IVF Procedure Explained

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ivf-procedureWhat is IVF?

In Vitro Fertilization (IVF) is an assisted reproductive technique where the eggs (ova) and the sperms are fertilized in the lab ‘outside the body’ and later the embryo formed is placed in the uterus of the woman. The IVF procedure is a treatment for infertility when a couple cannot conceive naturally due to any reason. The couples facing infertility issues can enjoy parenthood with the help of IVF procedure.

When is IVF needed?

IVF is needed primarily when a couple is faced with one or more of the following conditions:

Male infertility

In case of inadequate sperm count or reduced sperm motility or poor sperm structure (for male partner)

Ovulation issues

If the ovary is not releasing healthy eggs or releasing fewer eggs or absence of ovulation (female partner)

Damaged or blocked fallopian tubes

The eggs reach the uterus via fallopian tube. If the tubes are damaged, removed or blocked due to any reason, woman cannot conceive.

Uterine Problems

Uterine fibroids or benign tumors and endometriosis interfere with implantation of fertilized egg preventing the pregnancy.

Absence of uterus

If the woman has no uterus by birth or if the uterus is removed due to some disease like cancer, pregnancy can be attained through IVF by using a surrogate mother’s uterus.

Unexplained infertility

When pregnancy is not attained even though there are no signs abnormality in both male and female.

Genetic testing

When there is a risk of passing a genetic disorder to the child, couples can choose IVF for pre-implantation genetic diagnosis (PGD) in which the embryos fertilized in lab are screened for genetic disease. Only the healthy embryos without identified problems are transferred to the uterus.

Death of a partner

If one of the partners is dead and the couple has already stored their egg or sperm, pregnancy can be achieved through IVF.

Fertility preservation

Women having a disease like cancer which may affect their chances of pregnancy or lower the egg quality can choose egg freezing technique to preserve their fertility. Egg freezing is a part of IVF procedure. Later whenever the couple wants to conceive the embryo can be transferred to the uterus.

Same sex couples

Same sex couples can have their baby through IVF using sperm or egg of third party. However, this is not allowed in many countries of the east.

IVF procedure step-by-step

The following section would give a step-by-step detail of the procedure of IVF.

STEP 1: Egg Stimulation

egg stimulationFertility medicines or hormones are given to stimulate the egg production by the ovaries. Multiple eggs are necessary to increase the chances of fertilization as not all eggs may fertilize into embryo after retrieval. During stimulation process regular blood tests to measure the hormones levels and transvaginal ultrasound to monitor the ovarian follicles are done.

If your ovaries are not producing eggs or absence of ovulation, donor eggs are recommended.

STEP 2: Egg Retrieval

egg-retrievalOnce the eggs are produced, they are retrieved from the body. Eggs retrieval involves a minor surgery in which an ultrasound probe is guided into the vagina to identify egg follicles followed by a needle to retrieve the eggs. The whole process takes about 20 minutes to complete. The retrieved eggs are placed in a culture medium and incubated for fertilization with sperm.

STEP 3: Egg Fertilization and Embryo Culture

egg-fertilization and embryo-cultureThe next step in IVF procedure is egg fertilization and formation of the embryo. It is done either by insemination or ICSI (Intracytoplasmic Sperm Injection) method.

During insemination, your partner’s or donor’s sperms are acquired and mixed with the egg in the lab for fertilization and observed for the embryo development. If the chances of fertilization are low due to male infertility, ICSI technique is recommended, in which a single sperm is directly introduced into the egg to form the embryo. The eggs are then closely monitored to confirm fertilization and cell division. The fertilized eggs are embryos ready for transfer into the uterus.

Sometimes, before the Embryo Transfer (ET), you may be recommended below procedures based on your case and requirement:

Pre-implantation Genetic Diagnosing (PGD)

PGD in IVFPGD technique can identify genetic defects in the embryos formed through IVF. It is recommended when one or both the partners have any genetic disorder which they fear can be transferred to their offspring. The genetic testing ensures the healthy embryo without the defected genes is transferred to the uterus for pregnancy. While new advanced PGD technique is very accurate, but cannot guarantee 100% precision. Prenatal testing is still recommended by IVF specialists.

Assisted hatching

assisted-hatchingFor successful implant of the embryo into the uterine lining, an embryo has to hatch out of its outer layer called the zona pellucida and then attach to the walls of the uterus. Experts found likelihood of embryo implantation during IVF increases when zona pellucida is thin. Thus, assisted hatching technique is used in which a hole is made in the zona pellucida of the embryo on the fourth day of embryo development. This embryo after assisted hatching is ready for uterus implantation. Assisted hatching is recommended to older women or those with multiple failed IVF or who have poor embryo quality.

STEP 4: Embryo Transfer

Embryo transferThe last step in the IVF procedure is ET or embryo transfer. It takes place after two to five days of egg retrieval. A flexible catheter carrying embryos is guided through the vagina to reach your uterus where they are transferred. It is a painless process with little discomfort and just takes about five minutes to complete.

In six to 10 days after ET, the embryo implants in the uterus lining. Post the embryo transfer, a rest for a day is advised after which you can get back to normal work. After about two weeks a pregnancy test is done to confirm pregnancy. Once you conceive through IVF, it is same as normal pregnancy.

Cost of IVF

IVF cost

The cost of IVF treatment varies with every patient based on their medical reports. The cost of complete in-vitro fertilization treatment can be divided into three parts:

 – Pre-IVF procedure expenses

– IVF procedure expenses

– Post-IVF procedure expenses

1. Pre-IVF procedure expenses

The first visit to the infertility specialist entails the initial consultation charges and the expenses of recommend tests to determine your probability of undergoing IVF or any other ART procedure. Thus, the pre-IVF expenses would include:

  • Initial consultation fee
  • Diagnostic tests like FSH, LH, E2, TSH, HSG, Prolactin tests etc.
  • Laparoscopy (if required) – The cost varies in each country. In the U.S. laparoscopy cost is about US$1,700-US$5,000 while in India it is approximately US$300-600 (INR 20,000-40,000)
  • Hysteroscopy (if required) – The cost differs in each country. In India it is approximately US$250-450 (INR 15,000-30,000) while in the U.S. it cost around US$750-US$4,000.

2. IVF procedure expenses

The IVF procedure cost is different in every country. Its average cost in the US is about US$12,000 plus medications and in India it is US$3,000 (INR 2 lakh). Your IVF procedure includes the cost of below:

  • Ovarian Stimulation
  • Hormonal injections and other drugs
  • Egg Retrieval
  • Sperm Washing
  • Egg Fertilization
  • Embryo Transfer

Other additional IVF costs

There are other additional costs that may occur on case-to-case basis. You may medically require them or prefer to opt, based on your medical case. Below are the additional expenses that may add to your IVF treatment:

  • Donor egg, donor sperm, or donor embryo
  • Freezing (cryopreservation) of egg, sperm, and or embryo
  • Thawing of frozen egg, sperm, or embryo
  • Add-on advanced procedures (ICSI, Blastocyst culture, SET etc.)
  • Surrogacy costs, if required

3. Post-IVF procedure expenses

After your IVF procedure, once you conceive, the expenses would be that of normal pregnancy, like gynecologist’s consultations, ultrasounds, and delivery charges etc.

IVF Treatment Package Cost

Some IVF centers also offer option of IVF procedure package that includes the cost of one IVF cycle (sperm collection through PESA/TESA, Ovarian Stimulation, Egg Retrieval, Sperm Washing, Egg Fertilization, and Embryo Transfer), drugs, sperms or eggs preservation for a year, and any of the advanced procedure like ICSI, to enhance the IVF success rate. The package generally excludes pre-IVF expenses and post-conceiving delivery charges.

Package is usually beneficial, if your first IVF fails. In the next cycle you will not have to go through complete process and will spend only for the embryo transfer.

Before taking the IVF procedure you should be aware and well-informed about which procedures you are paying for.

Side effects of IVF

An IVF Procedure is mostly considered safe (when done by qualified specialists). However, you may experience one or more of the following conditions.

  • Little fluid clear or blood-tinged discharge after the procedure
  • Mild cramping and bloating
  • Breast tenderness
  • Constipation

However, if you experience any of the following conditions, please see your doctor immediately.

  • Pelvic pain
  • Heavy vaginal bleeding
  • Blood in the urine
  • Fever above 100°F

Risks of IVF

Multiple births

multiple-pregnancy in IVFIf more than one embryo is transferred and in the uterus during the IVF procedure the chances of multiple births increases. This raises the risks of early labor and low birth weight of the babies born.

But with advancement in technology, multiple births are coming down in IVF procedures.

Ovarian hyperstimulation syndrome

Certain fertility drugs used for ovulation can lead to swollen and painful ovaries, a condition known as ovarian hyperstimulation syndrome.

Egg-retrieval risks

The procedure to collect eggs may cause bleeding, infection or damage to the bowel or bladder.

Ectopic pregnancy

Though very less but there are chances of an ectopic pregnancy (when the fertilized egg implants outside the uterus). Such pregnancies pose serious health risk and need to be terminated. However, ectopic pregnancy can happen even in normal pregnancies and is not special to IVF.

Stress

Although IVF is a big hope for childless couples, at the same time it is physically, emotionally and financially exhausting procedure, especially if repeated IVF cycles fail. You need support of spouse, family and friends to keep your spirits intact.

Frequently Asked Questions of IVF, with responses

How long does it take for an IVF procedure to finish?

One IVF cycle takes about four to six weeks to complete starting from ovarian stimulation to embryo transfer (ET).

When will I know if I’m pregnant after the IVF procedure?

Pregnancy test is done two weeks after the day of embryo transfer.

How many embryos will be transferred in my uterus during IVF?

The decision of number of embryos to be transferred depends on age and individual medical condition. Generally those in their 30s have only one or two embryos transferred while if over 40 years of age, more than two to three embryos are placed in the uterus. Multiple embryos increase the risk of multiple pregnancy. Your doctor will discuss this with you before your ET.

How to prepare my body for embryo transfer?

Not only embryo transfer but throughout the IVF procedure, it is important for the woman to keep calm, relax, stress-free and maintain healthy lifestyle including healthy eating habits, no smoking, and no alcohol intake.

Will there be bleeding after the egg retrieval?

Yes, a minor vaginal spotting or bleeding is normal after egg retrieval.

Is the embryo transfer painful?

The embryo transfer is not a painful process. There might be little discomfort and takes hardly five minutes to complete.

Shall I do bed rest after embryo transfer?

Post the embryo transfer, a rest for the day is advised after which you can get back to normal work.

Will I have multiple pregnancy (twins, triplets, or quadruplets etc.) through IVF?

Not necessarily. The new advanced IVF technology has largely reduced the chances of multiple pregnancies as mostly one or two embryos are only transferred in the uterus. While multiple pregnancy can also be tackled through selective reduction (multi-fetal pregnancy reduction or MFPR) method in which the number of fetuses are reduced.

Which pregnancy test should I do after my ET?

If you have undergone an IVF treatment, a blood pregnancy test should be taken to find out if you are pregnant. The blood test can detect beta-HCG hormone, if the embryo implantation has occurred. Do not take a urine pregnancy test after IVF treatment as there are chances of false results.

What next if I become pregnant through IVF?

If pregnant after IVF, you will be evaluated to ensure successful pregnancy. Once the fetal heartbeat is confirmed, you are referred to an obstetrician for the rest of the pregnancy period. The pregnancy through IVF is same as that of natural pregnancy.

What shall I do if my IVF cycle fails?

You can always go for another cycle with your frozen embryos.

What should be the gap duration for next IVF cycle after a failed IVF?

Usually doctors advise a wait for at least two ovulation cycles (two months) before starting the next IVF cycle. Also, your specialist may want to treat any clinical condition, he/she may advise the break accordingly. However, you should ensure your physical and emotional health before starting with the second IVF attempt.

After my failed IVF, shall I go for the same IVF specialist or look for second opinion?

If you feel your doctor is not responding well to you after a failed IVF and not able to clear your doubts you always have the option to take second opinion. A second opinion can confirm if you are on the right treatment mode. Carry with you detailed treatment reports of your IVF cycle including the pictures of your embryos to help the IVF specialist give sound second advice.

Is there a guarantee that my next IVF cycle will be a success?

No, not even best of IVF specialist can guarantee success in any of the IVF cycle. This is something you have to be prepared for as we all know IVF success rate is 40-50% only. You should not lose hope as there had been cases when couples conceived in first or second cycle, or had to undergo multiple cycles before finally getting pregnant.

What should I do with any extra embryos?

It is always better to store and freeze any extra embryos via the technique called cryopreservation. In case the first IVF cycle is not successful, frozen embryos can be further used in next cycles and you do not need to go with the fresh egg retrieval and fertilization process again. This means the following cycles will also be less expensive. The good thing is that the embryos can be frozen for several years for future use.

Can I donate my extra embryos?

Yes, you have the choice to donate the unused frozen embryos to a research facility for the use of another couple.

Can a woman without uterus or ovaries conceive through IVF?

Yes, you can still become a parent through IVF. If you do not have a uterus or face absence of ovulation, surrogacy and donor eggs can help you become parents.

What is the cost of an IVF cycle?

The IVF cost varies with the location and treatment procedures undertaken. In the US the cost of IVF is approx. US$12,000 while in India it comes to over US$3,000 (INR 2 lac) which may go up with the procedures opted such as PGD, donor eggs or surrogate mother etc.

Is IVF cost covered under insurance?

IVF is generally not covered under insurance plan. In some countries only few components of IVF treatment are covered under insurance, provided by select few companies. You should check with your insurance provider for the same.

Can I exercise during the period of IVF treatment?

Yes, you can do light exercises like walking, swimming or yoga but avoid high-impact workouts such as jogging, weight lifting or aerobics, etc.

What are the lifestyle restrictions during an IVF cycle?

Stop smoking and discontinue the intake of alcohol at least three months prior to the IVF cycle. Try to relax and be stress-free.

If I am on any medication before IVF cycle, can I continue taking it?

Share with your infertility specialist, if you are on any medication, or taking over-the-counter drugs as some medicines may interfere with the IVF treatment and ovulation.

Do I need a support at home during IVF cycle?

An IVF cycle is an emotional and stressful journey. You can be at your normal routine work during IVF cycle but it is always helpful to have an emotional support to speak to, such as friends and family, or a psychologist/counselor.

Can I undergo acupuncture during IVF treatment?

Yes, you can undergo acupuncture prior or during your IVF cycle. The traditional Chinese treatment method, Acupuncture is said to increases the chances of conception but there are still divided views on the claims.

Will I be at a higher risk of miscarriage, if conceived through IVF?

Miscarriage risk in an IVF pregnancy is same as that in natural pregnancy. The risk increases in older couples. There can be many reasons for a miscarriage, mostly unexplainable. But couples who suffer a miscarriage can go on to have a successful IVF pregnancy.

Does IVF increases the risk of ectopic pregnancy, i:e., embryo implantation outside the womb?

The chances of ectopic pregnancy through IVF are same as would be in natural pregnancy. The embryos are very carefully transferred into the womb, but it does not instantly attach itself to the uterine wall. It can sometimes migrate to the fallopian tube and develops there.

IVF Myths and Facts

Myth 1: IVF is unsafe.

On the contrary, IVF is a safe procedure. There are some temporary side effects of IVF which are easily managed. Hardly 2% of IVF patients may have severe ovarian hyperstimulation syndrome, which can be also managed by the doctors.

Myth 2: IVF is the first & last option for infertility treatment.

Not at all! IVF is just one of the ART techniques that may be recommended based on the cause of infertility or in cases of unexplained infertility. There are other smaller ART procedures such as Intra Uterine Insemination (IUI) or ovulation induction (OI) that can treat the infertility problem.

Myth 3: IVF makes the women and men fertile.

No, IVF does not cure infertility. It helps the couples to become parents despite their infertility problem.

Myth 4: IVF guarantees pregnancy.

Sadly, this is not true! Even the worldwide success rate of IVF procedure is 45-50%. The IVF success rate depends upon multiple factors like age, your medical history and the precision of your IVF specialist. Although in spite of all the precautions and the best of treatment there is no 100% guarantee of pregnancy through IVF.

Myth 5: IVF is not worth after 40 years of woman’s age.

This is not true. Although age is an important factor for conceiving but there are cases of successful IVF in which woman were over 50 years of age. The chances of IVF success reduce after 40 years but it does not mean one cannot conceive at all.

Myth 6: IVF babies are different.

Absolutely not! Children born through IVF are same as born via normal natural pregnancy.

Myth 7: Pregnancy through IVF leads to multiple births of twins, triplets, etc.

Risk of multiple births has largely reduced with advanced IVF technology. Generally more than one embryo is transferred in the uterus during the IVF procedure to maximize chances of conceiving but risk of multiple births can be decreased by reducing the number of embryos transferred. Multiple pregnancy can also be tackled through selective reduction (multi-fetal pregnancy reduction or MFPR) method in which the number of fetuses is reduced.

Myth 8: IVF is never successful in first cycle. You have to undergo multiple cycles.

Not true, IVF can be successful even in first attempt. But there is still not any way to guarantee the pregnancy in first IVF cycle, or predict number of cycles required. Even if the highly experienced IVF specialist is doing the procedure with utmost precision, he can never guarantee the success.

Myth 9: IVF is only for rich.

It is not true. Though IVF is expensive, but its cost has been stable over the years and not increased. It is also much less than the cost of other major procedures such as joint replacements surgeries or heart bypass etc.

Myth 10: IVF requires admission in the hospital.

Not at all, IVF is an out-patient treatment.

Myth 11: IVF treatment involves lot of pain

No at all, there is little discomfort and you may experience temporary bearable pain.

Myth 12: IVF is only for young people.

On the contrary, IVF is for couples of all age groups, including those who have crossed their fertility age. By using donor eggs, older couples too have enjoyed parenthood due to the IVF treatment.

Myth 13: IVF leads to early menopause.

Not true. IVF treatment does not deplete your egg reserve. In fact it retrieves the egg follicles that would have gone wasted during a menstrual period. Early menopause will not occur even if you undergo multiple IVF cycles. Also to note, women having infertility issue are at anyways at risk of early menopause due to poor ovarian reserve irrespective of whether they undergo IVF or not.

Myth 14: IVF hormone injections cause emotion turmoil.

Again a myth, the female estrogen hormones given to stimulate egg production during IVF are considered to be “happy hormone.” They do not cause any anxiety or change in emotions. IVF procedure is stressful and often women get anxious probably due to the concerns related to the success of IVF cycle and not because of hormone injections.

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