The desire to have children is natural and normal, but for some couples, it is a physical impossibility. Whatever the reason, the only choice for these couples, till a generation ago, was adoption. In recent years, medical science has made immense strides in the fields of human reproductive technology and today in vitro fertilization enables couples who were unable to conceive to have a child of their own.
In Vitro
Normally, male sperm enters the female body and fertilizes an egg. If this fertilized egg becomes attached to the lining of the womb and continues to grow, the woman is pregnant and the baby is born after about 9 months. If this natural conception is not possible, then the process is done outside the woman’s body, in a laboratory. In Vitro means “outside the body.”
The procedure is usually performed when either the man or woman has one or more that could impede the possibility of pregnancy. These include:
- Blocked or damaged fallopian tubes.
- Endometriosis.
- Low sperm count or other sperm impairments.
- Problems with your uterus.
- Risk of passing on a genetic disease or disorder.
- Unexplained infertility.
- Polycystic ovary syndrome (PCOS) or other ovarian conditions.
- Uterine fibroids.
The procedure is a complex one that must be done under carefully controlled conditions by experts in the field of IVF. IVF does not guarantee a pregnancy or that the delivery will be successful. The couple must understand this before starting the process. That said, IVF does have a high success rate and is one of the most effective assisted reproduction technologies.
The Process
IVF has 5 basic stages:
Stage 1: Stimulation or super ovulation
- Various medicines, generically known as fertility drugs are administered to the woman to increase egg production.
- While a woman will normally produce 1 egg a month, with fertility drugs, the ovaries will typically produce several eggs during the same period.
- During stage 1 the woman will be regularly monitored using transvaginal ultrasounds and other procedures to monitor the ovaries and blood tests will be done to check hormone levels.
Stage 2: Retrieval Of Eggs
- Eggs are removed from the woman’s body employing a minor surgical procedure known as follicular aspiration.
- The procedure is usually an outpatient one, done in the doctor’s office. The woman is given medication to avoid pain and discomfort. Using advanced imaging technology the doctor inserts a fine needle through the vagina to the ovaries. A suction device connected to the needle is used to suck out the eggs, one at a time. After the eggs have been removed from one ovary, the same procedure is followed for the other one.
- In some cases, there may be slight discomfort after the procedure, but it fades within a day.
- In case the woman is unable to produce eggs, the suction procedure is used to collect eggs from an egg donor.
Stage 3: Insemination and fertilization
- The eggs are examined to find those that appear to be of the best quality. The male sperm is placed with the selected egg. The mixing of the egg and sperm is called insemination.
- The egg and sperm are placed in a special chamber that is environmentally controlled so that fertilization can occur. This usually takes some hours. In case the doctor feels that the chances of fertilization this way are low, an option is to inject the sperm directly into the egg.
Stage 4: Embryo culture
- After fertilization, the egg will start to divide and in this manner become an embryo. In about 5 days, the process of cell division stabilizes. During this time the egg is regularly checked to see that it is developing properly.
- At this stage, if there is a significant risk of a child developing a hereditary (genetic) disorder, a pre-implantation genetic diagnosis (PGD) may be done, if the couple desires it. This involves the removal of a single cell for the embryo to check for specific genetic disorders. The embryo is not harmed by this process.
Stage 5: Transfer of the embryo
- About 5 days after fertilization the embryo is removed from the controlled laboratory environment and placed in the woman’s womb.
- In some cases, more than one embryo may be placed in the wombat the same time. This can increase the chances of success, but may also lead to twins or triplets. The decision to implant more than one embryo will depend on various medical factors and the woman’s age and will be decided on in consultation with the parents.
- The procedure is an outpatient one done in the doctor’s office. A thin tube known as a catheter is inserted into the vagina, through the cervix and into the womb. The embryo is pushed through the catheter into the womb. If the embryo implants itself onto the lining of the womb, it will start to grow and the woman will be pregnant.
- If more than one embryo is grown in the laboratory and only one is used, the unused ones may be frozen for later use or donated to other couples where the woman is not able to produce eggs.
After the Procedure
After stage 5 is complete, the woman will be advised a day’s rest after which normal activities may resume. The woman will need to take daily doses of a hormone called progesterone for between 2 to 3 months after the embryo is implanted. This hormone strengthens the lining of the uterus and supports the development of the embryo. The woman will need to keep returning to the hospital through the course of her pregnancy so that the growth of the fetus can be monitored and any corrective action, if required to prevent problems, can be taken.
IVF is today a safe and established way for couples who cannot conceive through normal sexual activity to have children. It is a highly complex procedure and must be done only at a hospital with a gynaecology department that has specialization if fertility-enhancing procedures. While becoming increasingly popular, IVF does not guarantee pregnancy and is not without its risks. The couple must discuss all aspects of the procedure with an IVF specialist so that they can make informed choices.