Now in vitro fertilization has become a common procedure followed in
many infertility clinics around the world.
But in 1978, when Louise Brown
was born in England as the first baby born out of in vitro fertilization, it
was considered as a miracle and the baby was nick named test tube baby.
Unlike artificial insemination in which sperm is kept in the uterus and
conception takes place otherwise normally, in IVF the egg and sperm are
combined outside human body in a laboratory. After the formation of an embryo
or embryos, the they are then placed inside the uterus. This is a very
complicated and extensive procedure and due to high expenses involved, only 5 %
of the infertile couple dares to attempt in vitro fertilization techniques.
Since its inception in the year 1981, about 200,000 babies were born using the
in vitro fertilization technique.
In IVF procedure, mature eggs are retrieved from ovaries and they are
fertilized by sperm in a laboratory. Then the embryo so formed is implanted in
the uterus. It takes about two weeks for the completion of one cycle of IVF.IVF
are more effective and more natural when the sperm and egg of the parents take
part in the fertilization process or in some cases IVF may involve eggs or
sperms of an anonymous donor and yet in some other cases, it may involve a
gestational career woman acting as the carrier for the fertilized embryo of the
parents involved in the IVF procedure. Your doctor will be able to guide you
and teach you the pros and cons of IVF procedure. The probable risk factors
will be explained by him and he will also state whether you are a fit person
for the IVF procedure.
When is it necessary?
In vitro fertilization is considered as a treatment procedure intended
for infertile patients who suffer generally due to genetic problems. Before
attempting this method doctors prefer that you and your partner had undergone
other treatment options including
fertility drugs and intrauterine insemination. IVF is also considered as an
infertility treatment option for women who have crossed the age of 40. Similarly,
this procedure is suggested for people who are under certain health conditions
as detailed below.
Block in fallopian tube: When fallopian tube is damaged or blocked due
to some reason, it will be difficult for the egg to get fertilized and for an
embryo to travel through fallopian tube and enter the uterus.
Ovulation disorders: In some cases ovulation is found to be
inadequate or completely absent. In such cases fewer eggs are available for
fertilization.
Disorders in ovulation: If your
ovaries fail, they do not produce the normal amount of estrogen so that the
eggs are not released regularly.
Premature failure of ovaries: This is condition in which both the ovaries
loss normal functionality before the age of 40.
Endometriosis: Endometriosis can be defined as the growth of uterine tissues
outside the uterus. This may affect the functioning of ovaries, fallopian tubes
and uterus.
Uterine fibroids: Tumors
in the wall of uterus are known as fibroids. These can interfere with
implantation of the fertilized egg.
Previous removal of tube for sterilization: For persons who have already under gone tubal
ligation procedures for controlling the birth of children, it may be necessary
to undergo IVF for further pregnancy.
Low sperm concentration: if the sperm has lower concentration and less
mobility, or abnormal size or shape, IVF will be required to sped the fertilization process.
Unexplained infertility: In some cases even after detailed study, the
doctors may not be able to explain the
reason for the infertility experienced. In such cases IVF is considered as a
suitable option for getting the problem settled for ever.
Genetic disorder: If you or your partner has some genetic
disorder and you are keen not to pass over this disorder to your child, doctors
may suggest IVF as a solution. After in vitro fertilization the embryo so
formed are scanned for genetic disorders. All the all genetic disorders cannot
be identified through scanning. This method is carried out and the embryos
which are found to be free from genetic disorders only are implanted in the
uterus of the mother undergoing IVF.
Fertility preservation for patients with cancer
or similar diseases: Some women
who are about to undergo chemo or radiation therapy for cancer that would harm the
embryo would prefer to store their eggs or
the embryos in a frozen state and for this the IVF techniques are often
made use of.
Women without functional uterus : Women who does not have a functional uterus
but are capable of ovulation can make use of a surrogate woman for carrying the
embryo produced using IVF procedure. In such cases the women’s egg is
fertilized using her husbands or an anonymous sperm and the embryo so formed is
placed in the uterus of a gestational carrier.
Risks
Multiple births: When multiple embryos are formed in IVF
procedure, the risk of multiple births is natural. Such pregnancies can be
risky and early labor can be expected and the babies so born will be having lower weight at the
time of birth.
Premature birth and lesser weight at the time of
birth. Research has shown that babies born out of
IVF procedure are born earlier than usual and they have a lower weight compared
to the babies born normally.
Ovarian hyper stimulation: Use of
drugs like chorionic gonadotrophin (HCG) can result in hyper stimulation of
ovaries resulting in the swelling of ovaries and pain in them. Symptoms like nausea,
vomiting, diarrhea etc are shown in such cases and they may continue for weeks if pregnancy takes place. This can
result in rapid weight growth and breathlessness.
Miscarriage: Miscarriage
rate in the case of IVF increases with age of the women, use of frozen embryos,
etc.
Complications in egg
retrieval: Eggs are retrieved
form ovary using an aspirating needle and this can cause bleeding, infection
and even damage to bladder, bowel or blood vessels. General anesthesia given
during this procedure can also lead to dangerous situations.
Ectopic pregnancy: in some cases the fertilized egg gets implanted
outside uterus, sometimes in fallopian tubes. Occurrence of such cases is estimated to be
about 2 to 5 percent. A fertilized egg
cannot survive outside uterus and as such there is no way to continue the
pregnancy.
Birth defects: Birth defects are believed to be related to
the age of mother at the time of pregnancy. More study is needed to confirm the
effect of IVF on the defects found at the time of birth.
Ovarian cancer: Some studies suggest that there can be some
link between medications used for the stimulation of egg growth. But more
studies are required to confirm this belief.
Stress: IVF can bring physical emotional and
financial stress on the patient undergoing this procedure.
Preparations
for IVF:
Before starting IVF procedure for a couple, they will have to
undergo a series of tests
Test to find out
ovarian reserve status:
Concentration of follicle-stimulation hormone is a test usually conducted before IVF. In this
test the quality and quantity of the eggs available in the female partner is
calculated using the blood samples in the first few day of your menstrual cycle.
This test combined with ultra sound test of your ovaries will help the
physician to predict the response of your ovaries during the procedure.
Semen analysis: Semen analysis is a diagnostic test performed
to find the semen count and its mobility.
Screening for
infectious diseases: The couple
undergoing IVF will be screened for infectious diseases like IVF, STD etc.
Mock embryo transfer: Sometimes your physician may carry out a mock
embryo transfer to understand the your uterine cavitie’s depth and to determine
the most appropriate test for embryo’s successful placement in your uterus.
Examination of your uterine
cavity: Sonohisterography is a test
in which a fluid is injected through the cervix to the uterus and with the help
of ultra sound the image of your uterine cavity is obtained. Or doctors may
perform a hysteroscopy in which a flexible lighted telescope is inserted into
the vagina and cervix to reach the uterus. The uterus is viewed by the surgeon through
this instrument to understand the depth and other vital aspects needed for IVF.
Number of embryos transferred: the number of embryos transferred to the uterus
is decided considering the age of the patient and the number of eggs retrieved.
For older women more embryos are implanted except in the case where donor eggs
are used.
Some doctors have given guidelines for the transfer of embryos
to uterus and in some countries there are laws regulating this matter. Get clarification
about this matter from your doctor before you get ready for the procedure.
What to do with
multiple embryos?: Extra embryos
formed during IVF procedure are stored frozen for many years. Some of them may
not survive freezing. Cryopreservation helps in making future IVF cycles less
expensive and less difficult. But one has to remember the fact that the birth rate
of frozen embryos is considerably lower than the birth rate obtained from fresh
embryos
How to
handle multiple pregnancy: Pregnancy with more than one embryo often has
health risks and doctors may suggest fetal reduction. This is major decision
which involves many ethical and emotional considerations.
Donor eggs: using donor eggs can lead to legal and
ethical issued regarding the right of the donor of eggs over the child born.You
might need the help of an attorney to sort out the matters.
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( Incomplete. will e completed shortly)
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