IVF - In Vitro Fertilization And Infertility

Statistics from the Federal Centers for Disease Control and Prevention (CDC) reveal that nearly 15% of women of childbearing age have received some form of infertility treatment. In Vitro Fertilization (IVF) is a first form of ART (Assisted Reproductive Technique) that revolutionized the treatment for infertile couples. With the first IVF birth in 1978 in England and in 1981 in the U.S., IVF has seen increasing success rates and is popular on account of its simplicity, efficacy and lack of invasive procedures. This process involves uniting egg and sperm in the laboratory to treat infertile couples. The process involves basic procedures such as egg retrieval, fertilization and embryo transfer. Read on to find out more about IVF and infertility, the costs and other factors involved.

Infertility and In Vitro Fertilization (IVF):

Blocked or damaged fallopian tubes can make it difficult for the egg to be fertilized or for an embryo to travel to the uterus.

Ovulatory dysfunction:

IVF can be resorted to in cases where the ovaries are not producing eggs in a normal manner or egg production is diminished with age. Women with polycystic ovarian disease fall into this category.

Endometriosis:

The presence of endometrial tissue outside of the uterus and in the pelvis can lead to infertility.

Uterine factors:

Disorders of the uterus that lead to decreased fertility, such as fibroids can be overcome with IVF.

Even in other situations of unexplained infertility or chromosomal problems, immunological problems and serious illnesses, IVF can be resorted to. Besides, the characteristics of couple seeking treatment also play a vital role in the success of having a baby.

Studies indicate a rise in overall live birth rate per treatment cycle of IVF every year. Though the cost is high, people take up IVF treatment for its success rate and simple process. The cost of IVF treatment depends upon your insurance policy. In general IVF treatment may cost around $9,000 to $10,000 which includes office visits, injection training, estrogen and ultrasound monitoring, hospital retrieval costs, 6 months of embryo freezing, lab fertilization expenses, hospital transfer costs and physician services. The rates vary from clinic to clinic. The overall success rate of the clinic plays a major role in the chance of a couple having a baby with one completed cycle of IVF treatment.

The IVF Cycle

To attain pregnancy through IVF treatment, the couple has to pass through several steps - IVF Cycle or the IVF process. Though there is slight variation in treatment between clinics, the basic steps of an IVF cycle include the control of woman's menstrual cycle, stimulation of her ovaries, growth of follicles, egg retrieval and finally the transfer of embryo to her uterus. Pregnancy occurs when an egg released from the ovary unites with the sperm to form an embryo. However, in IVF process, the egg and sperm are collected from each partner and united in the laboratory to produce an embryo. This embryo is then transferred back to the uterus for continued growth. The IVF process involves the following steps:

Control of menstrual cycle: The initial stage of the IVF process commences with optimizing control over the menstrual cycle. This is done by giving birth control pills to the woman to prevent ovulation and keep the female reproductive cycle quiet. This can be extremely distressing for women who are trying to conceive.

Ovarian stimulation

Vaginal ultrasound test is conducted to ensure that the pituitary gland is successfully suppressed and that the ovaries and endometrium are ready for stimulation. This is followed by medication whereby a woman is given fertility drugs to produce multiple eggs.

Monitoring the cycle

This step is crucial to the IVF procedure. Usually the follicle growth is checked after 5-7 days of the fertility drugs injections. This involves a blood test to measure estradiol and a vaginal ultrasound to count and measure the diameters of the growing follicles. This ultrasound also assists in measuring the thickness of the endometrium and its quality for implantation. Since each patient has varying ovarian responses, it is essential to monitor the follicle development closely. Few women have follicles big enough to discontinue the medications at this point. But most of the women continue the injections and return for another blood test and ultrasound in 1-3 days. Eventually the follicles reach a critical size and at this time the fertility drugs are stopped.

Egg retrieval The eggs would have attained a mature size and a HCG (human chorionic gonadotropin) injection is given at this stage to serve the same function as a natural cycle's LH surge. After 36 hours of HCG injection, egg retrieval is done in a surgical setting where the patient is sedated. The retrievals are done transvaginally under ultrasound guidance. A thin needle attached to the side of the ultrasound probe, pierces the top of the vagina and the eggs are retrieved. Though complex, the process is painless and it takes approximately 15 minutes to retrieve the eggs.

Fertilization:Fertilization is a process by which the egg and sperm are allowed to unite. The retrieved eggs are fertilized with the husband's sperm either conventionally or with the help of intracytoplasmic sperm injection (ICSI). In conventional method the eggs and sperm are place in a petri dish thus allowing the sperm to find the eggs, whereas ICSI involves injecting individual egg with an individual sperm to promote fertilization. ICSI is mostly done in cases of severe male factor infertility.

Embryo Transfer The fertilization of the egg and sperm result in embryo and days after monitoring they are transferred to the woman's uterus for further growth. The embryo transfer is usually done 3 days after the egg retrieval when the embryos are at the 4-10 cell stage. In selected cases embryo transfer is done at the 5-day point when the embryos are blastocysts. The transfer is very simple and painless which involves the passage of a very small plastic catheter through the cervix.

IVF Technique - Blastocyst Embryo Transfer

The first IVF human pregnancy was achieved by blastocyst transfer. The rational behind a blastocyst transfer is that an embryo, which has failed to reach the blastocyst stage, would have limited chances of resulting in a pregnancy. However, if it reaches the blastocyst stage it has about 50% chance of implantation. Hence blastocyst transfer is claimed to be more physiological as it mimics nature more closely. This IVF technique is recommended in the following cases:

• Patients who have repeatedly failed to achieve a pregnancy following the transfer of good quality cleaved embryos.
  
• Patients who wish to achieve a pregnancy without the risk of multiple pregnancies.
  
• Patient who do not wish to have their spare embryos frozen.

Risks and Complications with IVF

Serious complications are quite uncommon in IVF treatment.

1. Follicle retrieval is relatively simple, yet may cause some damage to internal organs such as the bowel, bladder or blood vessels. This is quite uncommon and is highly dependent on the patient's anatomy. The common complication could be bleeding due to the inadvertent puncture of a small blood vessel.
   
2. Ovarian hyperstimulation can occur due to higher doses used in IVF. This condition is characterized by fluid retention, with excess accumulations of fluid in the abdomen, pelvis and occasionally in the chest cavity. Mild or moderate hyperstimulation is quite common, occurring in perhaps 20% of patients. Severe hyperstimulation is a very rare complication, occurring in less than 1% of all IVF patients. It is characterized by more severe fluid retention and often necessitates hospitalization for control of the symptoms.
   
3. Multiple pregnancies are one of the most critical complications of IVF and the techniques used to overcome it differ from clinic to clinic. Multiple pregnancies occur due to the excess transfer of embryos, hoping that one or two will implant and develop. However, this occasionally results in double or triple pregnancies. The outcome of these pregnancies is not optimal thereby causing severe impact on the newborn. Many clinics adopt different techniques to avoid multiple pregnancies based on patient's health and anatomy.
   
4. Psychological support is essential when undergoing IVF and infertility treatment. The emotional ups and downs can be stressful and can even strain the relationship between the couple. Further, the financial costs involved lay an added burden.

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