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    in vitro fertilisation (ivf)

    IVF Procedure - What are the Side Effects, Risk and Need of IVF Treatment

    • 10879 views
    • 4.5   (1 Votes)
    Medically Reviewed by Dr. Deepika Tiwari - MS, MBBS on 04 Jun 2019 - Written by Dr. Shakuntla Kumar - Diploma, MBBS, DGO - Grammatically Approved by Dr. Kavita Jaggi Agrawal - MS, MBBS

    IVF treatment is needed in infertile couples in cases of PCOS, endometriosis, Fallopian tubal blockage, Genetic disorder. However, the side effects of IVF treatment comprise of heavy vaginal bleeding, pelvic pain, and high fever. Risks of IVF process include multiple gestations and premature birth of a baby.

    In Vitro Fertilization (IVF) is one of the most prominent and promising treatments under artificial reproductive Technology (ART). In comparison to other treatments, IVF procedure proves to be solely and including other range of infertility treatmentgives the highest success rates. Infertility includes distinct causes like age, endometriosis, fallopian tubal blockage, and certain male factors. An IVF expert first identifies the reason for infertility in the couple and then suggests a combination of treatments to help to attain desired pregnancy. Achieving pregnancy for infertile couples is challenging, and to sustain that pregnancy remains a substantial problem in a woman with infertility. Before commencing infertility treatment, examining aspects such as uterus size and capability of a woman's body to sustain pregnancy is crucial. Through medical examination, IVF experts observe the necessities of a donor. 

    The most substantial benefit of IVF treatment includes a combination of several sub infertility treatments with the inclusion of egg, sperm or embryo donor. Through IVF, a couple has vast options to choose, how they want to treat their infertility and what could be the most suitable ART treatment for them. It may take up from 3-4 IVF cycles to attain pregnancy in couples with elderly age or a woman with a dismal prognosis. Whereas, an infertile woman with a good prognosis may achieve pregnancy in her first IVF cycle. However, there are several risks associated with IVF treatment like preterm labor and delivery, maternal hemorrhage, delivery by cesarean section (C-section), and multiple gestations. Therefore, IVF doctors first try all the primary treatments at least twice before recommending IVF treatment. (4) The requirement of IVF treatment is directly suggested in the case of elderly couples above 40 to attain pregnancy because of their poor quality or an insufficient number of sperm cells and eggs. Couples suffering from genetic disorders or have the presence of the same in the genes may also avoid transmitting these diseases to the next generation through IVF treatment. (5) There are many other benefits of undergoing IVF treatment, which we will discuss later in this article.

    In this article you will get to know about:

    In Vitro Fertilization (IVF), it is the most useful treatment of infertility cases among couples. IVF has diverse aspects involved in it, covering a wide range of treatments to infertility diseases. There are several causes and disorders, which lead to infertility in both men and women. IVF procedure has 70 to 75 percent success in establishing potential pregnancy in many infertile couples. Here, we have covered almost all the aspects of IVF treatment like its process, needs, and risk. (1)

    1. How does IVF Process works?

    In Vitro Fertilization (IVF) represents a unique process, where fertilization of sperm and egg is performed in a special IVF lab to produce a viable embryo. After embryo formation, the embryo is placed inside the uterus to get implanted and nurtured by the endometrial lining of the uterus. (2) Once the embryo implants itself in the endometrial lining of the uterus, pregnancy will start to develop. During pregnancy, a fetus grows through several stages in the womb of the mother to become a healthy baby. Conventionally, the process takes place naturally in the body of a woman, but in IVF the initial process is performed in an IVF laboratory. An embryologist observes the fertilization throughout the process under a microscope. In pregnancy, the principal role is determined by three key characteristics:

    How does IVF Process works

    • Eggs in a woman: A growing female fetus consists of a certain number of eggs that she will ovulate throughout her life. The ovulation happens naturally every month in girls, most probably after her adolescence age. After the age of 13 - 14, a girl starts undergoing periods every month. These periods occur for 3 to 4 days in a month and solely responsible to produce a child if fertilization occurs with sperms. During periods, a cell ruptures from the follicles of ovaries to convert into an egg. This mature egg upholds female (Y) chromosomes. After rupturing, these eggs travel towards the fallopian tubes, where they wait for the sperm to fertilize them within 24 hours. After 24 hours, if the eggs are unfertilized, then they will break down leading to her periods after 2 weeks. In case the sperm promptly enters the fallopian tube fertilizing the egg on time, an embryo will develop. The developing embryo will start moving towards uterus in the woman within the next 30 to 40 hours by continuously dividing itself into distinct stages. Once the embryo reaches the uterus, it will implant itself on the uterine lining and initiates a procedure to become a baby starts.
    • Sperm in men: In men, sperm cells carry two chromosomes: female chromosome Y and male chromosome X. These chromosomes decide the gender of the baby born following the fertilization of egg and sperm. During intimate intercourse, the semen is released into the vagina through the man's penis. The semen carries millions of sperm cells, which uses their full force and energy to reach inside the fallopian tube to fertilize an egg. The sperm uses their motility and shape to traverse the considerable distance. Sperm has a life of five days when released in the body of a woman. For five days, a sperm stays in the female body, and wait for an egg to rupture out. When the egg originates, both combine together to develop an embryo. In some cases, sperm is unable to reach fallopian tubes due to their low motility rate and improper shape. Therefore, with the help of Intracytoplasmic Sperm Injection (ICSI) best quality of sperm are retrieved and then inserted into the female partner for conception.
    • Embryo: An embryo is an end result of combining the egg with sperm. In many infertile couples, the completion of a fundamental step becomes difficult to form an embryo. When a couple is incompetent to conceive and leads to a situation where their eggs and sperm cells are unable to meet, a requirement of Artificial reproductive technology (ART) treatment generates here. Therefore, several techniques are demonstrated in IVF treatment to combine sperm and eggs. Once the embryo is developed, the next step to implant itself in the uterus becomes significant. However, failure of implantation also comprises of poor quality of egg or sperm combination. The other potential reasons for the failure of embryo implantation comprise of the irregular endometrial lining and size of a uterus. An embryo is a primary form of a baby, which later develops into a fetus which proper growth during pregnancy.

    IVF Step by Step Process:

    IVF is a long, time consuming and invasive treatment. In IVF several hormonal medications, injections, and instruments are used. 

    Step 1:Examination of reproductive organs of the couples.
    Step 2: Retrieval process of eggs and sperm.
    Step 3: Fertilization of eggs and sperm in the IVF laboratory.
    Step 4: Inserting the embryo into the uterus.

    Below we have mentioned detailed step by step process:

    Step 1: The examination of female and male reproductive organs is executed. Through the examination, the IVF specialists conclude the reason for infertility. It is critically substantial to determine the factors causing infertility to avoid unnecessary expense and putting efforts in analyzing the wrong cause of infertility. There are several reasons for infertility in men and women. In fact, some reasons remain unknown even after the IVF treatment is performed. Therefore, certain hormone stimulating medication is given to the patient to balance her hormones.

    Step 2:After medication, the hormonal level balance out, and the egg retrieval process begins by collecting 10-15 eggs from the ovaries. Through a thin needle, the follicle fluid is removed from ovary sacs to accumulate the eggs. IVF experts perform the egg collection process while the patient is on sedation. However, the process is painless and may be performed without sedation also. Egg retrieval surgery is performed under the observation of an ultrasound machine. Out of all the accumulated eggs, only the best quality eggs are separated and mixed with sperm to perform fertilization. Similar to the egg retrieval process, sperm cells are also retrieved from the male reproductive organs with the help of a thin needle. After the retrieval process, Intracytoplasmic Sperm Injection (ICSI) is performed to penetrate an egg with quality sperm. ICSI is equally useful, and most of the time yield success in male infertility. In ICSI procedure, quality sperm cells are separated and combined with eggs in an IVF laboratory to produce an embryo. Using ICSI procedure in the IVF treatment process primarily gives a head start to sperm in performing fertilization without competing and traversing the distance up to the location of fallopian tubes.

    Step 3:The process of fertilization occurs outside the female body in a special IVF lab. During this organic process, IVF experts either penetrate the eggs directly with sperm or keep them together in a petri-dish to perform fertilization naturally. Once a viable embryo is developed naturally, embryo analysis begins cautiously. An embryologist carefully analyzes the best embryo and precisely places it into the uterus through a catheter. In some crucial cases, to accomplish the desired results, multiple embryos are also placed inside the uterus. Implanting multiple embryos lead to multiple births like twins and triplets. Many civilized countries, around the world prominently include a specified parameter of transplanting only one embryo per IVF cycle, reducing the risks of multiple gestations and potential health risk to an expectant mother. 

    Step 4: Developed embryos are transferred into the uterus of a woman, while she is at ease in an unconscious state. The process is properly executed with the help of a flexible medical instrument called a catheter. Several fluids and embryos are filled inside the curving catheter carefully. The catheter is later inserted through the cervix into the vagina and then into the uterus to transfer the embryo into the uterus. The developed embryo is usually transferred after the blastocyst stage, where the active cells have multiplied from 100 to 125 cells. Certain hormonal medication is still prescribed to the patient so that her body progressively develop an environment to adopt pregnancy. A patient is strictly advised, not to work vigorously and take stress to have a successful pregnancy. A pregnancy test is typically practiced after 14 days of the transferring embryo. The potential failure of embryo implantation additionally requires another specific range of tests to identify the reason for failure. In a successful pregnancy, leftover embryos are either frozen for the next IVF cycle or may be donated to the childless couple for
    IVF treatment according to the couple's choice.

    2. What is the need for IVF Treatment?

    IVF procedure is an effective treatment for treating many different causes of infertility. It often offers hope where other methods have failed, especially for those women who have been unsuccessful with other fertility treatments, including fertility medications and Intrauterine Insemination (IUI) procedure. People suffering from different types of infertility may suffer from below mentioned disorders. Whereas, some female infertility treatments comprise of the sub-treatment first for the following disorders and then IVF treatment is performed (3):

    What is the need for IVF Treatment
    Advancing age: Due to increasing age fertility in men and women starts reducing. The quality and quantity of sperms and eggs begin to decrease and develop infertility in them. Therefore, after examining the age-related factors, IVF treatment is suggested by experts directly. 

    Polycystic Ovary Syndrome (PCOS):Under PCOS condition, levels in male hormones in a woman's body, which increase gradually and develop irregular periods. If a woman skips her menstrual cycle without having sexual intercourse may gain weight, and develop unwanted hair on the face, which requires a regular checkup for PCOS. The presence of PCOS in women directly causes infertility or makes it difficult for them to conceive. PCOS comprises of three key factors affecting the periods in a woman which includes cysts in the ovaries, elevated levels of male hormones, and skipped or irregular periods. In PCOS, the word 'Polycystic' refers to several small sacs filled with fluids grow inside the ovaries. Thus, the immature eggs present in the ovaries never get mature enough to ovulate due to these sacs. (7) 

    Male factor Infertility: Male factors like low quality of sperm, an insufficient number of sperm cells, or any problem with the reproductive body part may lead to infertility in men. These factors should be recognized before commencing with IVF treatment because male factor infertility may also be treated with Intrauterine Insemination (IUI) treatment.

    Genetic disorder:In IVF treatment, Preimplantation Genetic Diagnosis (PGD) test stands important in couples with genetic diseases. IVF experts through a PGD test, examine the chromosomal abnormalities or genetic defects in developing the embryo. These genetic defects may naturally transfer to the child by birth. Through diagnosis, embryologists help in examining and recognizing the genetic defect free embryos. After consulting with the patient and her partner, the healthy embryo is implanted into her uterus. This specific test reasonably requires at least a week's time to be performed. If all the developed embryos are found with genetic disorders, then either the complete IVF process is repeated, or donor egg or sperm is considered. (9)

    Unexplained infertility: Many couples find it difficult to conceive even after having regular intercourse for several months. This cautiously raises their genuine concern towards infertility causes and its effective treatment. By examining various parameters of an infertile couple, causes of infertility are identified. Either these infertility causes are treated first through specific medication and curative surgeries, or IVF is straightway suggested by consulted IVF experts.

    Fallopian tube damage or blockage: Fallopian tube blockage is identified through the Hysterosalpingography (HSG) type of X-ray. The process is performed during the first half of a menstruation cycle. Blockage in a fallopian tube may occur due to Pelvic Inflammatory Disease, (PID), Endometriosis, Chlamydia, and Gonorrhea. These blockages hinder the sperm to travel and reach fallopian tubes to fertilize a mature egg. (6)

    Ovulation disorders: A woman may experience symptoms of ovulation disorders like irregular periods, overweight or clotting of blood leading towards infertility. The ovulation disorder is caused due to the accumulation of several small cysts in ovaries disturbing the balance of the key hormones which leads to an insufficient number of eggs and a problem in the functioning of ovaries. PCOD is a common ovulation disorder these days, but maintaining a nutritious diet and continual exercise may support one in overcoming its profound effects on conceiving and daily life. (10)

    Premature ovarian failure: It refers to the failure of the normal functioning of ovaries before 40. In this situation, the ovaries stop producing necessary hormones like estrogen and progesterone due to insufficient eggs. This condition also at times states as early menopause in a woman. During Premature Ovarian Failure (POF), a woman's body naturally, generates certain disorders in the ovaries, thus not allowing them to work adequately.

    Endometriosis: When the uterine tissues grow and implant outside the uterus lining. These overgrown tissues hinder the functioning of other crucial organs like fallopian tubes, ovaries, and uterus. Endometriosis also hinders the IVF treatment and must be treated before beginning the procedure of IVF. 

    Uterine fibroids:These refer to the benign tumors accumulated on the walls of the uterus. It usually occurs in the age of 30s to 40s in some women. Uterine fibroids hinder the implantation of an embryo and must be cured to have a healthy pregnancy through IVF procedure.

    Previous tubal sterilization or removal: If previously any tubal surgery or sterilization took place to stop the pregnancy, may be reversed with the help of infertility treatment. In IVF reversing the tubal sterilization is effective for couples, who plan to conceive in the near future and not in the current times. (8)

    3. What are the Symptoms, Side Effects of IVF, and Fertility Medication?

    IVF procedure may cause various side effects after the procedure is completed. Although a woman should take enough rest and avoid stressful work after the completion of the IVF procedure especially after the Embryo Transfer (ET) procedure. After a successful process of IVF, the patient may feel certain side-effects of the medication, which should be informed to the doctor. A woman may also feel nausea, fatigue, and drowsiness, which is common after so many new changes in the hormones. The below-given points indicate the symptoms and side effects of IVF procedure as well as the side effects of fertility medication:

    Symptoms and Side Effects of IVF

    • Symptoms experienced after IVF treatment:A woman may experience various symptoms as side effects after her IVF treatment is completed. The symptoms of the presence of side effects are heavy vaginal bleeding, pelvic pain, having a high fever over 100.5 °F (38 °C), and visibility of blood in the urine.
    • Side effects after IVF procedure:A woman may experience mild cramping, constipation, mild bloating, breast tenderness, and may experience spotting of blood in a small amount of fluid after the IVF treatment cycle is completed.
    • Side effects of Fertility Medications: After taking various fertility medications during the IVF cycle, a woman may experience mood swings, hot flashes, headaches, abdominal pain, and bloating. Other than these side effects, a woman can also suffer from Ovarian Hyperstimulation Syndrome (OHSS), which is rare and may be avoided if precautions are taken before proceeding with the IVF process. However, OHSS is a life-threatening disease and must be handled cautiously by IVF experts. 

    4. What are the risk factors associated with IVF treatment?

    IVF process has a significant success rate in infertile couples to experience a positive pregnancy. It is the best infertility treatment, but some patients also experience certain side effects. In the IVF procedure, a doctor will extract the eggs from the female partner and combine them with a viable sperm in a petri dish for a combination of egg and sperm to produce a quality embryo. One IVF cycle essentially takes between 4 to 6 productive weeks to complete the procedure.
    Risk Factors Associated with IVF Treatment

    Like most other medical treatments, IVF treatment also has various risk factors associated with it, which are mentioned below:

    • A woman may experience shortness of breath, nausea or vomiting, severe stomach pain, decreased urinary frequency and increased weight within 3 to 5 days. 
    • While performing egg retrieval during the IVF process, one may experience risks of bleeding, infection, and damage to the bowel or bladder.
    • IVF treatment increases the chance of having multiple pregnancies. Multiple gestations occur due to the transfer of multiple embryos to boost the chances of a successful pregnancy with respect to the IVF procedure. The risk of miscarriages increases with maternal age.
    • There is a risk of having an ectopic pregnancy after IVF procedure if the fertilized egg is implanted anywhere outside the uterus. Ectopic pregnancy normally results in miscarriages because other parts of the body do not have enough capacity to bear a growing fetus other than the uterus.
    • A woman undergoing the IVF process may feel stress due to the pressure of financial, physical, and emotional factors. It is very tough for some of the infertile couples to afford expensive treatment. Another important factor is that only a few of the insurance companies cover IVF treatment under their insurance schemes due to the involvement of natural factors of the body. (11)
    • It is observed in many infertility types of research, that the rate of miscarriages attained through IVF treatment, is almost the same as normal miscarriages in naturally attained pregnancy. The chances of miscarriages remain 15 to 25 percent on average in pregnancy until the first trimester, whereas the chances may increase due to the advancing age of a woman. (11)

    IVF procedure is one of the in-demand and popular infertility treatments. It is important to choose the right infertility centre for the right type of infertility treatment which will eventually help in achieving the desired results. Patients will find useful information related to Surrogacy, IUI, ICSI, TESA, MESA, and other helpful infertility treatments by visiting elawoman.com or else one can make a call on +918929020600 for more details.

    Dr. Shakuntla Kumar

    Written by

    Diploma, MBBS, DGO, FICOG
    Laparoscopic Surgeon, Gynecologic Surgeon
    Delhi
    Dr. Shakuntla Kumar is an infertility specialist and gynecology surgeon specializing in Endoscopic Surgery, Gynecology Laparoscopy, IUI, IVF and Hysterectomy procedures. Dr. Shakuntla has completed MBBS from Maulana Azad Medical College in 1987 and DGO in Obstetrics and Gynecology from Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi in 1992. She has also completed Diploma in Endoscopy procedure from Kiel University, Germany in 2008 and Fellowship of Indian College of Obstetrics and Gynecology in 2016. She has received numerous awards and recognitions in her career for her excellent work in the field of obstetrics and gynecology. Dr. Shakuntla is practicing her expertise at Nulife Hospital and Maternity Centre and Fortis Hospital, Shalimar Bagh, Delhi. To know more, visit elawoman.com

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    Pralay Datta

    June 4, 2019, 10:11 a.m. 4.5

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