What is In-vitro Fertilization (IVF)

In-vitro fertilization is a combination of procedures used to help with infertility and aid the conception of a child. During IVF treatment, mature eggs are retrieved from ovaries and fertilized with sperm in a lab. Once an embryo or embryos are formed, they are placed in the uterus. One complete cycle of IVF takes about three weeks. Sometimes these steps are carried out over time, and the process may take longer. 

IVF has become known as the most effectual method of assisted reproductive technology. It can be done using a couple’s own eggs and sperm or may involve those of a known or anonymous donor. The success rate of IVF depends on factors such as the age of the female and the cause of infertility. In addition, it is also time-consuming, expensive and invasive. If more than one embryo is formed after fertilizing the eggs and sperm, IVF may result in multiple pregnancies. 

Why is IVF treatment Done and What Causes of Infertility Can it Treat

IVF is a treatment for infertility or genetic problems. It may be offered as a primary treatment for infertility for women over 40 years of age. IVF treatment can be adopted if a couple is experiencing any of the following conditions:

1. Damage or blockage of the fallopian tube makes it difficult for the egg to be fertilized and the embryo to travel to the uterus.
2. Uterine fibroids or benign tumours in the uterus are common in women in their late 30s and 40s. Fibroids obstruct the implantation of the fertilized egg in the uterus. 
3. Ovulation disorders lead to fewer eggs being available for fertilization.
4. Endometriosis occurs when a tissue implants and grows outside the uterus, affecting the function of the uterus, ovaries and fallopian tubes. 
5. Impaired sperm function or production, including poor mobility or sperm size and shape abnormalities, can make it difficult to fertilize an egg. 
6. A genetic disorder compelling couples to go for preimplantation genetic testing.
7. Cancer treatment, including radiation and chemotherapy, could harm fertility, making IVF an option. 

Risks of IVF treatment

Risks of IVF treatment include:

1. Premature delivery and low birth weight- Research suggests that babies born through IVF treatment may be born prematurely or have low weight at the time of birth
2. Multiple births- If more than one embryo is planted in the uterus, the IVF process could lead to multiple births. A pregnancy with multiple fetuses carries its own risk elements. 
3. Miscarriage- The rate of miscarriage in women who conceive using IVF increases with maternal age compared to women who conceive naturally.
4. Ectopic pregnancy- There are high chances for women using IVF to develop an ectopic pregnancy- when the fertilized egg implants outside the uterus, usually in a fallopian tube. Since the embryo cannot survive outside the uterus, the pregnancy cannot be continued. 
5. Complication in egg-retrieval- The process of egg-retrieval is invasive and can cause bleeding, infection or damage to the bowel, bladder or a blood vessel. Sedation and general anesthesia are risky as well.
6. Cancer prevention– More recent studies suggest that IVF treatment significantly increases the risk of developing breast, endometrial, cervical or ovarian cancer. There are multiple types and causes of cancer.
7. Congenital disabilities- The mother’s age is a major risk factor in developing congenital disabilities, irrespective of how the child is conceived.  
8. Stress- The IVF process can be emotionally, physically and financially draining. Support from a close network of people helps the couple through the ups and downs associated with the procedure. 

The Process

IVF involves ovarian stimulation, egg retrieval, sperm retrieval, fertilization, and embryo transfer. One cycle of IVF can last up to two to three weeks, and sometimes more than one cycle may also be required. 

1. Ovarian stimulation- Synthetic hormones stimulate the ovaries to produce multiple eggs- since some eggs won’t fertilize or develop normally after fertilization. Medication at this stage may be prescribed for FSH (follicle-stimulating hormone), oocyte maturation, preventing premature ovulation and preparing the uterus lining. 
2. Egg retrieval- This is done by administering sedation, after which the eggs are removed from the follicle and placed in a nutritive medium and incubated. Eggs that appear healthy are then mixed with the sperm to attempt the creation of embryos. 
3. Sperm retrieval- A semen sample must first be provided to the doctor if the couple plans to use the male partner’s sperm. Sperm are separated from the semen fluid in a lab. The semen is collected through masturbation. Donor sperm can also be used.
4. Fertilization- This can be attempted through conventional insemination, in which healthy sperm and mature eggs are mixed and incubated overnight. Alternatively, Intracytoplasmic sperm injection (ICSI) may be used to inject a healthy sperm directly into a mature egg. 
5. Embryo transfer- The embryo is planted in the uterus under sedation through a syringe. 

Cost of IVF treatment

IVF treatment is relatively new in India and certainly not one of the cheapest procedures of assisted reproduction. The average cost of an IVF varies from one hospital to another and also depends upon specific patient characteristics and the number of cycles needed. One cycle of IVF can cost approximately 1.25 to 3 lakh INR.  

Success Rate

The success of IVF treatment depends upon a number of factors. These include the reason for infertility, where the procedure is being done, whether eggs are donated or of the mother, and maternal age. Quality of the sperm and endometrial development will also have an impact. Given these reasons, the success rate of IVF in India ranges from 30% to 35%. Globally, the average success rate is around 40% in young women. The chance of success also increases in women younger than 35 years of age. 

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