In Vitro Fertilization (IVF)
What is IVF?
In vitro fertilization (IVF) is one of the assisted reproductive technologies (ART) that can help infertile couples have a baby that is biologically related to them. IVF is a complex clinical procedure. The process involves the 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. It is a time-consuming and invasive procedure that takes around 2 weeks for the completion of a single fertilization cycle.
Indications for IVF
The most common indications for IVF include:
- Damaged or blocked fallopian tubes
- Ovulation problems
- Premature ovarian failure (loss of the normal function of your ovaries before the age of 40)
- Severe endometriosis (presence of endometrial tissue outside the uterus)
- Presence of uterine fibroids (benign tumours 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
The steps involved in IVF treatment are:
- Ovulation induction: Your doctor will administer fertility drugs to boost the production of your eggs. Transvaginal ultrasounds will help 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 your vagina and into the follicles under ultrasound guidance. Each follicle in the ovary is pierced to retrieve the egg.
- Insemination and fertilization: The eggs are mixed with sperm in an environmentally-controlled chamber to facilitate the process of insemination. The egg is fertilised a few hours after insemination. If the chance of fertilization is low, intracytoplasmic sperm injection (ICSI) may be suggested, where the sperm is directly injected into the egg.
- Embryo culture: The division of the fertilised 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 your vagina through the cervix and into the uterus. After transfer, if an embryo attaches or sticks to the womb lining, it results in pregnancy.
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 perform a pregnancy test 10 days after embryo transfer to confirm pregnancy.
Complications of IVF
As with any surgical procedure, IVF may involve certain risks and complications such as risk of multiple births, premature and low birth weight baby, ovarian hyperstimulation syndrome (a condition of ovarian enlargement accompanied by fluid accumulation in the abdominal cavity) and miscarriage. The risks of egg retrieval include bleeding, infection, damage to the bowel, bladder or blood vessels, and possibility of ectopic or tubal pregnancy.