In vitro fertilization, commonly known as (IVF), a type of assistive reproductive technology (ART), is used to help infertility when other medical and surgical interventions failed to respond.

During IVF, mature eggs from the woman’s ovaries are collected and fertilized by a man’s sperm in an incubator outside the woman’s body. The fertilized egg (embryo) is transferred back to the woman’s uterus. The entire cycle of IVF generally takes about three weeks.

The IVF procedure not necessarily involves fertilization between Your Eggs and Your Partner’s sperms. It is also possible to use sperms, eggs, or even embryos from anonymous donors.

The IVF can be between

• Your egg + Your Partner Sperm
• Donor egg + Donor Sperm
• Donor egg +Your Partner sperm
• Your egg + Donor sperm

When IVF is indicated?

• Before going for IVF, it is always advisable that one should try for less-invasive options. IVF may be considered as an option if
• one fails to conceive even after using fertility drugs or intrauterine insemination (placement of sperms directly in the uterus near the ovulation time).
• Blockage or damage of fallopian tubes
• When ovulation is infrequent, there are fewer eggs available for fertilization.
• Endometriosis is a growth of uterine tissue outside the uterus impacting the normal functioning of the ovaries, uterus, and fallopian tubes.
• Uterine fibroids (benign tumors in the wall of the uterus commonly seen in women between 20 to 30 years)
• Previous history of tubal sterilization or removal
• Abnormality in concentration, movement, size, or shape of sperms making it difficult for them to fertilize an egg.

What are the potential risks of IVF?

• Multiple births It may occur when more than one embryo is transferred to a woman’s uterus. – Common complications maybe early labor and low birth weight
• Ovarian hyperstimulation syndrome (swollen and painful ovaries causing mild abdominal pain, bloating, vomiting, nausea, and diarrhea) due to the use of fertility drugs to induce ovulation
• Ectopic pregnancy (Implantation outside the uterus usually in Fallopian Tube) Seen in 2 to 3% of cases.

IVF Treatment Procedure

The entire patient journey can be divided into the following stages

1. Pre-treatment Tests and Preparations

The success of IVF depends on many factors, such as age and underlying medical conditions. Various screening tests that may be required before IVF is

• Ovarian reserve testing It determines the quality and quantity of woman’s eggs, Semen analysis.
• Screening Tests for various infectious diseases including HIV.
• Examination of the inside lining of the uterus, using Son hysterography or Hysteroscopy 

2. IVF Procedure

The IVF is a 6 Step Procedure

• Ovarian Stimulation

Normally a woman’s ovary develops one egg in a month. However, IVF requires multiple eggs to increase the success of fertilization. During IVF, several medications like medications for ovarian stimulation, medications for egg maturation, medications to prevent premature ovulation, and medications to prepare the uterine lining.

The entire process of ovarian stimulation takes one to two weeks. During this period several investigations like vaginal ultrasound and blood tests are performed to measure the response of ovarian stimulation therapy and appropriate time for egg retrieval 

• Egg retrieval

Egg retrieval is usually done by Transvaginal ultrasound aspiration During this procedure, the follicles are identified using an ultrasound probe that is inserted into the vagina. A needle is inserted through an ultrasound guide into the ovarian follicles to retrieve the eggs. Sometimes an abdominal ultrasound can be used if the ovaries can’t be accessed through transvaginal ultrasound. The entire process is of about 20 minutes in which multiple eggs can be retrieved.

• Sperm retrieval

Partner’s or donor’s sperm can be collected from the Semen sample taken in the lab.

• Fertilization

Fertilization of retrieved eggs with the sperms can be done by

Conventional insemination – It involves mixing and overnight incubation of healthy sperm and mature eggs

Intracytoplasmic sperm injection (ICSI) – (Injection of healthy sperm directly into the egg) It is used in case of inadequate sperm count

• Embryo transfer

It is usually done 2 to 3 days after egg retrieval A long thin flexible tube (catheter) is inserted into the uterus through the vagina. One or more embryos are inserted into the uterus using a syringe, attached to the next end of the catheter.

Pregnancy happens when an embryo will implant in the lining of the uterus. It typically happens a week after egg retrieval

3. Post IVF procedure 

Care of the Patient

The patient can have a  routine after IVF avoiding vigorous activity.

Result of IVF

A pregnancy test can be done between 12 days to two weeks after egg retrieval, through a blood or urine test.

• If pregnancy is confirmed, the mother is referred to the pregnancy specialist.
• If pregnancy is not confirmed, the woman will get the period within the week. In case of absence of period or unusual bleeding, one should immediately connect with her doctor.

The success of having a healthy baby after IVF depends on various factors like Maternal age, Embryo status, Reproductive history, and Lifestyle factors.