In Vitro Fertilization (IVF)
In vitro fertilization is procedure used to treat certain fertility conditions. With In vitro fertilization, the fertilization of an egg takes place outside of the body. A woman’s eggs are removed from her ovaries, placed in a laboratory culture dish and then mixed with sperm. Fertilization takes place in the dish. Once the eggs have been fertilized and embryos have formed, one to two embryos are placed back inside the woman’s uterus. If the embryo implants in the uterus, the woman becomes pregnant.
When is IVF used?
IVF is often considered as a first line treatment for women with diminished ovarian reserve and severe male factor infertility in which case ICSI is used. However, it is also indicated for several other reasons and may be needed when other treatments fail or in cases of unexplained infertility.
What to Expect:
When an IVF cycle is the treatment option you and your physician decide is right for you, you can expect the following.
1. Ovarian Stimulation :
Ovarian stimulation is performed (controlled ovarian hyperstimulation) using injectable hormones (gonadotrophins). Cycle monitoring is done using ultrasound scans. The aim of treatment is to develop an appropriate number of eggs in your ovary. This is done by adjusting the dose of the medication based on the results of ultrasound scans and blood tests. Ovulation is triggered (HCG) and egg retrieval is scheduled 36 hours later.
2. Egg Retrieval :
Egg retrieval is a surgical procedure performed under conscious sedation in our specially designed operating room at the Oasis Fertility Centre. The retrieval is done using a needle mounted on an ultrasound scan probe. This probe is the same as the one used for cycle monitoring. The eggs obtained are handed to our expert team of embryologists. This procedure takes 20 to 30 minutes.
3. Insemination, Fertilization and ICSI: :
Eggs retrieved are either placed in specialized IVF dishes and mixed with your partners sperm, or in cases of severe male factor infertility the sperm is directly injected into the egg using a procedure known as intracytoplasmic sperm injection (ICSI). The fertilized eggs are then placed in our state-of-the-art incubators for further development. At Oasis Fertility Centre we use real-time time lapse monitoring to assess the health of the embryos which helps us decide which are the best embryos to place in your uterus.
4. Embryo Transfer: :
Fertilized eggs are called embryos. One or two embryos are transferred into the uterus either on day 3 or 5 of the cycle depending on various factors including the number of embryos available, their quality, and other clinical considerations. This is a painless procedure using a narrow catheter inserted under ultrasound scan guidance. The procedure generally takes 15 to 20 minutes. Progesterone, which was started before the egg retrieval, is continued until your pregnancy test. Progesterone may be in the form of either an intravaginal capsule or intramuscular injection.
5. Freezing of Embryos:
When there are more good quality embryos than are being transferred, you will have the option to freeze these embryos so that can be used at another time to try to achieve a pregnancy. The process used to freeze embryos is called vitrification.
A blood pregnancy test is performed approximately 2 weeks following the embryo transfer and is generally repeated within 48 hours to confirm pregnancy. A viability ultrasound scan is performed when you are approximately 6 weeks pregnant. You will then be offered of choice of being referred to your family physician or an obstetrician of your choice.
There are some risks associated with the IVF Procedure including infection and bleeding, along with:
• OHSS – OHSS is a potentially life-threatening complication of fertility treatment associated with injectable hormones (gonadotrophins). The exact cause of OHSS is unknown although increased leakiness of the blood vessels is thought to be responsible. The severity of OHSS varies from mild to severe. While it is common to experience mild symptoms of abdominal bloating and moderate weight gain, severe cases may be associated with accumulation of fluid in the abdomen, vomiting, diarrhea and shortness of breath. Fortunately, the incidence of severe OHSS is less than 5 %. The treatments used to reduce this complication is careful follicle tracking. Should your physician be concerned about the development of OHSS, your cycle may be cancelled, and/or other medications may be prescribed.
• Multiple Birth – is a serious complication of any fertility treatment.
• Ectopic Preganancy– An ectopic pregnancy occurs when the fertilized egg starts to grow in a location other than the uterus. In 95% of cases, ectopic pregnancies are in the fallopian tube, but they can also occur in other sites. The incidence of ectopic pregnancy is higher after IVF than in a naturally occurring pregnancy. The first indication of an abnormally situated pregnancy is a slowly rising pregnancy hormone in the blood (Beta HCG). However, ectopic pregnancy can only be confirmed by demonstrating an absent pregnancy sac in the uterus, seen by ultrasound. Ectopic pregnancies can be a life-threatening emergency if not detected early. Symptoms include severe lower abdominal pain, shoulder tip pain, abnormal bleeding, fainting and difficulty in urination. It is important to seek medical attention immediately as this condition can be managed medically or by conservative surgery if detected early.
• Miscarriage – A miscarriage is defined as the loss of a fetus before 20 weeks of pregnancy. 80% of miscarriages occur within the first 13 weeks of pregnancy. There is a slightly higher chance (approximately 22%) of a miscarriage when undergoing IVF. Women over the age of 35 have a higher (20% to 35%) chance of having a miscarriage than younger women. Chromosomal abnormality of the fetus is the most common reason why a miscarriage occurs. Women over the age of 35 and men over the age of 40 are more likely to be affected by chromosomal abnormalities than younger couples. If you have had multiple miscarriages Comprehensive Chromosomal Screening (CCS) should be considered.
• Stress – Undergoing any fertility treatment can be physically, emotionally, and financially stressful. We at Oasis Fertility Centre recognize how important it is to alleviate stress as much as possible to improve your fertility treatment outcomes. We have dedicated health care professional that can offer you support and counselling.
Success rates for IVF are very dependent upon the age of the woman.
National Averages representing live birth rates per embryo transfer, with a woman using her own eggs: