and then she can walk to home
In our clinic embryo loading live relay facility is available upon the request.
If surplus embryos available can be frozen for future use.
The live birth rate per IVF/ICSI cycle approximately
√ 41-43% for women under age 32
√ 33-36% for women ages 33 to 37
√ 23-27% for women ages 38 to 40
√ 13-18% for women ages over 40