IN VITRO FERTILIZATION

IVF & ICSI

 In Vitro Fertilization (IVF) is a process by which an egg is fertilized by sperm In Vitro or outside the body, in laboratory. If the sperm fertilizes the egg, an embryo is formed which is allowed to develop in the laboratory and is then transferred into the woman’s uterus where it will hopefully implant and develop further.

The main steps in an IVF cycle are:

  • Controlled Ovarian Hyperstimulation (COH) and Follicular Monitoring

  • hCG Trigger and Oocyte Retrieval

  • Oocyte Culture, Insemination and Fertilization in the IVF Laboratory

  • Embryo Transfer

  • Luteal Support

Intracytoplasmic Sperm Injection  (ICSI) takes the process one step further and involves the insertion of a single sperm directly into the cytoplasm of a mature egg (oocyte) using a special microinjection pipette (glass needle).

  • Do I need IVF?

IVF is indicated when alternative treatments are either unlikely to achieve a pregnancy or have failed to result in a pregnancy. If you have blocked fallopian tubes or extensive pelvic adhesions preventing the egg from entering the fallopian tubes, IVF is indicated.

Another common indication for IVF is low sperm counts Because IVF allows us to super concentrate sperm, successful fertilization can occur even if your partner has low sperm counts.

Infertility is said to be ‘unexplained’ if you are unable to conceive in spite of all tests being normal. In this case, IVF is an option if you have failed to conceive with Intrauterine Insemination (IUI).

IVF may also be advisable if you have Polycystic Ovaries (PCO) and if ovulation induction with or without IUI has not been successful. If you have mild to moderate Endometriosis, IUI may be tried before proceeding to IVF, but in case of severe Endometriosis, IVF may be advised directly.

IVF is also inducted in cases where any  of its expansions is of interest, for example, if Egg Donation or Gestational Surrogacy is advised, where the woman providing the egg is not the same as the one who will carry the pregnancy to term.

  • Do I need ICSI?

Intracytoplasmic Sperm Injection (ICSI) has revolutionized the treatment of male infertility. ICSI is advisable if the male partner’s sperm count or number of motile sperm is very low or the morphology is excessively poor. Your will be advised ICSI based on the results of the Semen Analysis and other risk factors.

  • Is IMSI better than ICSI? Is it a big advantage?

IMSI stands ‘Intracytoplasmic Morphologically Selected Sperm Injection’. It involves examining the semen sample under an extremely powerful microscope to pick out the best appearing sperm, which are then used in the ISCI protocol. An efficiently performed ICSI, carried out by a competent embryologist already ensures that good quality sperms are picked up. Evidence based medicine is yet to conclusively prove the advantages of IMSI over ICSI in terms of pregnancy rates and long term outcomes.

  • Are birth defects more common in babies conceived using IVF / ICSI?

The percentage of birth defects with IVF is roughly the same as in the general population (3-4%). The chances of birth defects after ICSI are rare.

  • What are the health risks for women undergoing IVF / ICSI?

The drugs used during IVF / ICSI may on occasion cause side effects. There is a small but significant risk of multiple Pregnancies, Ectopic Pregnancy, Pelvic Infection and rare injury to nearby organs. Controlled Ovarian Hyperstimulation (COH) is associated with a risk of Ovarian Hyperstimulation Syndrome (OHSS). Symptoms of OHSS include the following in varying degrees of severity: nausea, vomiting, diarrhea, extreme bloating, rapid weight gain, difficulty in breathing etc.

  • What do we do if extra embryos remain after Embryo Transfer?

Extra embryos remaining after the embryo transfer may be frozen by the Vitrification procedure which gives near about a 100% survival rate. This makes future cycles simpler, less expensive and less invasive than the initial cycle, since the woman does not require ovarian stimulation or egg retrieval.