What is the IVF Process?
Will IVF Process for me!!- This is the first question that comes into the mind of prospective intended parents.
Fertility-related awareness is not common like any other stream of healthcare. The lack of awareness makes it more difficult for couples who silently suffer from infertility or sometimes not even aware of it.
Infertility is the inability of a couple to become pregnant even after one year of unprotected sexual intercourse using no birth control methods.
Any medical intervention that is done to assist a couple to have their own child can be considered an infertility treatment.
This can be as simple as receiving advice on the right time of the month to have regular sex, and as complex as a cycle of In-vitro fertilization. In laymen term, IVF meaning or IVF definition is to facilitate fertilization outside the body in a petri dish and then put back embryos back into the female uterus.
In-Vitro Fertilization (IVF-ICSI) or IVF Process has become the most widely used infertility treatment for thousands of Intended Parents to fulfill their dream of parenthood.
IVF is a form of assisted reproductive technology (ART), which gives infertile couple chance to have a biological child of their own.
In Vitro Fertilization (IVF) involves the mixing of woman’s eggs and male’s sperms under an artificial condition in a laboratory and then transferring resulted embryos to woman’s uterus. The patients with the following conditions will be indicated for IVF.
- Male Factor Infertility
- Absent or Damaged Fallopian Tubes
- Unexplained Infertility
- Recurrent Intrauterine Insemination Failure
- Tubal and Pelvic Adhesions
- Preimplantation Genetic Diagnosis (PGD)
IVF-ICSI – Intracytoplasmic Sperm Injection, or ICSI, is a technique in which a single live sperm is injected into the center of a single human egg.
This technique is developed to help achieve fertilization for couples with severe male factor infertility or couples who have had a failure to fertilize in a previous in vitro fertilization attempt.
IVF-ICSI could be one of the best options for the couple struggling with male factor infertility, which includes low sperm count, low number of live sperms, or sperm motility and morphology issues. ICSI is also used to increase the success rate for unexplained infertility.
Generally, the fertilization rates with ICSI are 75%, which is the same as fertilization with a normal semen sample. The success rate of IVF and IVF with ICSI is same; however, the current medical community believes that with ICSI success rate is better, may be due to a higher number of fertilized embryos it yields, making it more popular among the fertility experts.
IVF cost in India and abroad
It goes without saying that having IVF baby or IVF babies is not easy to achieve. The IVF Cost is high and it does not give 100% desired outcome. The emotional and financial burden is not easy to handle for most couples.
Till now, infertile couples around the world are struggling to have affordable IVF treatments. Although in Asian countries like India, the IVF cost is still cheaper.
For some couples, using Third-Party Reproductive services like egg donation and surrogacy is required to give them optimum chances of success. In such cases, the cost of overall infertility is much higher as IVF Egg donation and IVF surrogacy is needed.
Although we offer IVF treatment in many countries, our aim is to to give our lovely couples affordable IVF services in our New Delhi IVF Clinic as in India the cost of IVF is still low.
IVF Process- Step-by-Step Guide
The IVF Process involves multi-steps and can be done at a specific time of female parent menses cycle. Although IVF is a costly treatment, it does not guarantee 100% success for pregnancy.
To have the optimum IVF Success rate, an experienced fertility doctor is needed can diagnose and provide the best line of treatment for the childless couples.
An IVF treatment cycle typically includes the following steps:
Step 1. Suppressing the natural monthly hormone cycle
As a first step of the IVF process, you may be given a drug to suppress your natural cycle. To start this treatment either a daily injection (which is normally self-administered unless you are not able to do this yourself) or a nasal spray is given. This continues for about two weeks.
Step 2. Increasing the Egg Numbers
After the natural cycle is suppressed, you are given a fertility hormone called FSH (or Follicle Stimulating Hormone). This is usually taken as a daily injection for around 10 to 12 days.
This hormone will increase the number of eggs you produce in each ovary. It means you will have more eggs to be fertilized with sperms of the male partner and thus, many embryos for implantation.
With more fertilized eggs, the IVF clinic has a greater choice of embryos to use in your treatment. This means you can have more attempts for embryos transfer and so improved IVF success rates.
Step 3. Checking on progress
Throughout the drug treatment, the clinic will monitor your progress for the number of follicles in ovaries. The number and size of the follicles are closely monitored via vaginal ultrasound scans and blood tests.
Around 34 to 36 hours before your eggs are due to be collected you have a final hormone trigger to help your eggs mature and subsequently get ready for retrieval.
Step 4. Collecting the eggs/semen sample
In the IVF process eggs are usually collected by ultrasound guidance under local anesthesia. This involves a needle being inserted into the scanning probe and into each ovary, facilitating egg pick up. Sometimes a cramping and a small amount of vaginal bleeding can occur after the procedure.
The collection of sperm in the male partner is much easier. Around the same time when the female partner is going through eggs collections procedure; the male partner is asked to produce a fresh sample of sperm.
This is stored for a short time before the sperms are washed and spun at a high speed. This is so the healthiest and most active sperm can be selected. If you are using donated sperm, it is removed from frozen storage, thawed and prepared in the same way.
In case the childless couple is using an egg donor, the pre-IVF tests and stimulation and egg pick up process is done with the egg donor.
Step 5. Fertilization of eggs with sperms
The eggs retrieved from the female partner are mixed with male partner sperm udder strict artificial condition. The environment of the lab is closely monitored to give optimum chances of fertilization.
The embryos are cultured in the laboratory for 16 to 20 hours. A lab technician keeps a close look to check the fertilization rate.
Those that have been fertilized (now called embryos) are grown in the laboratory incubator for another one two days before being checked again.
Step 6. Embryo Transfers
After fertilization, the best 1-2 embryos are selected and transfer to the female partner with the help of a thin catheter. This process can be done without anesthesia and takes 15-20 mins.
This process is known as embryos transfer and it is relatively simpler and does not require any anesthesia.
The number of embryos transferred is restricted because of the risks associated with multiple births.
Remaining embryos are frozen in vials for future use, if this cycle is not successful. If not required immediately frozen embryos can be kept for years. Or if not required, these embryos can be donated.
Some IVF Clinics may also offer blastocyst transfer ( Day 5 embryos), where the fertilized eggs are left to mature for five to six days and then transferred. This is known as Blastocyst transfer.
Step 7. Follow-up after Embryos Transfers
After embryos transfer, the recipient is asked to take 2 days rest and to avoid any strenuous activities. You need to take progesterone supplement continuously to support the implantation. Following 12 to 14 days embryos transfer, blood tests know as BHCG Serum test is done to confirm the pregnancy.
Step 8. Follow-up for pregnancy or next attempt
In case a successful pregnancy is confirmed through blood tests, continuous support of hormone is given until 10 weeks to 12 weeks.
If pregnancy confirmed, then the rest of the antenatal care can be carried out like a normal pregnancy. In Scenarios where there is no pregnancy, further options are discussed with the couples.
In case you have frozen embryos stored, you can go ahead with frozen embryos transfer (FET). In case there are not surplus embryos, a new fresh IVF cycle is repeated.
If couples have multiple failed IVF cycles, your fertility doctor can suggest egg donor IVF for you.
Some other ART-related terms for IVF Process which intended parents should know are:
Frozen Embryos Transfer
Frozen embryo transfer (EFT) is a process in which frozen embryos are transferred to the uterus of the female partner, rather than fresh embryos.
Who is eligible to go through frozen embryos transfer:
- This process can be useful when the couple is using donated embryos.
- If couples have surplus good quality frozen embryos left after IVF cycle and they wish to use them in the future.
- If the female partner does not have adequate lining as required for the embryos transfer, the doctor might decide to freeze the embryos and use them in subsequent months.
With the development of the latest technology, it is possible to freeze and store good quality embryos on day 3 or blastocyst-stage with various freezing techniques.
Nowadays embryos are frozen using a vitrification technique; this process involves rapid freezing to prevent any ice crystals forming in the cells of the embryo. The faster the freezing process, the more likely it is that a frozen embryo transfer will result in a successful pregnancy.
Frozen embryos can be stored for years. Although the chances of pregnancy are lower with frozen embryo transfer, the data is open to interpretation. When high-quality embryos are compared, there seems to be no difference in the likelihood of getting pregnancy whether you have a fresh or frozen embryo transfer.
Typically, while doing embryos transfer, Day2 to Day3 embryos are placed in female partner uterus, and this is a procedure followed by most of the fertility clinics.
However, blastocyst embryos transfer is a process in which embryos are cultivated till day 5 in the lab and then embryos transfer is done on Day5 to Day6 after fertilization. By this time embryo reaches to about 120-150 cells stage and known as the blastocyst.
The benefits of Blastocyst Transfer are:
- A blastocyst can significantly reduce the chances of multiple births as only 1 or 2 good looking embryos, which have survived till Day5 in artificial condition are chosen and transferred.
- Nowadays most of the fertility clinics offer IVF with blastocyst transfer as it has been shown to improve the success chances.
- A Blastocyst can withstand till day 5 in the lab and seems to be strong enough to survive. Thus parents can expect to optimize success rate with it.
Embryo Donation and Embryo Adoption are similar concepts, and sometimes the terms are used interchangeably.
Both refer to the giving and receiving of embryos created during an In Vitro Fertilization (IVF) cycle. Once IVF has done, and it is successful, the remaining embryos are frozen for future use. Or else, can be donated to prospective Intended Parents or scientific research.
However, recipients intended parents have no genetic link with the baby and female partner is an only gestational carrier of the child. So, embryo donation is like adoption; however, there is more emotional connect as the female partner carries the baby for full pregnancy and subsequent delivery.
Few couples like to choose an egg donor and sperm donor of their choice to create embryos before embryos transfer in the female partner. In this case, couples have particular egg donor requirements and ready to spend more on a new IVF cycle.
Infertility is a widespread phenomenon in the current time. Not all fertility-related issues are women oriented, a matter of fact there is a fundamental rise in male-related infertility issues. Out of 5 infertile couples, one of the couples is unable to conceive due to male related fertility issues.
The male fertility is on rising owing to stressful and sedentary lifestyles. The good news is that most of the infertility related issues can be diagnosed and cured with the correct medical help
For male, the first line of assessment is via Sperm Analysis. It is a simple sperm analysis tests which can indicate the quality and quantity of the sperm to a fertility specialist.
Male-related fertility issues
Male-related fertility factors are mostly due to low sperm counts, low sperm motility, abnormal morphology, no sperm at all or some other genetic inherited condition.
Low Sperm count
Male infertility is the common factor nowadays due to unhealthy lifestyle and excessive stress in the present time. In ART treatment like IVF-ICSI, even a few good sperms could be utilized to fertilized the eggs. There are few medicines, and vitamin supplement suggested to use before starting the IVF process.
Less sperm motility can cause hindrance in successful fertilization, and that is why IVF is used to rule out this male fertility issues.
This factor is related to the abnormal shape of sperms, head part or tale part. Generally, abnormal looking sperms are seen under the microscope, but what needs to be analyzed further is their genetic makeup. There is more chance of having unsuccessful conceptions, miscarriage with such sperms. DNA fragmentation is common in sperms with morphology defect.
Sometimes thick seminal fluid is also a reason for infertility. It became difficult for sperms to travel through seminal viscous liquid and thus no pregnancy achieved. Various ART treatment is available to fix this condition.
Male hormones imbalance also hinder successful conceptions. To rule out such a situation, a fertility specialist will make some tests, and hormonal imbalance can be corrected with regular medication.
Ejaculation issue is due to a medical condition where the male partner is unable to ejaculate seminal fluid. Ejaculations issues can be due to the blocking of tubes or other structural defects in the male reproductive organ. In cases, PESA is one of the methods in which fertility specialist obtain sperm sample via a minor surgical procedure.
The unexplained infertility is a common cause of infertility in both partners. All tests and clinical analysis or scan shows no apparent issues in any partner, but still, couples are unable to conceive. Unable to have a baby due to unexplained infertility is the most frustrating situation for couples who are unable to conceive without any apparent reason. In some cases, it is advised to go through genetic screening to rule out any underlying genetic defect in embryos, which might stop implantation or successfully grown of the fetus.
Surgical Sperm Retrieval
Sometimes a male partner is unable to ejaculate sperms because of blocked tubes in their testes or because of any other condition, which prevents their sperms from being released. For such a situation, a minor surgical intervention is needed to extract the sperms. This is known as Surgical Sperm Retrieval.
Some form of surgical intervention is required for sperms retrieval for testicles before doing IVF with intracytoplasmic sperm injection.
There are various methods of removing sperms as below depending upon the individual case.
TESA (Testicular Sperm Aspiration)
TESA involves placing a needle attached to a syringe through the skin of the scrotum and merely sucking out the fluid inside the testicle.
PESA (Percutaneous Epididymal Sperm Aspiration)
PESA involves the same needle and syringe technique, but the needle is placed directly into the epididymis.
Perc biopsy (Percutaneous biopsy of the testis)
Perc biopsy is similar to TESA, but a larger needle is used. The need used is a 14 gauge needle usually used to biopsy testicular tissue, and it usually extracts a more significant number of sperms.
MESA (Microsurgical Epididymal Sperm Aspiration)
An open surgical sperm retrieval procedure that uses an operating microscope to locate the tubules of the epididymis precisely, so that large numbers of sperms are extracted.
The fertility-related treatment option for a male partner are as follow:
IUI ( Intrauterine insemination)
It is a fertility treatment that involves placing sperms inside a woman’s uterus to assist fertilization. IUI aims to increase the number of sperms that reach the fallopian tubes and subsequently increase the chance of fertilization. This is the first line of treatment for infertility. If there is no success even after 3 round of IUI, the fertility expert might suggest you go for an IVF process.
IVF (In Vitro Fertilization)
It is a process of fertilization of eggs and sperms, manually, in a laboratory dish, and then transferring the embryo to the uterus of the female partner. It is useful for couples, who have less number and quality of sperms.
ICSI ( Intracytoplasmic Sperm Injection)
It is an advanced form of IVF that is used for the treatment of severe cases of male-factor infertility. It is done by manually injecting a good single sperm directly into a mature egg, thus facilitating fertilization. In the case of IVF, there can be a less fertilized embryo, but the idea behind the ICSI is to promote the fertilization in as many eggs as possible manually.
In the rare case of extreme male infertility, the doctor will advise using a sperm donor. The sperm donor can be a young, healthy man who is used to fertilize the female eggs so to achieve a successful pregnancy.
Conclusion for the IVF Process
If you are looking to have a low IVF Cost Cycle with optimum success rate, we are here to help. IVF Cost in India is much lower than the rest of the countries, with an excellent success rate.
We have built a relationship with multiple IVF Clinics in different countries and you can get the benefit of it by having world-class coordination services and higher success rate.
Contact us to know about the various IVF services we offer globally.