Definition of In-Vitro Fertilization (IVF)

In Vitro Fertilization is an Assisted Reproductive Technology (ART) where a woman’s eggs and man’s sperm are combined in an advanced high-tech laboratory to create an embryo. In fact, the actual meaning of the word “In Vitro” is “Outside the body of living organism” therefore the entire fertilization process in an IVF procedure takes place outside the human body. When the egg combines with a sperm it starts to fertilize and develops into an embryo. Usually, on Day 5 of fertilization, the embryologists identify the best embryo which is then transferred into the female uterus. Of course, optimum laboratory environment and high-tech equipment are required to ensure healthy embryos develop and the desired pregnancy can be achieved.

Assisted reproductive technology comprises several techniques used to help infertile couples in achieving parenthood. In Vitro Fertilization, IVF is also an advanced assisted reproductive technology (ART) that aids infertile couples in conception. “In-vitro” means outside an organism’s body. IVF is a series of complex procedures in which eggs and sperm are meticulously combined, for fertilization, in the laboratory under optimal conditions. The resulting embryo is implanted into the uterus to achieve conception.

IVF is the most effective type of ART however, it is imperative to consult a fertility specialist to understand the procedure, and potential risks, and to determine whether it is the right option for you.

Historical Milestones

The experiments of fertilization outside the human body began in the 1960s thus by 1978, the first test tube baby, Louise Brown was born in the United Kingdom. The birth of this baby transformed the field of medicine and infertility. With the passage of time, assisted reproduction techniques kept on advancing. Consequently, IVF and later on, ICSI were introduced. These techniques not only aimed at achieving parenthood but also helped with the prevention of genetic problems and other fertility issues.

Initially, the techniques were subjected to a lot of criticism. However, today assisted reproductive techniques are widely accepted as they merge hope with science standing as a beacon for countless couples striving for parenthood.

Infertility Prevalence

Infertility has become a significant concern globally. It has been roughly estimated that around 10-15% of couples struggle to conceive naturally. It can be due to female or male factors i.e., sperm abnormalities, ovulatory dysfunctions, and blocked tubes can lead to infertility in men and women. Several other factors including, environment, increased age and lifestyle choices, also contribute to the prevalence of infertility. In such cases, IVF offers hope to couples struggling to conceive naturally. It has aided in transforming countless infertility tales into stories of successful parenthood.

Fertility Specialists

A fertility specialist is trained to diagnose and treat infertility and reproductive issues. They help, couples who struggle to conceive naturally, in realizing their dream of parenthood with the help of various medical techniques.

Fertility specialists play a vital and invaluable role in IVF treatments. They are the backbone of IVF procedures. They provide expert diagnosis, advanced treatment plans, and counselling which educate couples on reproductive health and various infertility treatment options available depending on their case.

The role of a fertility specialist goes beyond diagnosis and treatment because the IVF journey impacts emotional health. Therefore, the fertility specialists at Australian Concept counsel patients to help them with any psychological or emotional challenges they might be going through during their IVF journey.

IVF Process and Stages

IVF comprises a series of complex procedures and stages which require concentration and care for their success.

Ovarian Stimulation

To ensure successful in vitro fertilization more than one egg is required. Therefore, ovaries are stimulated with follicle-stimulating hormone and/or luteinizing hormone (LH) to produce more than one egg per cycle. The production of multiple eggs increases the chances of fertilization because sometimes eggs may fail to fertilize.

It is vital to monitor hormones during the procedure so the right amount of hormones are administered alleviating the chances of over or under-stimulation and indicating impending ovulation. Furthermore, monitoring helps to determine that the trigger shot is given at the right time so, the eggs are timely retrieved.

Generally, about two to three weeks of ovarian stimulation is required before eggs can be retrieved.

Egg Retrieval

Egg retrieval is a minor surgical procedure which takes place at the clinic after about 36 hours of administering a trigger shot. To keep the patient from pain, anesthesia is administered.

To retrieve eggs from the ovaries, the doctor finds follicles, firstly, with the help of a thin needle to which an ultrasound guide is attached. The eggs are retrieved from follicles using a needle attached to a suction device. It takes about 30 minutes to remove eggs from follicles.

The patient may feel cramps, pressure or a feeling of fullness after the procedure which eventually fades away.

Fertilization and Embryo Development

The retrieved eggs are placed in a liquid to aid development. During this stage, eggs are monitored so that healthy eggs can be chosen to be put together with sperm for fertilization.

The healthy eggs and sperm are combined in laboratory petri dishes under optimal conditions for fertilization where the sperm fertilizes the egg on its own. At this stage, not all eggs are successfully fertilized hence, a greater number of eggs means higher chances of successful fertilization.

Embryo Transfer

After successful fertilization, the eggs are kept under observation so the embryologist can select the healthiest embryos for embryo transfer. The embryo transfer procedure takes place at the clinic. This procedure is painless however, mild anesthesia may be administered to help the patient relax.

One or more embryos are filled in a syringe containing some amount of fluid. This syringe is attached to a catheter which is placed into the uterus. With the syringe, the embryo/embryos are implanted into the uterus where the embryo attaches itself to the lining of the uterus to achieve pregnancy.

Luteal Phase Support

A successful natural conception depends upon adequate endometrium development. Estrogen and progesterone, produced by developing follicles before ovulation and by corpus luteum after ovulation, help in successful endometrium development. However, this physiology is disrupted in IVF conducted with gonadotropin-releasing hormone agonists or antagonists. Hence, in IVF stimulating cycles, supplementation of the luteal phase with progesterone is essential for higher pregnancy rates and to achieve optimal results.

Human chorionic gonadotropin (hCG) can also be administered for this purpose but an increased risk of ovarian hyper-stimulation syndrome (OHSS) is associated with it therefore, progesterone is preferred. It supports the endometrium lining hence, giving a nurturing environment for embryo development and healthy pregnancy.

Medications and
Protocols

For a healthy and successful pregnancy, a well-functioning reproductive system is essential. IVF treatment requires various hormones to regulate the cycle, prevent premature ovulation and stimulate ovaries. We will delve into various types of essential hormones that are required in an IVF program.

• Follicle Stimulating Hormone (FSH): 

  Primarily, FSH is used to produce more than one egg in a single menstrual cycle. the reaction of each patient to this hormone may vary. In some, it can result in ovarian hyper-stimulation syndrome, while in others it may not have enough eggs. Therefore, an individual’s response to FSH is monitored through blood tests and ultrasounds. It can also be used with LH or hCG for ovulation or maturation of eggs. The FSH administered for ovarian stimulation can also play a role in the preparation of the endometrium lining.

• Luteinizing Hormone (LH):
  

  In IVF, LH hormone is administered for the final maturation and release of eggs from the ovaries. While in a natural cycle, LH triggers ovulation but in IVF, a natural surge of LH is suppressed from doing so to prevent premature ovulation. Hence, an artificial surge of LH hormone is administered when eggs are ready for retrieval.

• Anti-Mullerian Hormone (AMH):

  This hormone plays a vital role in the planning stages of IVF treatment as it gives insights into the woman’s ovarian reserve. Moreover, AMH levels help in predicting how the patient’s body will respond to fertility drugs. Thus, each patient’s IVF protocol is made keeping his needs in view.

• Progesterone and Estrogen Hormones:

  Estrogen and Progesterone hormones are administered in IVF, as the former aids in follicular development and in preparation of endometrium lining while the latter supports in preparation of endometrium lining and maintaining early pregnancy. The administration of these hormones is closely monitored to increase the chances of a successful pregnancy. Furthermore, they aid in the prevention of premature ovulation while progesterone also plays a vital role in luteal phase support.

• Human Chorionic Gonadotropin:

  Human Chorionic Gonadotropin play several roles in IVF treatment. It aids in the final maturation of eggs, the luteal phase, and the potential risk of ovarian hyper-stimulation syndrome (OHSS). It mimics luteinizing hormone for the maturation of eggs and ovulation. hCG can cause OHSS therefore, patients who are at a higher risk of developing it are given other alternatives instead of hCG.