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    in vitro fertilisation (ivf)

    In Vitro Fertilization (IVF) - Process, Requirement, Success Rate, Risks and Cost

    • 196974 views
    • 4.6   (5 Votes)
    Medically Reviewed by Dr. Deepika Tiwari - MS, MBBS on 30 Mar 2019 - Written by Dr. R K Sharma - MD, MBBS - Grammatically Approved by Dr. Kavita Jaggi Agrawal - MS, MBBS

    In IVF treatment an egg is combined with sperm outside the body. It is suggested in cases of blocked tube/s, endometriosis and unexplained infertility. IVF risks include multifetal gestations and birth defects. The success rate of IVF is 1.5 in 5 and the average cost ranges from Rs. 2 to 5 lacs.

    In Vitro Fertilization (IVF) is a procedure used to treat fertility or genetic problems and assist with the conception of a child. During IVF, mature eggs are retrieved from a woman’s ovaries and fertilized by sperms in a laboratory. Finally, the fertilized egg (embryo) or eggs are transferred in a woman’s uterus for implantation. One cycle of IVF takes about two weeks. IVF procedure can be done using a woman’s own eggs or the partner's sperm. IVF may also involve transfer of eggs, sperm or embryos from a known or anonymous donor. In some cases, a gestational uterus might be used. The chances of having a healthy baby through IVF depend on many factors like age and the cause of infertility. Also, IVF can be time-consuming, expensive and invasive. If more than one embryo is implanted in a woman’s uterus, IVF can result in a pregnancy with more than one fetus (multiple pregnancies). Many countries ban or otherwise regulate the availability of IVF treatment, giving rise to fertility tourism. Restrictions on the availability of In Vitro Fertilization include costs and age, in order for a woman to carry a healthy pregnancy to term. IVF is generally not used until less invasive or expensive options have failed or been determined unlikely to be successful. (1)

    Cases When IVF Becomes Necessary

    In Vitro Fertilization (IVF) may be the first-line treatment for couples struggling with infertility. In other cases, In Vitro Fertilization (IVF) may be recommended only if simpler treatment fails. IVF may be recommended under any of the following conditions:

    • Endometriosis: Endometriosis is a disease of reproductive-aged women characterized by endometrial glands or stroma in sites other than the uterine cavity, usually the ovaries or peritoneum. Endometriosis is one of the most challenging diseases for gynecologists helping infertile women to conceive. For more stages of endometriosis, including the presence of endometriomas, IVF is the optimal first-line treatment and offers the highest pregnancy success rates. (2)


       
    • Premature ovarian failure: POI (Premature ovarian insufficiency) is when the ovaries stop working properly before the age of 45. If a woman is suffering from POI the ovaries stop producing normal levels of a hormone called oestrogen and may not release eggs. It is also known as premature ovarian failure or premature menopause. Women with POI may still occasionally release an egg and have a period. Women with POI do not ovulate (release an egg) every month. This makes it difficult to get pregnant. Women who have POI and are having difficulty getting pregnant may be able to receive eggs from a donor. Treatment with donor eggs is carried out using In vitro Fertilization (IVF). (3)
       
    • Impaired sperm production or function: Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm shape and size can make it difficult for sperms to fertilize an egg. Low or zero sperm count can be the result of damage to the reproductive system. About 4 out of every 10 men with a total lack of sperm or azoospermia have an obstruction (blockage). A birth defect or a problem such as an infection can give rise to blockage in the reproductive system. If semen abnormalities are found, one might need to see a specialist to determine if there are correctable problems or underlying health concerns. (4)
       
    • Uterine fibroids: Uterine fibroids are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. These fibroids are also known as uterine myomas, fibromas or leiomyomas. It is estimated that between 20 to 50 percent of women of reproductive age have uterine fibroids, although not all are diagnosed. In more than 99 percent of fibroid cases, the tumors are benign or non-cancerous and do not increase a woman's risk for uterine cancer. They may range in size, from the size of a pea to the size of a small grapefruit. (5)
       
    • Tubal blockage or damage: A blockage or damage caused to fallopian tubes can come in the way of a sperm from fertilizing it. It can stop an embryo from traveling to uterus.
       
    • Unexplained infertility: It means no cause of infertility has been found despite evaluation for common causes.
       
    • Genetic Disorder: If a woman along with her partner is at risk of passing on a genetic disorder to their child, they may be candidates for preimplantation genetic diagnosis, a procedure that involves IVF. After the eggs are fertilized, they are screened for certain genetic problems, although not all genetic problems can be found. Embryos that do not contain identified problems can be transferred back to the uterus.
       
    • Previous tubal sterilization or removal: If the patient had a tubal ligation, a type of sterilization in which the fallopian tubes are cut or blocked to permanently prevent pregnancy and the patient wants to conceive, IVF may be an alternative to tubal ligation reversal.
       
    • Fertility preservation for cancer or other health conditions: If the patient is about to start cancer treatment such as radiation or chemotherapy, that could harm their fertility, IVF for fertility preservation may be an option. Women can have their eggs harvested from their ovaries and frozen in an unfertilized state for later use. Or the eggs can be fertilized and frozen as embryos for later use. (6)

    Process of IVF

    During IVF, eggs are removed from the ovaries of a woman and fertilized in a laboratory with sperm provided by a partner or a donor. Given below are the typical stages in an IVF cycle:

    • A woman’s natural menstrual cycle is switched off with daily injections or a nasal spray.
    • The woman has injections of fertility hormones to stimulate her ovaries so she produces several eggs, instead of just one.
    • When the eggs mature, they are collected using a fine needle, guided by ultrasound, under light sedation.
    • The eggs are fertilized in the laboratory with sperms provided by the woman’s partner or a donor.
    • The fertilized eggs (embryos) are grown in an incubator for a few days.
    • One or two healthy embryos are transferred into the woman’s uterus using a thin tube inserted into the vagina and cervix.
    • If an embryo successfully implants, the woman becomes pregnant. She needs to wait for two weeks for a pregnancy test.
    • Remaining healthy embryo (s) can be frozen and stored for later use if needed.

    Women who have IVF often opt to have more than one cycle. There are many variations included in the IVF procedure, for example, sperms or eggs may be collected from a donor. (7)

    Success Rate with IVF

    The success rate of IVF depends on a number of factors like reproductive history, maternal age, the cause of infertility, and lifestyle factors. It is also important to understand that pregnancy rates are not always the same as live birth rates. In the U. S, the live birth rate for each IVF cycle started is approximately:

    • 41-43% for women under age 35.
    • 33-36% for women ages 35 to 37.
    • 23-27% for women ages 38 to 40.
    • 13-18% for women ages over 40. (8)

    Since the birth of the world’s first ‘test tube baby’, Louise Brown, 40 years ago, 6 million babies have been conceived worldwide through assisted techniques like IVF. The success rate of an IVF cycle varies greatly as it depends on many factors, but it generally ranges between 35 percent and 40 percent. According to research conducted by US Centers for Disease Control and Prevention, IVF cycles resulted in live births in 38.3 percent of women under 35 years of age, with the percentage falling to 32 percent for women aged 35 to 37 years. The success rate of IVF fell to 23.1 percent for those aged 38 to 40 years, and to 10.4 percent in women over 40 years. In the UK, IVF is successful in 29 percent of women under 35 years, 23 percent of women aged 35 to 37 years, 15 percent of women aged 38 to 39 years, 9 percent of 40- to 42 years and 2 percent of women over 44 years. According to research, it has been found that the success rate of IVF is increasing in every age group as the techniques are refined and doctors become more experienced. Close to 400 centers are enrolled for now, of an estimated 1,500 to 2,000 centers across the country. What has been shown to improve the chances of success are freezing eggs before the woman is 35 years, for use when she is ready to start a family. Not only are a younger woman’s eggs healthier, but it has also been observed that in the case of frozen eggs the chances of implantation are better. (9)

    Risks Associated With IVF

    Some of the risks associated with In Vitro Fertilization (IVF) include the following:

    • Multiple births: More than 40 percent of all IVF techniques usually used have led to a rash of multiple births because doctors commonly transfer two or more embryos in hopes of achieving a successful pregnancy. In the United States, between 1980 and 2001, according to a report, a fourfold increase in triplets and high-order births was documented, as was a 60 percent increase in twin births. More than 60,000 babies, about 1.6 percent of all infants born were conceived through IVF and 41.1 percent of all IVF deliveries were multiples. This was directly attributable to the common practice of transferring multiple embryos to the uterus to enhance pregnancy rates. (10)


       
    • Premature delivery and low birth weight: The University of Manchester led a study of 5,200 IVF children, where it was found that singleton babies conceived from fresh embryo transfers used in two-thirds of all IVF are associated with lower birth weights and premature delivery. (11) According to a Data on IVF pregnancies from 1994 to 1996 within Alberta, it was observed that the IVF component of increased low birth weight (LBW) rate was 17.8 percent for infants (<2500 g) and 4,3.5 percent for those born (<1500 g). During a 3-year period, IVF has affected the incidence of LBW, preterm delivery, and multiple births. IVF is a substantial contributor to changes in view of low birth weight and delivery before 30 weeks, which is partly related to multiple births. (12)
       
    • Ovarian hyperstimulation syndrome (OHSS): Use of injectable fertility drugs, such as human chorionic gonadotropin (HCG), to induce ovulation can cause ovarian hyperstimulation syndrome (OHS) which causes swelling of the ovaries with leaking of fluid within the body. OHS affects about 10 percent of women who undergo traditional IVF. Signs and symptoms typically last a week and include mild abdominal pain, bloating, nausea, diarrhea and vomiting. It is possible to develop a more severe form of ovarian hyperstimulation syndrome that can also cause rapid weight gain and shortness of breath. (13)
       
    • Miscarriage: The extremes of BMI (body mass index) are associated with an increased risk of miscarriage both in spontaneously conceived pregnancies and after fertility treatment. According to an analysis carried out on 3330 first pregnancy cycles, performed during the years 1999–2004, of which 2198 were fresh, 666 were spontaneous and 466 were hormonally substituted FET cycles. Categorical, linear and quadratic models of the effect of BMI on miscarriage were studied by logistic regression. Multivariate logistic regression analysis revealed that the relationship between BMI (body mass index) and the risk of miscarriage is not linear but quadratic, indicating a higher risk of miscarriage in underweight and obese women. Obese and underweight women have an increased risk of miscarriage, and hormonally substituted FET is associated with an even higher MR (miscarriage risk). (14)
       
    • Ectopic pregnancy: An ectopic pregnancy is a complication that occurs when an embryo implants outside of the uterus. Ectopic pregnancies occur in 1 percent to 2 percent of all pregnancies and remain an important cause of maternal morbidity and mortality in the first trimester. Epidemiologic studies have identified several risk factors for ectopic pregnancy like smoking, tubal damage and chlamydia trachomatis infection. These risk factors have been considered to lead to embryo implantation within the fallopian tube by altering tubal smooth muscle contractility and the tubal microenvironment, leading to arrest of the embryo within the fallopian tube and an environment more apt to encourage implantation. (15)
       
    • Stress: Use of IVF can be financially, physically and emotionally stressful. Support from counselors, family and friends can help the patient through the ups and downs of infertility treatment. (16)
       
    • Egg-retrieval procedure complications: Most of the surgical complications surrounding egg retrieval stem from two basic facts about the surgery that is when a needle must be pushed through the vagina and into the ovary and a number of other organs and sensitive tissues lying nearby. The surgeon often finds the ureter right next to the ovary, which might put the ureter at high risk for inadvertent damage. Another complication can be an ovarian torsion, which occurs when the ovary twists around on itself, cutting off its blood supply. In a study of 1,500 women who underwent In Vitro Fertilization (IVF), ovarian torsion occurred in 0.13 percent of the cycles. Ovarian torsion occurs late around 6 to 13 weeks after the oocyte retrieval and since the risk of torsion increases with the softening of the ligaments that appear in pregnancy, ovarian torsion is a complication that is mainly associated with women who get pregnant with IVF. (17)
       
    • Birth defects: According to a new research infertile women aged 40 and over who used assisted reproduction had less than half the rate of birth defects of fertile women of the same age, while younger women are at an elevated risk. Researchers believe that the average prevalence of a birth defect was 5.7 percent among naturally conceived births, 7.1 percent for the IVF births, and 9.9 percent for the ICSI births, across all age groups. In births from assisted reproduction, the prevalence of birth defects was 3.6 percent for women aged 40 and above using IVF. For women treated with IVF and ICSI combined, the greatest age-related risk of birth defects was among younger women, at or around 29 years of age. (18)
       
    • Ovarian cancer: A large-scale study finds that women who have used assisted reproductive technologies (ART) are over a third more likely to develop ovarian cancer than other women. It is likely the increased risk reflects underlying health problems in women who need help conceiving, rather than being a result of the treatment itself. (19)

    Costs of IVF

    IVF costs in India can also vary greatly depending on location. For example, the cost of IVF in Mumbai can range between Rs. 2 to Rs. 3 lacs while the cost of IVF in Gurgaon can range from Rs. 90,000 rupees to Rs. 1.25 lacs. Due to the vast differences in costs, some couples prefer to travel to other cities where IVF is more affordable. (20) Hence it is important to talk with the doctor about any factors that apply to you and how they may affect your chances of a successful pregnancy.

    Hope this article has provided you information about IVF. For more articles on IVF, follow Elawoman blog. The decision to have a baby is one of the most challenging and emotional journeys that a woman or a couple can take. If you are considering In Vitro Fertilization (IVF), contact Elawoman today to schedule a consultation. Elawoman will be happy to answer any questions you have and provide guidance while you decide which procedure is right for you. Elawoman can also answer questions about costs and financing options. Reach us at +918929020600 - Elawoman.

    Dr. R K Sharma

    Written by

    MD, MBBS
    Reproductive Endocrinologist, Hysteroscopic Surgeon
    Delhi

    Dr. R K Sharma is ranked among the best infertility specialist and gynecologists in Delhi. He has treated hundreds of infertile patients and has helped many couples achieve their dream of parenthood. He specializes in Embryo Transfer (ET), Intrauterine insemination (IUI), In Vitro Fertilisation(VF) and Hysteroscopic surgery. He is dedicated to his work and gives his best to achieve success. He is well-versed with the latest technological advancement in medicine. He completed his MBBS from the University of Pune in 1981 and continued to pursue MD in Obstetrics & Gynaecology. He was brilliant in his academics which earned him Membership of Federation of Obstetric and Gynaecological Societies of India (FOGSI). He also provides counseling services to couples who are going for IVF for the first time. He performs the treatments with precision and care to improve the chances of success in the first try. Dr. R K Sharma is the founder and director of ART Centre at Army Hospital (R & R) Delhi and Southern Star ART Centre at Command Hospital (SC), Pune. He is presently practicing at Primus Super Specialty Hospital, Chanakyapuri, Delhi.

    Primus Super Specialty Hospital is a reliable and affordable multispeciality hospital in Delhi. They are serving patients in different specialties like sports physiotherapy, Diagnostic Laboratory, Intrauterine Insemination (IUI), Intra Cytoplasmic Sperm Injection (ICSI), Electrocardiogram (ECG), X-ray, In-Vitro Fertilization (IVF), Blood Test, pregnancy care and women wellness. The hospital follows modern methods of treatment to ensure the utmost comfort and care.

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    5 Comments

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    Raj Sanchita

    My wife was suffering from endometriosis. The problem has become a taboo in the way of becoming a mother. But we never gave up and finally with the help of IVF we became parents.

    Nov. 7, 2018, 3:21 p.m. 5.0

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    Nimisha Sahani

    Due to the problem of PCOS becoming a mother seemed difficult to me. But at that tough time, I got the support of Ela. They told me about the treatment for PCOS and also helped me to get the best doctors for it.

    Oct. 17, 2018, 8:45 p.m. 4.5

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    Sheila Saxena

    IVF treatment can even help women suffering from cancer and cannot conceive naturally.

    Aug. 24, 2017, 3:06 p.m. 4.5

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    Deepak Patel

    Great information on IVF process and things required for it. Thanks!

    Aug. 24, 2017, 2:59 p.m. 4.5

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    Phinni Manalo

    It becomes a tough task for couples to attain pregnancy with low sperm count. For such couples IVF treatment is a boon.

    Aug. 24, 2017, 1:43 p.m. 4.5

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    It is not advised to self-diagnose or treat any medical condition or disease following the information given in this article. We insist you to consult a registered practitioner and never try to replace their advice or discontinue treatment in between by relying solely on the information obtained. External links to different websites as well as videos given on the website serve the purpose of sharing knowledge only. Ela being an Independent Medical Information platform is neither responsible nor guarantees the authenticity, reliability, and accuracy of these videos and websites in any way. We do not intend the information displayed here to be used for a medical emergency, if you seek medical attention for yourself (or any other person with whom you want to share the information with), we advise you to directly get in touch with the hospital or the doctor.

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