From if to IVF
In-vitro-Fertilization (IVF) is a common infertility treatment. Using “fertility medicines,” the ovaries are first stimulated to generate several follicles, each of which contains an egg. When a single injection matures the eggs, ultrasound monitoring of follicle number and development, as well as blood hormone levels, is used. The fertility specialist then removes the eggs from the ovaries with a small needle while the woman is under mild aesthetic and fertilizes them in a specialized lab using sperm. Following fertilization, the eggs are cultured and grow into embryos. The specialist re-implants the embryos into the uterus three to five days later. IVF is a sort of ART (Assisted Reproductive Technologies) in which fertility doctors help people become pregnant if they are unable to do it normally. IVF stands for In Vitro Fertilisation, with in vitro meaning “in the dish” and fertilisation taking place outside of the body. In a nutshell, IVF is a technique that involves stimulating the ovaries for about two weeks in order to create more eggs. After stimulating the ovaries to produce these eggs, a fertility doctor physically takes them and sets them in a dish with the male’s sperm in the hope that the eggs will fertilise and develop into embryos over a five-day period.
You may also learn more about typical laboratory methods performed during an IVF cycle:
- Egg Retrieval: A simple surgical technique performed under light anaesthesia in which a doctor extracts eggs from the ovaries’ follicles.
- Donor Insemination: A gynecologist inserts sperm straight into the vagina at the cervix or the uterus (called Intrauterine Insemination or IUI). Previously, donor insemination was known as artificial insemination.
- Embryo Development: When the sperm fertilizes the egg effectively, an embryo develops and continues to grow. The embryo is at the ‘cleavage stage’ when it is 2 to 3 days old, and a ‘blastocyst’ when it is 5 to 6 days old.
- Intracytoplasmic Sperm Injection (ICSI): To initiate fertilization, a single sperm is injected into an egg. This is done in the embryology laboratory using specialized equipment.
- Assisted hatching: A laser or chemical solution is applied to the embryo to boost the likelihood that it will implant in the uterine lining (endometrium).
- Fertilized eggs (embryos) are transferred back into the woman’s uterus through the cervix.
- Implementation: After inserting the embryo(s) into the uterus, the embryo must go through a difficult procedure to attach itself to the endometrium, which is the uterus’s inner layer.
- Cryopreservation of embryos: An embryo is frozen at very low temperatures. The stored embryos may be utilized in the future.
Why is IVF performed?
IVF is the most often used treatment procedure for infertility and genetic issues. If IVF is used to treat infertility, you and your partner may be able to attempt less intrusive treatment alternatives first, such as fertility-boosting medications to increase egg production or intrauterine insemination (a procedure through which sperms is placed directly into your uterus near the time of ovulation).
IVF is occasionally recommended as the main therapy for infertility in women over the age of 40. IVF is also an excellent technique if you have a medical condition. Under the following conditions, you or your partner may consider IVF:
Damage or blockage of the fallopian tube: It is difficult for an egg to be fertilized or an embryo to get to the uterus if the fallopian tube is damaged or blocked.
Ovulation disorders: When ovulation is rare or absent, fewer eggs are accessible for fertilization.
Endometriosis is a disorder in which uterine tissue implants and develops outside of the uterus, causing the ovaries, uterus, and fallopian tubes to malfunction.
Fibroids in the uterus are benign tumours that grow in the uterine wall. Uterine fibroids are rather frequent in women in their 30s and 40s. Fibroids may obstruct the implantation of a fertilized egg.
Previous tubal sterilization or removal: If you have had sterilization in which your fallopian tubes are cut or blocked to permanently prevent pregnancy (tubal ligation), IVF may be an alternative to reversal of tubal ligation.
Impaired sperm production or function: If the sperm concentration is low or weak, it may lead to poor sperm motility or abnormalities in sperm size and shape, making it harder for a sperm to fertilize an egg. If abnormalities in the sperm are discovered, your spouse may need to consult a professional to determine if the condition is treatable or a hint of underlying health issues.
Unexplained infertility: Unexplained infertility occurs when no identified cause of infertility is detected despite testing for typical reasons.
Genetic disorder: If your family has a genetic illness, you and your spouse are at risk of passing it on to your child. If this is the case, you may need pre-implantation genetic testing, which is a treatment that requires IVF.
Fertility preservation for cancer or other chronic illnesses: If you are about to begin cancer treatment, such as radiation or chemotherapy, which may compromise your fertility, IVF for fertility preservation may be a possibility. Women may have their eggs extracted from their ovaries and stored in an unfertilized form for later use. In addition, the eggs may be fertilized and saved as embryos for later use.
If a woman’s uterus is not functioning properly or pregnancy involves a serious health risk, IVF can be chosen to carry the pregnancy using another person (gestational carrier). In this situation, eggs are fertilized with sperm, but the resultant embryos are implanted in the uterus of the gestational carrier.
So, where do I begin?
The first step is to receive a referral from your primary care physician to see your preferred fertility doctor or facility for yourself and your partner (if present). When you come in for your initial consultation, your fertility doctor will go over your entire journey thus far, including how long you’ve been trying and what has happened so far. He or she will also review your medical history, surgical history, gynaecological history, and menstrual cycle data. Your doctor will ask lifestyle-related questions to gain insight into your current reproductive status.
After gathering this information, and bearing in mind that each situation is unique, your doctor will recommend particular investigations. These infertility tests are often performed early on to identify and treat any previously undetected problems that may be interfering with pregnancy.
What types of testing are being carried out?
The initial fertility test is a simple blood test that you and your spouse will both do. Antenatal testing, Anti Mullein Hormone (AMH), hormonal profile (pituitary, ovaries, and thyroid), and Karyotype (checking chromosome – genetic material) are all included to guarantee the correct number of Chromosomes and that they are in the correct order. A pelvic ultrasound will also be performed to identify the shape of the pelvis, the uterus and how it appears, the ovaries and their positioning, and whether there are any problems that need to be studied further. Although these tests are not harmful, you may experience some discomfort.
If your male spouse is present, a sperm check will be performed to confirm that there are enough beautiful swimmers. Shape, size, count, and movement are all important to them.
The consultation will be followed up on.
After all testing is completed, you will return to your fertility specialist for a two-week follow-up consultation to receive your results. Based on these findings, your doctor will devise and prescribe the best treatment strategy for you.
Depending on your unique circumstances, treatment may begin on the first day of your period. Whether you intend to use ovulation tracking, IVF, or IUI, today is the first day of your cycle and an excellent time to begin treatment.
The IVF procedure steps.
If you’re having IVF, you’ll need to call the doctors when you get your period, and they’ll ask you to come in for an orientation. You will learn about the drug, how to inject it, how to dispose of it, and any other information relevant to your treatment. Your nurse will also do a blood test to ensure that all levels are optimal for beginning the cycle, and you will be informed of the results and whether or not you can begin treatment that night.
The first injection is an FSH shot, which stands for Follicle Stimulating Hormone and stimulates the ovaries to generate follicles. Follicles are egg-containing fluid-filled sacs. Naturally, only one is produced each month, but during IVF, the growth is stimulated to produce more, therefore the FSH injection. You administer these injections to yourself for the next five days, then return to your clinic to examine how your body responds to the injections (to avoid under or over stimulating the ovaries). Based on how your body has responded, the nurses will then advise you on whether to increase or decrease your dosage.
If your FSH injections are on schedule, you will have a follow-up ultrasound scan and blood test to confirm your body is ready (stimulated) for your IVF cycle. Your doctor will count your eggs to check that they are growing normally and at the appropriate rate. When they are satisfied with your development, you will be given a ‘trigger’ injection, which causes the eggs to mature and become available for collection.
You will have a day procedure to retrieve your eggs two days later (this is the only day you will need to take off work during your IVF cycle). This treatment takes about 5-10 minutes, and you will be completely unconscious while your fertility specialist uses a small needle to extract the follicles, which are guided by an inside scan. These follicles are immediately delivered to an embryologist, who counts the number of eggs in the fluid and prepares them for fertilisation in a dish with sperm from your spouse or donor. If your boyfriend is bringing the sperm sample, he will do it first thing in the morning so that it can be processed for the fertilisation process.
The embryologist will analyse the eggs the next day to see whether ones have fertilised. The fertilised eggs develop in an incubator for five days before dividing and growing into Blastocysts. A Blastocyst is the optimal stage of development for an embryo; the word “blast” means “creating,” and the word “cyst” means “pool,” and it essentially mimics a visual of this stage of development.
Five days after egg collection, the best-looking embryo will be implanted into your uterus using a very thin catheter inserted through the cervix. You should be on day 19 of your IVF cycle at this point, with a few embryos to choose from for transfer. This is something that a scientist and your fertility specialist would advise you on. This procedure is comparable to a pap smear in that it takes about five minutes and you can return to work right away.
What about the two-week waiting period?
The time between transfer and pregnancy test is commonly referred to as two weeks, however it is actually 10 days.
Once a week, nurses will provide you with detailed advise regarding your lifestyle activity and nutritional needs. This usually means eating a well-balanced meal and not drinking alcohol for the next 10 days. After this time, which may be when you are due for a period, you will be summoned back into the clinic. If you have missed this period, it is a sure sign that you are pregnant; nonetheless, a pregnancy blood test is usually recommended for confirmation.
What happens next?
If you were unsuccessful during this cycle, the next step is to schedule a consultation with your fertility specialist to go through the previous cycle in depth and explain why it did not work. For example, how well your medication worked, how well your sperm performed, and the quality of your remaining embryos. All of this information is taken into consideration for the next cycle to be finished.
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