In Vitro Fertilization – IVF

Louise Brown, who was born on 1978 in England, she is the first baby to be conceived using the procedure of IVF. During that time IVF was not yet so popular and it seems to be a mysterious kind of procedure for infertility that made what so to speak as “test-tube babies.” Nevertheless, after it was introduced in the United States in 1981, in vitro fertilization and with other same techniques have ensued more than two hundred thousand of babies.

And more four million babies have been conceived and born all over the world using in vitro fertilization technique. Today, IVF is almost a household word that it became very popular. Statistically, more than 1% of babies are born in the US today as a result of a pregnancy assisted by reproductive technologies.

The genius of this treatment is the physiologist; Robert G. Edwards who was given an award in 2010 entitled Noble Prize in Physiology or Medicine.

In-Vitro-Fertilization - IVF

Image source : Wikipedia by Bruce Blaus shared under CC BY-SA 3.0

What is IVF?

Literally, in vitro means “in glass” and fertilization means a sperm attached to an entered egg. In vitro fertilization (IVF) is an involved series of approaches or procedures used to treat genetic issues, fertility, and support with the conception of a baby.

It is one of the assisted reproductive technology (ART) processes. There are two types of infertility:

Pregnancy week by week
  1. Secondary infertility- it refers to the inability to maintain pregnancy until delivery.
  2. Primary infertility is the inability of a couple to become pregnant (regardless of the cause.) It affects about 6.2 million people in the United States of which about 10% of both men and women are in reproductive age.

The IVF is to help those who have primary infertility and it is being done by manually collecting and combining an egg and sperm in one laboratory dish where fertilization process occurs then the embryo or embryos will be transferred to the uterus to be implanted and developed naturally, to grow as a baby and to be born about nine months later. IVF offers infertile couples an opportunity to have a child and become a parent to someone who is biologically related to them using a special medical technique.

IVF is the most frequent used high-technology treatment, counting for over 99% of ART (assisted reproductive technology) procedures. Apart from using your own egg and you partner’s sperm, it may sometimes involve a sperm or embryos of another person whom you know or whom you may not know.

There are also some cases that the fertilized egg will be implanted into a surrogate’s womb which will result to giving birth to a baby who is genetically unrelated to the surrogate. IVF is very costly thus it is mostly attempted just after more affordable options have failed.

 

Who needs it?

IVF can be useful in assisting infertility with the following:

  1. Women at their age 40 and above. Women who are over their reproductive years or who are already menopause can still have an opportunity of getting pregnant. Just to give you an idea how possible it is, Adriana Iliescu is recorded in 2006 as the oldest woman to give birth using in vitro fertilization, she gave birth in 2004 at the age of 66.
  2. Problems with ovulation. If the ovulation is infrequent, fewer, or absent.
  3. Fallopian tube blockage or damage. This kind of state makes it difficult for an egg to become fertilized or for an embryo to make its journey to the uterus.
  4. Premature ovarian failure. It is the damage or loss of regular ovarian function before even reaching the age of 40. It is because once the ovarian function fails, they will not be capable of producing the sufficient amounts of the estrogen hormones or they will not be able to release eggs regularly.
  5. Uterine fibroids. Fibroids are types of benign tumors in the uterus wall and can intervene with implantation of the fertilized egg. It is common in women who are in their 30s to 40s.
  6. It happens when the uterine tissue embeds and grows outside the uterus which can affect the functions of the fallopian tubes, ovaries, and uterus.
  7. Prior tubal sterilization or removal. If you have had a tubal ligation where your fallopian tubes are blocked or cut to prevent pregnancy and now wanting to conceive. This treatment is an alternative for tubal ligation reversal.
  8. Unexplained infertility. It means that no cause can be found despite of assessment of common causes.
  9. Impaired sperm function or production. Poor mobility or weak movement of the sperm, below-average concentration of sperm, or irregularities in shape and size of the sperm can make it so difficult for the sperm to fertilize an egg.
  10. Fertility preservation due to cancer and other health issues. Your fertility can be harmed if you are in the beginning of cancer treatment like radiation or chemo. Women can opt to have her eggs collected from their ovaries and have it frozen in unfertilized state for future use. Women who have serious health risk may choose to undergo IVF using another individual to carry the pregnancy (commonly known as gestational carrier.)
  11. Genetic disorder. If you and your partner have the possibility of passing a genetic disorder to your future child, you may then be a candidate to have pre-implantation genetic diagnosis in which IVF is involve. The eggs will be harvested and fertilized to undergo screening for certain genetic issues. The embryos that do not contain detected issues will then be transferred to the womb.

 

How it is being done?

The following timeline is provided to help you visualize the events on how the IVF is being done:

  • Before the IVF Procedure. A count of screening tests will be performed before the beginning of IVF cycle. Examinations will typically include the following:
  1. Imaging studies like transvaginal ultrasound of ovaries and uterus.
  2. To further examine the inside of your uterus.
  3. Blood test.
  • The stimulation of the ovary. Fertility medications will be required to stimulate multiple egg production.  Between eight to fourteen days before menstrual cycle begins, they will ask you to take a gonadotropin for the stimulation of your ovaries to develop compound mature eggs for fertilization. Multiple eggs are needed because some eggs will fail to develop after the retrieval. They may also require you to have a synthetic hormone to let your body releasing eggs earlier.
  • Development of the follicle. During taking of the necessary medications, you will have to visit your doctor’s clinic more frequently to check blood hormone level. They will also conduct ultrasound to monitor the growth of those follicles.
  • The trigger injection. Once the follicle is ready, you will require you to have a trigger shot, a shot that will help your eggs mature and become able to be fertilized. After 36 hours of the injection, the eggs will then be prepared to be collected.

  • Collecting of the eggs. Your eggs will be retrieved through minor surgical procedure. Your doctor will use an anesthesia and will enter an ultrasound probe into your vagina and will use it as an imaging guide. They will then insert a very thin needle through your vagina wall to take out the eggs out of the follicles. They will typically take out eight to fifteen eggs. You will experience a bit of cramps and spots for several days but you feel better after two days.
  • A scientist (embryologist) who is expert in sperms, embryos, and eggs will be the one who will assess the eggs prior to letting it join the sperm that was taken out from your partner. They will then put it in an incubator for one night.
  • Developing embryos. After three days, few of the eggs that retrieved that are effectually fertilized become embryos. By the end of day five, some of the embryos will turn into blastocysts with cavities full of fluids and tissues which are starting to split into placentae and baby.
  • Embryo election. The expert will then select the most worthy embryo or several embryos to put in the womb five days following the collection of the egg. If extra embryo are available, they may opt to frozen it for preservation for future use.
  • Planting the embryos. The doctor will decide basing on your age and the result of diagnostics, your doctor may implant between one to five embryos inside your uterus using a catheter into your cervix. During this process, you may feel a moderate cramp. However, you will not need anesthesia during this time.
  • Successful outcome. Supposing the procedure turns out to be successful, the embryo in your womb will continue to grow and will eventually become a baby.

All of these processes will take about four to six weeks to finish one cycle of IVF.

Risk using IVF, does it have any?

The following are the possible risk that can carry by the IVF:

  1. Multiple births. If the doctor inserted and implanted over one embryo in your uterus, there is a risk of multiple births.
  2. Ovarian hyper stimulation syndrome. The use of injectable fertility drugs to induce fertilization like human chorionic gonadotropin or HCG can cause ovarian hyper stimulation syndrome. It when your ovaries become painful and swollen.
  3. The rate miscarriage for mothers who conceive naturally and using IVF is just similar, about 15-20%. But the rate of miscarriage using IVF slightly increases with the maternal age and the use of frozen embryos.
  4. Complications in egg-retrieval procedure. The utilization of an aspirating needle in collecting eggs can possibly cause infection and bleeding. It can also damage the bowel, blood vessel, and bladder.
  5. Ectopic pregnancy. IVF procedure can bring about 2-5% of ectopic pregnancy particularly if the fertilized egg was implanted outside the uterus. The fertilized egg obviously cannot survive outside the uterus and continuing the pregnancy will be simply impossible.
  6. Birth defects. No matter how the child is conceived, the age of the mother is always being considered as the primary risk factor in the development of birth defects.
  7. Premature delivery and low birth weight. Studies suggest that the IVF procedure slightly increases the possibility of giving birth earlier than expected or having a low birth weight.
  8. The use of IVF can be physically, emotionally, and financially draining. Family and friend are most useful during this time.

The results of IVF differ on each couple’s cause of infertility and their ages. Of course younger women have the higher potential of producing healthier eggs thus have a higher rate of success.  The list of data below shows the recent percentage of IVF with live birth:

  • Women younger than 35: 41%
  • Women of age between 35-37: 31%
  • Women of age between 38-40: 22%
  • Women of age between 41-42: 12%

Good news is that since 1978 IVF track record found no medical problem that affects the children born in IVF procedure.