What Is IVF (In Vitro Fertilization ) And What Are The Risks?
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If you’ve decided to start IVF treatment after years of trying to conceive, you must be excited! At the same time, you’re probably anxious about the entire process, wondering whether it will succeed and whether you will finally be able to hold your bundle of joy in your arms.
Well, the good news is that IVF treatment is usually quite successful. And, here we talk about IVF Treatment and offer you a sneak peek at the step-by-step procedure. So, read on and put your doubts to rest.
Factors Affecting Success Of IVF Treatment:
A study conducted among 156,000 women found the success rate after the first cycle is 29.5%. Your odds of conceiving increase after repeated cycles of treatment. The study found after six treatment cycles, the success rate of live birth jumped to 65.3%. If you opt for six cycles, you will undergo IVF treatment for about two years.
Today, women are putting off starting a family due to work or personal reasons. Such women need not despair, as they can always use IVF as a way of starting their families. However, age plays a significant role in the successful outcome of IVF treatments. The older you are, the lower will be the success rate if you intend to use your eggs.
Here are some statistics that you should be aware of before you commence your IVF treatment.
- The success rate for women aged 35 to 37 years is 30.5%.
- The success rate for women aged 48 to 40 years is 20.9%.
- The live birth per cycle for women aged 41 to 42 years is 11.5%.
- For women aged 43, the success rate per cycle is 6.2%.
- After the age of 44, the success rate is a little over 1% per IVF cycle.[1]
As you can see the success after each IVF treatment cycle declines after you cross the age of 40. However, if you use donor eggs, the success rate goes up. When you use donor eggs, there is no cause for concern, as your age does not play a role in the successful outcome of the treatment.
Is IVF Treatment Right For You?
Typically, you opt for IVF treatment is all other methods fail. The fertility clinic recommends IVF only if:
- You have an unknown reason for your infertility.
- There are blockages in your fallopian tubes.
- Other fertility treatments, such as fertility drugs and intrauterine insemination, did not have the desired results.
- Your partner has a fertility problem, which is not severe enough to necessitate intra-cytoplasmic sperm injection.
- You intend using the frozen sperm of your partner and are not a suitable candidate for intrauterine insemination.
- You intend using donor eggs or your frozen eggs for the IVF treatment.
- You are opting for embryo testing to prevent passing on a genetic condition to your offspring. [2]
[ Read: Blocked Fallopian Tubes ]
Step-By-Step IVF Treatment:
Now that you have decided to go through IVF treatment, it makes sense to understand the step-by-step treatment procedure. Before you begin the treatment, you will have to sign several consent forms. Also, you and your partner will have to undergo blood tests to check for HIV, Hepatitis B, Hepatitis C and Human T-Cell Lymphotropic Virus I and II.
When you understand the treatment procedure, you will feel more in control as you will know what to expect at each stage of the treatment. While each IVF clinic may vary their treatment protocol slightly, the IVF procedures is more or less the same.
Step 1: The First Scan:
The first step in an IVF treatment is an ultrasound scan. This scan is extremely important for deciding the treatment protocol. The scan lets the doctor see the ovaries and count how many follicles they have for future egg retrieval. Also, the scan lets the doctor check the blood flow to your ovaries to determine your fertility status.
It is during this scan the doctor checks how accessible the ovaries are for collecting the egg and presence or absence of ovarian cysts, as they could have an effect on egg production. Even your uterus will be examined to ensure it is healthy for embryo implantation.
Step 2: The Monitoring Scan:
Regardless of your IVF treatment protocol, you will have to undergo about 3 to 4 ultrasound scans starting Day 5 of your menstrual cycle. These scans help the doctor check the growth of the follicles and see whether the endometrium is thickening, as anticipated. When your follicles grow and get ready to ovulate, they produce estrogen. So, in all probability, you also will have a couple of blood tests to ascertain estrogen levels in your body. When blood flow to the ovaries is high, it increases the chances of yielding high-quality eggs.
Step 3: The Cycle Before IVF Treatment:
The fertility doctor may put you on birth control pills a cycle before you start your IVF treatment process. You needn’t worry, as studies show taking birth control pills before your treatment cycle begins, increases your odds [3]. Furthermore, there are speculations birth control pills reduce the chances of ovarian cysts and ovarian hyperstimulation syndrome [4]. However, it depends on the doctor, as all doctors don’t believe in using the pill.
You may also have to track your ovulation during this period. You can do this by making note of your basal body temperature or using an ovulation predictor kit. Once ovulation occurs, you have to inform the doctor.
Some fertility clinics give patients GnRH antagonist or GnRH agonist after ovulation occurs. These drugs are injectables, but can be taken in the form of an implant or nasal spray. The two drug give the doctor complete control over your ovulation once the IVF treatment cycle begins.
In case your menstrual cycle doesn’t occur like normal, the doctor may prescribe progesterone to trigger your period. You may have to take GnRH antagonist or agonist about six days after taking the first progesterone tablet.
[ Read: IVF Treatment Cost In India ]
Step 4: Getting Your Menstrual Period:
Your IVF treatment begins the day you get your menstrual period. On the second day, you will have to undergo a blood test and ultrasound. The scan will be a transvaginal ultrasound to determine the size of your ovaries and check them for cysts. The blood is to determine your estrogen levels, namely the level of estradiol. This is to ensure your ovaries are inactive. This is the reason you were given GnRH antagonist or protagonist.
Step 5: Stimulation And Monitoring Your Ovaries:
This is the stage when fertility drugs will begin. These drugs help to stimulate the ovaries. The drugs are given in the form of injectables. You will have to inject anywhere from one to four injections per day for seven to 10 days.
Once you start taking the injections, the doctor begins monitoring the growth and development of your ovaries. Initially, you may have blood tests and ultrasounds every couple of days to monitor your estrogen levels and growth of oocytes. Once the follicle reaches a size of 16 to 18 mm in size, you will have to visit your doctor every day.
Step 6: Maturation Of Oocyte:
This stage is making sure the oocyte in the follicle matures completely. It is only after the egg completes its growth and development can it be retrieved. To stimulate this final spurt of growth and development, you will have to take hCG or human chorionic gonadotropin. It is important to time the injection. If you get hCG too early, the eggs will not mature sufficiently for retrieval. On the other hand, if you receive the shot too late, the egg will be too matured to get fertilized properly.
Usually, the hCG injection has to be taken when at least four follicles in the ovaries attain a size between 18mm and 20mm and your estrogen (estradiol) level is more than 2,000 pg/ML. The doctor will tell you the exact hour at which you have to inject hCG. Be sure to follow the instructions to the T.
[ Read: When To Take A Pregnancy Test ]
Stage 7: Retrieving The Egg:
About 34 to 36 hours after you take the hCG injection, the doctor will retrieve the egg. The anesthesiologist will give you a sedative intravenously to help you relax and ensure a pain-free retrieval. There is hardly any side effect of the medication.
The doctor will perform a transvaginal ultrasound to guide the needle through the vaginal wall to the ovaries. The needle aspirates the follicle and removes the oocyte and fluid. The oocyte is taken to the embryology laboratory where it is fertilized by your partner’s or donor’s sperm.
The number of oocytes retrieved varies from person to person. The doctor will remove anywhere from eight to 15 oocytes.
You may experience light spotting after this procedure along with cramps in the lower abdominal region. These symptoms will disappear a day after the procedure.
[ Read: Infertility Treatment – Gamete Intrafallopian Transfer ]
Stage 8: Fertilizing The Egg:
In the embryology lab, the oocytes that were retrieved are checked to ensure they are adequately matured. They should not be under- or over-matured. In case eggs are under-matured, the lab will stimulate them to reach complete maturity. After that, the oocytes are fertilized. This fertilization has to occur between 12 and 24 hours of retrieval.
The semen sample that your partner provided is put through a special washing process that separates the sperm from the other materials present in the semen. The healthiest sperms, around 10,000 of them, are placed into each Petri dish containing the oocyte. The Petri dish is placed in an incubator for 12 to 24 hours. Then they are checked to ensure successful fertilization. Typically, 70% oocytes will be fertilized.
Stage 9: Transferring Fertilized Egg Into Your Uterus:
After successful fertilization, the embryos are transferred into your uterus. This occurs three to five days after the oocytes were retrieved. Egg transference is a pain-free procedure and does not require anesthesia. However, some women experience mild cramping.
The doctor uses a catheter to transfer the embryos into your cervix. The number of embryos will depend on the quality of the fertilized eggs and the agreement you had with your doctor. Usually, two to five embryos are transferred.
After the transfer, you will have to lie down for about two to three hours before you can go home. The other fertilized eggs are frozen for future use if this process of IVF treatment cycle is unsuccessful. Alternatively, you can donate the frozen embryos.
Stage 10: Progesterone Support:
The day the eggs are retrieved, and before the embryos are transferred into your uterus, you will have to start taking progesterone. You have to give the shot yourself into the muscle, and the progesterone is mixed in oil. At times, the doctor may give the hormone supplement in the form of a pill, vaginal suppository or vaginal gel.
For the next two weeks after the transfer of embryos, it is a watch-and-wait game. There is not much to do, and unfortunately, it can be an emotional time for you. You will have all kinds of thoughts floating through your mind. It is best to speak to your doctor to clear your doubts and get answers to your question. You can try some meditation to calm your jangling nerves.
[ Read: Infertility Treatment – Zygote Intrafallopian Transfer ]
Stage 11: Pregnancy Test:
About 12 days after the embryos are transferred, the doctor will order a pregnancy test. This is a serum test that also will include a test for progesterone levels. You will have this test every few days.
If the test comes back positive, it is time to celebrate. However, before that, you would have to continue with the progesterone for another few weeks. You will have to visit the doctor, who will monitor your pregnancy and keep an eye out for ectopic pregnancy or miscarriage. So, you will be put through a battery of blood tests and ultrasounds during this monitoring phase.
The rate of miscarriage during IVF treatment is low for women under the age of 35. It is about 15%. On the other hand, the miscarriage rate for women aged 40 is 25% and after the age of 42, it increases to 35%.
The monitoring stage also includes keeping an eye out for multiple pregnancies. If the number of fetuses is four or more, the doctor may suggest a procedure called multifetal pregnancy reduction. Here, the doctor reduces the number of fetuses to increase the surviving fetuses’ chances of being healthy and developing properly.
Failure Of IVF Treatment:
If 12 to 14 days after the transfer of embryos your pregnancy test stays negative, the doctor will ask you to stop taking the progesterone supplement. This will trigger your period. Yes, it is sad that the treatment did not work, but you shouldn’t give up hope. The doctor may recommend another cycle. Remember, the more IVF treatment cycles you have, the higher the chances of success.
The key is to stay positive. Just because one cycle failed, it doesn’t mean the next one too will fail. So, do not give up hope and have a clear head when you, your partner and the doctor decide the next course of action.
Reasons For IVF Treatment Cycle Cancellation:
There are several reasons IVF treatment fails. Some of the reasons include:
1. Follicles Fail To Grow:
When you get ovarian stimulation medication, the doctor assumes the follicles will grow and produce healthy oocytes. However, this doesn’t happen always. Sometimes, follicles fail to respond to the drug. The doctor will then increase the dose of the medication. Even after this, if the follicles don’t develop normally, the doctor will cancel the IVF treatment cycle.
You should not give up hope. The doctor may recommend another cycle with different medications. If the same thing happens repeatedly, the doctor will suggest using a donor egg or embryo.
2. Premature Ovulation:
Sometimes, ovaries begin to ovulate before the healthy oocytes can be retrieved. Once this occurs, the eggs cannot be retrieved, and the IVF cycle process is canceled. The doctor will ask you to refrain from sexual intercourse. Be sure to follow this instruction. This is because your ovaries would have produced about 12 mature eggs, sometimes even more. If you have unprotected sex, there is a danger of these eggs getting fertilized. It could result in multiple pregnancies that could be dangerous for you.
Usually, cancellation is more prevalent among women, who are over the age of 35. It occurs in about 10 to 20% of treatment cycles.
[ Read: Chemical Pregnancy And IVF ]
Role Of Men In IVF Treatment:
Around the time when the doctor retrieves eggs (oocytes) from your ovaries, your partner will be asked to give a fresh sample of sperm.
This sample is washed and prepared for the fertilization process in the laboratory. It separates active and healthy sperms from poor-quality sperms.
Will Your IVF Treatment Be Successful?
The success of your IVF treatment is dependent on many factors. Some of these include:
- Your age
- The cause of your infertility
- Whether or not you are using donor egg or sperm.
- The competency of your IVF doctor [5]
As we mentioned earlier, the chances of success are higher when the woman is younger, and the odds reduce when the woman is coping with diminishing ovarian reserves. It has also been observed the rate of success increases if the couple seeking the treatment for IVF is dealing with male infertility.
Risks Of IVF Treatment:
Just like any other medical treatment, there are certain risks associated with IVF treatment procedure. However, on the whole, the treatment is safe. A good IVF specialist usually sits with the patients and explains the risk and side effects of IVF procedures.
Some of the IVF side effects and risks that women may experience are:
1. Ovarian Hyperstimulation Syndrome:
This complication occurs in about 10% women undergoing IVF treatment. It occurs when the ovaries are overstimulated due to the fertility treatment. The symptoms typically are mild, and women recover easily. However, a small percentage of women may experience severe symptoms that require hospitalization. About 1% of women may develop blood clots or kidney failure brought on by Ovarian Hyperstimulation Syndrome. These complications occur during the egg retrieval process.
2. Cramping And Discomfort:
During or after the egg retrieval procedure, women may experience cramping and discomfort. However, these symptoms abate after a day or two. On rare occasions, the doctor may accidentally puncture the bowel, bladder or blood vessel. Cramping also occurs during embryo transfer. Some women may experience bleeding or spotting after the transfer.
3. Pelvic Infection:
This infection is rare, but should you develop it; you will receive antibiotics intravenously. If the infection is severe, the ovaries, uterus and fallopian will have to be removed surgically.
4. Multiple Pregnancies:
Since IVF treatment sees transfer of several embryos, it increases the risk of multiple pregnancies, including twins, triplets or more. This can be risky to the mother as well as the babies. Babies can be born with low birth weight and cerebral palsy.
5. Birth Defects:
While birth defects are rare when you opt for IVF treatment, some studies have found that using IVF and ICSI to deal with male infertility increase the chances of sexual birth defects in male babies. However, the percentage is very low, less than 1%.
6. Premature Labor:
IVF treatment can result in premature labor and delivery, regardless of how many babies you are carrying.
7. Miscarriage:
The risk of miscarriage is the same for women who conceive naturally and if you opt for IVF treatment. The chances of miscarriage are 15% in young women, who are in their 20s. However, the rate of miscarriage increases to 50% when the woman is more than 40 years of age.
8. Ectopic Pregnancy:
This is a 2 to 4% chance of the pregnancy turning into an ectopic pregnancy. Should this happen, the pregnancy will be medically terminated. Ectopic pregnancy poses a huge risk to the mother, as it can result in rupture of internal organs which is life-threatening [6].
IVF treatment, on the whole, is a safe procedure and usually yields the desired results. However, you may require several cycles before you conceive successfully. Just make sure you choose the fertility clinic after you do your research. Do not be afraid to ask questions to assess the doctor’s knowledge. If you have doubts, find another clinic. You should be comfortable with the clinic, its practices, and the doctor.
Have you undergone IVF treatment? What was your experience? Tell us here.
[ Read: Ectopic Pregnancy ]
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