In Vitro Fertilization (IVF) has become one of the medical breakthroughs of the 20th century. Today, IVF is practically a household word but not so long ago, it was just a theoretical procedure for infertility that might be possible someday. Ultimately this knowledge and the rapid advancements in medical procedures led to the widely acclaimed first live birth of a "test-tube baby", Louise Brown in 1978. In India, “Harsha” is the first fully documented IVF baby born on 6th Aug, 1986 in Mumbai. In Vitro Fertilization is a medical procedure that many couples and individuals opt for when they face fertility issues. Today, IVF accounts for millions of births worldwide and the success rate is very high. Although there are other treatment options as well, such as ovulation induction and intrauterine insemination, IVF is the most talked-about of these treatment options and widely accepted medical practice.
How Does IVF Work?
IVF means fertilization “in the lab”. In other words, it is also called fertilization in glass which results in test-tube babies. Usually, IVF involves taking multiple eggs and placing them in a Petri dish with specially washed sperm cells. After mixing them in a Petri dish in a laboratory, a fusion of male sperms and female eggs occurs and gives rise to embryos. The best-fertilized eggs are selected and are transferred to a woman's uterus and a successful pregnancy can be achieved.
IVF is an efficient part of assisted reproductive technology (ART) that enables millions of infertile couples worldwide to have children. IVF is a combination of medicines and surgical interventions to help sperm fertilize an egg outside of a body and then place the fertilized egg or early embryo in woman's uterus. First, a hormonal shot is administered to stimulate the ovaries to bring eggs to maturity and prepare them for fertilization. Once the eggs are ready for fertilization, another shot is administered to prepare the eggs for retrieval. After retrieving sperms from the male partner, the sperms and eggs are mixed in a laboratory dish to help the sperm fertilize the eggs. The cells start dividing and proliferating and the healthiest fertilized egg called blastocyst is placed into the uterus. When the embryo attaches to the uterus lining, pregnancy happens.
Steps of IVF
IVF has many steps, and it takes about 6-8 weeks to complete the whole process. IVF increases the chances of pregnancy if the person is having infertility issues, but ultimately the success of IVF depends on few factors. IVF has become a game-changer for many couples and individuals. The steps are as follows:
i. Ovulation Induction: During IVF, a woman needs to take several medications, including follicle-stimulating hormonal shots, to stimulate healthy egg development. This allows retrieving a higher number of eggs.
ii. Egg Retrieval: Eggs are collected from the follicles of ovaries using a minor surgical procedure. On the same day, sperms are collected from the male partner.
iii. Fertilization: The eggs and sperms are fused in vitro. Sperm can be injected directly into the egg to assist fertilization in a process known as intracytoplasmic sperm injection (ICSI).
iv. Embryo Development: The sperm successfully fertilizes the egg, an embryo forms and begins to develop. As the embryo grows and divides, the healthy embryos are then selected for implantation or frozen for future use.
v. Embryo Transfer: The embryo is then placed into the woman's uterus using a catheter. After placing the embryo inside the uterus, the embryo undergoes a complex process in order to attach itself to the endometrium. Once it attaches to the lining of the uterus, pregnancy occurs. About 2 weeks after embryo transfer, a blood test should be performed to confirm the pregnancy.
IVF Success Rates
IVF is pretty successful. The success rate depends on a number of factors such as reproductive history, maternal age, healthy fallopian tubes, quality of the semen and lifestyle factors.
Pros and Cons of IVF
IVF is rarely the first treatment option used for infertility but it is a go-to option for several conditions. IVF can successfully treat the causes behind infertility such as endometriosis, low sperm counts, non-functional or missing fallopian tubes, problems with ovulation, the inability of sperm to penetrate or survive in the cervical mucus, poor sperm or egg quality, genetic disease of mother or father.
IVF may offer many advantages for a couple with infertility problems; however, it also has some disadvantages and risks like all medical procedures. IVF is usually safe, but as it is a medical treatment that includes changing hormone levels, some side effects are associated with it. The following are the side-effects commonly experienced by women after starting the IVF cycle. Ovarian hyperstimulation syndrome (OHSS) is a serious side effect that can occur in women going through IVF treatment. The symptoms of OHSS are usually mild. In some cases, OHSS requires medical attention. OHSS can also cause kidney failure. Common side effects during egg retrieval or embryo transfer are mild cramping, bloating, vaginal discharge, constipation. The symptoms vary depending on the types of medications used. These are mood swings, hot flashes, weight gain, dizziness, headache, nausea, breast tenderness, bloating, allergic reactions, fatigue, soreness from injections.
A clear disadvantage with IVF is that its success is not guaranteed. Another disadvantage of IVF is that the process involves an operative procedure. So, there are the associated risks of infection. Multiple pregnancies, miscarriage, preterm birth are the risks associated with this procedure. Ethical concerns about the treatment of the rest of the embryos after successful IVF pregnancy is also a concern in unregulated fertility clinics. Lastly, IVF can also be an expensive medical procedure. There are out of pockets expenses that come with IVF treatment.
Risks of IVF
Pregnancies conceived via IVF have the same risks as those conceived by natural process.
i. Multiple Pregnancies: Multiple pregnancies can be risky for both the babies and the mother. More than one embryo transfer will increase the risk of conceiving twins or more which can increase further complications like preterm labour, high blood pressure, gestational diabetes and the need for a C-section.
ii. Ectopic Pregnancy: In rare cases, embryos do not attach to the lining of the uterus and develop in other parts of the reproductive system which causes serious complications.
iii. Miscarriage: Older maternal age is associated with an increased risk of miscarriage.
In the three decades following the birth of Louise Brown, innovations in ART have overcome numerous seemingly insurmountable barriers to allow couples the chance to have families. Significant advancements in the first decade led to greater efficiency and expanded accessibility of IVF to the general public. More recently, the advent of pre-implantation genetic diagnosis (PGD) provided couples with sex-linked diseases and numerous genetic disorders the ability to have children free of the condition. However, there is increasing evidence that ART-conceived children may be at greater risk of perinatal complications than naturally conceived children. Now that ART is being recognized as an outstanding contribution to medical science, all clinicians involved in the care of these patients must maintain a heightened awareness of these potential issues. As ART approaches its third decade, new and existing technologies must be used responsibly to help infertile couples achieve their goals without compromising the ‘first, do no harm’ principle.