Infertility & IVF

Infertility :: In Vitro Fertilization (IVF)

Infertility

The inability of women to conceive after a year of having unprotected sex, or the inability of women to sustain pregnancy is known as infertility.

When to get help?

You may have reason to be concerned if you have been trying to get pregnant for at least one year and

• You are in your late 30s and have been trying to get pregnant for six months or longer
• Your menstrual cycles are either irregular or absent
• You have painful periods
• You have a known history of fertility problems
• You have a history of pelvic inflammatory disease or endometriosis
• You have had multiple miscarriages
• You have been treated for cancer with drugs and radiation

What are the causes?

Infertility can be present from birth (congenital) or can be acquired as you age. Some of the causes may include

• Problems with ovulation: Certain conditions, like polycystic ovarian syndrome (ovaries secrete excessive amounts of male hormone testosterone) and hyperprolactinemia (produce high amounts of prolactin, a hormone that induces the production of breast milk), can prevent your ovaries from releasing eggs.
• Damaged fallopian tubes: Fallopian tubes carry the eggs from the ovaries to the uterus. Any damage to them can affect the fertilization of the egg by the sperm. Pelvic surgeries and infections can cause formation of scar tissue that can damage your fallopian tubes.
• Abnormalities of the cervix and uterus: Abnormal mucus production in the cervix, problems with the cervical opening, abnormal shape and presence of benign tumors in the uterus can all contribute to infertility.
• Premature menopause: Mostly caused by a condition known as primary ovarian insufficiency, premature menopause occurs when menstruation stops before the age of 40. The exact cause of this condition is unknown, though various treatments for cancer and abnormalities with the immune system have been known to contribute to it.
• Adhesions: Bands of scar tissue can form in the pelvis after an infection or surgery.
• Other medical conditions: Diabetes, endometriosis, thyroid disorders, sickle cell disease or kidney diseases can affect the fertility of a woman.
• Medications: Certain medications have been known to cause temporary infertility. Stoppage of those medications can restore fertility in most of the cases.

Who is at risk?

Your risk for infertility increases with age. You are at a greater risk if you smoke, consume excess alcohol, or are overweight, obese, or underweight.

Diagnosis

Female infertility can be confirmed with the following tests

• Blood tests measure your hormone levels and determine if you are ovulating.
• Biopsies may be obtained to evaluate the inner lining of your uterus.
• Ovarian reserve testing may be performed in order to determine the number and quality of eggs ready for ovulation.
• Imaging studies such as a pelvic ultrasound may be performed to obtain a detailed view of your fallopian tubes and uterus.
• Laparoscopic evaluation involves inserting a thin tube fitted with a camera through an incision in your abdomen, in order to detect any abnormalities in your reproductive organs, such as the ovaries, uterus, and fallopian tubes.

How is infertility treated?

Your doctor will suggest a treatment suitable for your problem. Fertility drugs may be recommended to stimulate and regulate ovulation, in women who are infertile due to ovarian disorders. You could also be chosen for assisted insemination, where healthy sperm is collected, concentrated, and placed directly into your uterus, when your ovary releases eggs to be fertilized. This procedure is also known as intrauterine insemination (IUI), and can be in tandem with your normal menstrual cycle or fertility drugs. Apart from these, problems with your uterus, such as intrauterine polyps or scar tissue, can be treated with surgery.

In vitro fertilization (IVF) is a type of assisted reproductive technique, which involves collecting multiple mature eggs from a woman and fertilizing them with sperm outside the body, in the lab. Once fertilized, the embryos are implanted into the uterus within three to five days.

Some of the other techniques used in IVF include intracytoplasmic sperm injection (a single healthy sperm cell is directly injected into a mature egg) and using donor eggs or sperm. Gestational surrogates may also be considered for women for whom pregnancy poses high health risks, or for those who have a nonfunctional uterus.

Conclusion

Infertility can be of a variety of causes, and the treatment may differ accordingly. Dealing with infertility can be difficult and can be stressful and emotional, but there is hope -about two-thirds of the couples treated for infertility conceive successfully. Your doctor will be the best person to address your concerns.

In Vitro Fertilization (IVF)

In vitro fertilization (IVF) is a clinical procedure that helps to achieve conception by treating the existing infertility or genetic problems. IVF is a an invasive procedure which takes around 2 weeks for the completion of a single fertilization cycle. The process involves collection of mature eggs from the ovaries and combining them with the sperm in the laboratory. After fertilization, the eggs are implanted into the woman’s uterus.

Indications for IVF

The most common indications for IVF include

• Damaged or blocked fallopian tubes
• Ovulation problems
• Premature ovarian failure (loss of normal function of your ovaries before the age of 40)
• Severe Endometriosis (presence of endometrial tissue outside the uterus)
• Presence of uterine fibroids (benign tumors in the wall of the uterus)
• Male factor infertility, including low sperm count and low sperm motility
• Presence of a genetic disorder
• To preserve fertility for patients with cancer or other health conditions
• Unexplained infertility

Procedure

The steps involved in an IVF treatment are

• Ovulation Induction: The doctor will administer fertility drugs to boost the production of your eggs. Transvaginal ultrasounds will be conducted to monitor the development of the eggs and blood tests obtained to check hormone levels.
• Egg Retrieval: Your doctor will perform a follicular aspiration, a minor surgical procedure to remove the eggs from your ovaries. An ultrasound probe is inserted through the vagina and into the follicles under ultrasound guidance. Each follicle in the ovary is pierced in order to retrieve the egg.
• Insemination & Fertilization: The eggs are mixed with the sperm in an environmentally controlled chamber to facilitate the process of insemination. The egg is fertilized a few hours after insemination. If the chance of fertilization is low, intracytoplasmic sperm injection (ICSI) may be used where the sperm is directly injected into the egg.
• Embryo Culture: Division of the fertilized egg forms an embryo. The development of the embryo is monitored and within 5 days, a normal embryo has several actively dividing cells.
• Embryo Transfer: Embryo transfer is performed 3 to 5 days after egg retrieval and fertilization. A thin tube containing one or more embryos is inserted into the vagina through the cervix and into the uterus. After transfer, if an embryo attaches or sticks to the womb lining, pregnancy is the result.

After the procedure

As the embryo transfer is carried out under the guidance of ultrasound, you will have a full bladder during the procedure. You will be able to empty the bladder after the procedure. For the first two days after an embryo transfer you should refrain from heavy lifting, physical activity like running or aerobics, swimming, alcohol, smoking and intercourse.

You can do a pregnancy test 10 days after embryo transfer to confirm pregnancy.

Risks & Complications

As with any surgical procedure risks and complications can occur. The possible complications associated with specific steps of an IVF include

• Risk of multiple births
• Risk of premature and low birth weight
• Ovarian hyperstimulation syndrome (OHSS) (a condition of ovarian enlargement accompanied by fluid accumulation in the abdominal cavity)
• Miscarriage
• Risks of egg retrieval include bleeding, infection, and damage to the bowel, bladder, or blood vessels.
• Possibility of ectopic or tubal pregnancy