In vitro fertilisation

What is IVF?

IVF or In Vitro Fertilization is a procedure where female egg is fertilized with male’s sperm outside the body under culture condition, which is almost similar to that of woman’s tube.

When is IVF required?

This is a technique to provide a child to infertile couple. It is required in the following instances:

• Presence of irreparably damaged fallopian tubes and absent tubes
  
• Oligospermia that fails to respond to any other therapy
  
• Idiopathic infertility
  
• Presence of sperm antibodies
  
• Abnormal cervical factor
  
• Tuberculosis in which tubal reconstruction is contraindicated
  
• Endometriosis
  
• Peritonial factor

How is IVF done?

IVF does not involve any surgical procedure requiring a cut or stitch. The ovaries are stimulated on day 2 of a menstrual cycle with the help of drugs. These follicles take 12-14 days to develop fully. It is at this stage that eggs are aspirated out from the ovaries. The egg collection is done under sedation or short general anaesthesia in which a needle is inserted through the vagina, and under ultrasound guidance the eggs are collected from both the ovaries. One tries to get multiple eggs but each woman responds differently. This procedure takes 15-30 minutes. In normal circumstances hospitalisation is not required. Soon after the eggs are obtained, at the same time the partner is asked to collect a semen sample by masturbation.

How does conception occur in IVF?

Normally conception occurs by the fusion of sperm (male sex cell) and egg (female sex cell), inside the woman's womb. In IVF, the sperms and eggs are fused (fertilized) outside the womb. This is done in special tubes and petridishes in the IVF laboratory. Special incubators are used to keep these sperms and eggs together in an environment similar to the mother's womb. Once there is successful fertilisation, these embryos (earliest form of the baby) are put in to the mother's uterus. This procedure is known as Embryo Transfer or ET.

What is the duration of IVF treatment?

IVF is undertaken as a procedure which is effective only for the menstrual cycle in which it is applied. Therefore, the duration of treatment is as long as normal menstrual cycle lasts. At the end of the cycle, success of the treatment is marked by a positive pregnancy, otherwise the next menses ensues and the procedure can be repeated if the patient desires.

How many attempts of IVF can be undertaken?

Minimum three attempts would be a reasonable number for a couple to undertake. However, more attempts can be undertaken if the couple wants or if the IVF centre has something positive to add in the subsequent cycle.

How low a sperm count can be accepted for IVF?

Normally 50,000 actively motile sperms are required per egg for fertilisation. Therefore, a sperm count of 4-5 million with adequate motility can be accepted for IVF.

If the sperm count is lower than required, an Intracytoplasmic sperm injection (ICSI) is administered. In this procedure one sperm is directly injected in to one egg. This involves very sophisticated equipment along with adequate expertise.

How is Embryo Transfer done?

Four to six hours after the eggs and sperms are collected they are put together in the incubator. The eggs are fertilised by the sperms. After fertilisation takes place embryos can be transferred after two to three days. Embryos are transferred into the uterine cavity through the vagina with the help of special fine catheters. ET is a painless procedure and no anaesthesia is required. Normally 3-4 embryos are transferred if ET is done on the second or third day. However, if ET is done on the fourth or fifth day at an advanced stage of embryo development, only 1 to 2 embryos are sufficient to cause a successful pregnancy.

Surplus embryos can be safely cryopreserved (preserve at very low temperatures) in liquid nitrogen at temperature of minus 196 degree centigrade and kept for an indefinite period. These embryos can be used after thawing (bringing back to room temperature) in any subsequent cycle.

What are the complications?

The drugs used for stimulating egg development in ovaries can sometimes excessively stimulate ovaries leading to a symptom complex known as Ovarian Hyper Stimulation Syndrome (OHSS). This syndrome can be difficult to manage and at times can be life threatening. Multiple pregnancy is an another risk which patients undergoing IVF have to face.

What is the success rate of IVF?

The success rate in India is 40-45% which compares very favourably with other centres throughout the world .

What is the cost of one IVF treatment cycle ?

The cost varies across the country and various centres. In India it may cost Rs. 85,000 which includes all investigations, ultrasonography, medicines and procedure of IVF during one cycle.

All major metropolitan cities have facilities for IVF. In Delhi, it may be done at Sir Ganga Ram Hospital and the Mother and Child Hospital.