What is IVF?
IVF (In Vitro Fertilization) is a medical process in which the egg of the female partner and the sperm of the male partner is fertilized outside the body, in a laboratory. This fertilized egg, now known as an embryo, is then allowed to develop in a controlled, protected environment for a couple of days. After that, the embryo is transferred inside the woman’s uterus. Thus, increasing her probability of conceiving.
In Vitro Fertilization (IVF) can be used to solve a variety of fertility problems and for most couples, it’s their best chance of becoming parents.
Usually, the embryos are grown in the lab until day 5. If the embryo grows in a healthy way till day 5, it’s a strong indication that it will successfully get implanted inside the uterus. The embryos are transferred inside the uterus via a simple process called embryo transfer. If more than one embryo gets developed, there is an option to freeze the extra embryos for future use. The fertilization of the egg is executed via Intracytoplasmic Sperm Injection (ICSI). This technique injects one sperm in each egg.
IVF treatment protocols
IVF treatment is customized as per the patient’s need by the specialist doctor. Most patients who undergo IVF will be prescribed one of two main treatment protocols: Long Down-Regulation and Antagonist treatment cycles.
egnancy test two weeks later.
Long Down-Regulation [Agonist] treatment cycle
Long downregulation treatment is the procedure in which the natural hormones of the woman are suppressed before initiating the fertility medicines. 3 weeks after your period starts, blood tests will be conducted on you, and pre-IVF treatment will be initiated to control your hormones before the fertility medication starts.
After nearly 12 days, one more blood test is conducted to ensure the hormones are low. Then your second set of medications (Follicle Stimulating Hormone Injections) will be initiated. 5 days after you have started taking those injections, a blood test and an ultrasound will be conducted of your ovaries. Ultrasounds and blood tests are conducted to check whether you have developed follicles of the right number and size. After that, another medication is to be taken before scheduling the collection of your egg 36 hours later.
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Antagonist treatment cycle
The antagonist treatment process involves injectable drugs called antagonists that stop premature ovulation. It is the most preferred treatment protocol because of its shorter cycle which is of convenience to patients and also reduces the risk of hyperstimulation. On the second day of your menstrual cycle, your blood test will be conducted and if your hormone levels are low, Follicle stimulating injections are advised to be taken from that day onwards.
After four days of continuing this medication, you start a second injection [Cetrotide or Orgalutron] that turns your hormones off so that premature releasing of egg does not happen. 6-8 days after you have started FSH injections, your blood test will be conducted. You will be monitored closely with blood tests and ultrasounds until you have an optimum number and size of developed follicles.
Once you are prepared, your HCG trigger injection will be given to you and after 36 hours, your egg collection is scheduled. After egg collection, you will use supplemental progesterone either as a vaginal gel, pessary or subcutaneous injectio
What is ICSI?
Intracytoplasmic Sperm Injection (ICSI) is performed as a supplementary of the IVF treatment cycle wherein a single sperm is introduced inside each egg to support the fertilization. In severe cases of male infertility, ICSI is advised. Intracytoplasmic sperm injection is ideal for couple’s who are suffering from male fertility problem like low sperm morphology or motility, low sperm count, anti-sperm antibodies or have previously had a vasectomy or an unsuccessful vasectomy reversal.
If standard IVF has not yielded results, then IVF is coupled with ICSI to boost the chances of conceiving. There is no convincing proof that the children born via the ICSI process have increased chances of having birth defects. However, there is a small chance that the male child, which is born via this process, might have a male fertility issue.
Intrauterine Insemination (IUI)
How the IUI procedure works
A typical IUI procedure involved following steps:
- You are put on fertility medication and your ovulation cycle is monitored.
- A sperm sample of your partner, or a donor sperm, will be specially prepared for the process of insemination.
- The prepared sperm will then be injected into the uterus.
Following the IUI procedure
About a week after ovulation, the doctor may call you to check your progesterone levels. An ultrasound will be conducted to check the lining of your uterus. The thickness of the lining will indicate whether the process was effective or not.
Natural Cycle IVF
Natural IVF is the process in which the IVF procedure is conducted on the egg that was naturally selected and matured by the woman’s body, without using any fertility medications. The belief is that the naturally selected and a matured egg will be of a higher quality and might lead to better quality embryo formation.
What are the advantages of Natural IVF?
- Better implantation and a comparatively high quality of the egg.
- It’s more convenient, friendly and natural way of performing IVF.
- There is no risk of OHSS and it is less invasive.
- Less expensive as compared to stimulated IVF
- If need be, can be conducted multiple times in consecutive cycles.
Who is suitable for Natural Cycle IVF?
All women, who are still ovulating, can undergo the Natural Cycle IVF. It is particularly suitable for older age women whose ovarian reserves might be diminished or are not responding to the fertility drugs. It is an opportunity for such ladies to get pregnant via their own eggs, instead of going with donor eggs. It is also chosen by those who want to avoid fertility drugs and associated risks and side-effects.
What is the procedure for Natural Cycle IVF?
The initial step is to come in for an underlying scan and counsel. At this arrangement, the specialist will survey your condition and devise a customized treatment schedule. After this, you will come in 2 weeks before the start of your period to meet with your medical caretaker. They will discuss your treatment and share the consent-related documents with you. Your first scan is booked after you notify about your first day of a period. This will most likely be on day 5, however, could be scheduled prior or later, relying upon the guidance of the doctor. After the first scan, usually, 2 3 scans are performed every other day. Around day 12, egg collection is done. This is executed by keeping the patient sedated and is trailed by the transfer of the embryo, a couple of days later.
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Ovulation induction is a procedure used to build the quantity of eggs that a lady ovulates in a cycle. Although, ovarian stimulation performed for IVF and ICSI expects to manufacture many eggs for accumulation (in ladies who are typically ovulating), in ladies who are not ovulating regularly, ovulation induction is done to invigorate only some of the eggs. The treatment is mostly utilized for ladies with a polycystic ovarian disorder (PCOS), a condition described by numerous ovarian fibroids, sporadic or missing periods, and large amounts of male (androgen) hormones.
In an unstimulated cycle (regular cycle), a lady normally ovulates a solitary egg every month. Rarely, a lady’s ovaries may discharge 2 eggs in the same cycle, which can prompt non-identical twins. In a stimulated ovulation cycle, the point is to achieve multi-follicular development and ovulation, that is, ovulation of numerous eggs in a single cycle. When multiple eggs are ovulated together, the probability of conceiving increases considerably.
The treatment is a set of fertility hormones to invigorate the ovaries to deliver a mature follicle, and after that, coordinated intercourse or Artificial Insemination (AI)/Intrauterine Insemination (IUI) is performed to match with ovulation. Be that as it may, since ladies with PCOS are very sensitive to fertility drugs, there is a genuine danger to multiple follicle generations and multiple pregnancies. Standard checking with ultrasound and hormone estimations along these lines is important to guarantee just a single or two follicles are matured.
Ovulation induction might be performed utilizing orally ingested meds or injectable medicines and is regularly joined with intrauterine insemination (IUI). Patients who may profit by ovulation enlistment/IUI are couples with unexplained barrenness, PCOS, endometriosis, and ovarian dysfunction. To be a contender for ovulation induction you should have an ordinary uterine cavity, no less than one normal fallopian tube, and your partner must have a healthy sperm count.
Human oocyte cryopreservation (egg freezing) is a methodology to save a lady’s eggs (oocytes). The eggs are removed, solidified and put away. The goal of the methodology is that, later on, if need be, the lady may have the eggs defrosted, treated, and implanted to the uterus as developing embryos to encourage a pregnancy. The success rate of this process (given that the birth will be by utilizing frozen eggs) depends upon the age of the lady.
It is ideal for ladies:
- Who has been diagnosed with cancer but have not yet started the process of chemotherapy or radiotherapy
- The ones who have opted for one of the assisted reproductive technologies but don’t want to freeze their embryos.
- Those who might want to safeguard their ability to have kids in future, either because they don’t have a partner or because of any other medical or personal reasons.
- More than 50,000 ladies of reproductive age ladies are diagnosed to have cancer disease every year. Chemotherapy and radiotherapy are harmful to oocytes, leaving few or no healthy eggs. Egg freezing offers ladies with the tumor, an opportunity to protect their eggs so that they can opt to have kids later.
- Oocyte cryopreservation is a possibility for people experiencing IVF who protest, either for religious or moral reasons, the act of freezing embryos. Having the choice to prepare just the same number of eggs as required for the IVF procedure, and after that freezing, any unfertilized eggs can be a viable solution. Thanks to this process, an overabundance of fertilized, healthy embryos does not happen. Thus, the need of disposing of the unused embryos disappears.
- Furthermore, ladies with a family history of early menopause generally have an interest in embryo conservation. With egg freezing, they will have a frozen store of eggs, if their eggs get reduced at an early age.
The egg recovery process for oocyte cryopreservation is the same as that for in vitro treatment. This incorporates one to half a month of hormone infusions that stimulate ovaries to mature multiple eggs. At the point when the eggs are matured, last maturation induction is executed, ideally by utilizing a GnRH agonist as opposed to human chorionic gonadotrophin (hCG), since it reduces the danger of ovarian hyperstimulation disorder with no confirmation of reduction in live birth rate (rather than fresh cycles where utilization of GnRH agonist has a lower live birth rate). The eggs are then expelled from the body by transvaginal oocyte recovery. The process is typically performed under sedation. The eggs are then frozen immediately.
How egg donation works:
Stage 1: Egg Donor Matching
At the point when a couple chooses to utilize donor eggs, they can see the pre-screened pool of egg donors on the internet, and select an applicant from the pool. A tentative egg and donor match is made when the receiver chooses to go ahead with a particular donor. The IVF facilitator will contact the egg giver to affirm her availability. In the event that the egg donor is accessible for the time duration provided by the receiver, and passes an FDA-required round of testing, an official match is made. A few donors are chosen and matched to a recipient rapidly after they apply; others may take months or years before they are chosen; still others may never be chosen.
Stage 2: Suppression and Ovarian Stimulation for the Egg Donor
The egg donor will self-administer infusions of a drug called Lupron to herself every day to suppress her normal cycle, so her and the beneficiary’s cycles are synchronized. During the ovarian stimulation stage, the egg donor utilizes daily infusions of gonadotropin to stimulate her ovaries. In a normal cycle, just a single egg develops; gonadotropins infusions support more than one egg to develop for retrieval.
During the ovarian stimulation, the egg donors are examined closely through blood tests and ultrasound, guaranteeing that the ovaries are reacting properly and not going into hyperstimulation.
Stage 3: Endometrial Lining Development for the Donor-Recipient
On the beneficiary’s side, a supportive environment inside the uterus, particularly an endometrium of no less than 7 mm, is critical to the success of egg donor cycle. While the egg donor creates eggs for recovery, the receiver takes estrogen and progesterone to set up her endometrial coating for implantation. Building up the endometrium for developing life exchange is typically not an issue.
In uncommon cases, a few patients experience issues in achieving the minimal endometrial thickness and may require special medications. A few patients with immune system problems may utilize extra medications to enhance the possibility of implantation.
Stage 4: Triggering Ovulation and Egg Retrieval for the Egg Donor
At the point when the ultrasound imaging demonstrates that the donor’s eggs have adequately built up, the donor will be told to trigger ovulation with an infusion of hCG. After two days, her eggs are recovered in a short in-office procedure, called egg recovery. While the donor is sleeping (under I.V. sedation), the doctors will use the needle, guided by ultrasound, to trans-vaginally recover the eggs. The donor is then suggested to take the day off to recover.
Stage 5: Fertilization and Embryo Transfer to the Recipient
The recovered eggs are prepared with partner’s or donor’s sperm. The developing embryos that are the outcome of this treatment, are then incubated and evaluated. Normally, the embryos are moved into the receiver’s uterus on day 3 after donor egg recovery (in rare cases on day 5).
Stage 6: Post-Retrieval Checkup for the Donor and Pregnancy Tests for the Recipient
The donor will be required to come back to visit the medical facility for a post-recovery checkup, with the goal that it can be ensured that the donor is recovering properly from both the ovarian stimulation and retrieval. Mostly, donors have no issues and can go back to normal routine in a day or two after egg recovery. From the begin of the Lupron infusions to egg recovery, egg donation is a 3-5 week’s long process for a majority of the egg contributors.
Receivers will have a pregnancy test within two weeks after the embryo transfer, via a blood test that measures the level of hCG. After two normally rising hCG tests and an ultrasound exhibiting a pregnancy, beneficiaries are “released” to their obstetricians for pre-birth care.
Couples and singles who embraces or adopts embryos are the ones who might be
Frozen Embryo Program
What is involved in Frozen Embryo Transfer (FET)?
The solidified incipient organism exchange (FET) method is the same whether the patient uses donated fetuses or her own. The system is performed in a fertility facility and should be executed during an un-medicated/normal cycle, yet medicated cycles are more typical as they give more control over the timing of the transfer. In some cases, a mock cycle is done to test the impacts of the medicines on the body. On the off chance that this is fruitful, the cycle is done again, and the fetuses are transferred. Potential medications used as a part of the cycle include anti-infection agents, oral contraceptives, pre-birth vitamins/calcium supplements, pituitary suppressors, child headache medicine, estrogen supplements, and progesterone. Understanding the FET procedure might be a critical part of your selection of a fertility center.
Are there any risks in becoming pregnant via donated embryos for the Frozen Embryo Transfer (FET)?
A pregnancy achieved via donated fetuses does not include any unique or increased risk factors. It is vital to consider the age and any medicinal states of the donating parent’s guardians and to talk about this and all other subtle details with the obstetrician
Who adopts frozen embryos?
- Worried about male or female infertility
- Concerned by a high danger of passing on hereditary problems
- Frustrated with repeated IVF disappointments
- Feeling constrained to choose alternate fertility treatments. For example, IVF or donor egg beneficiary IVF
- Discouraged by the expenses of IVF or different techniques for treatment
- Or, they are just attracted to adoption as a method for bringing a family’s affection to a kid in need.
Presently, you can satisfy your need for a family, give birth to the very child that you adopted as a frozen embryo, and be sure that a valuable life is safeguarded in the meantime. Surrogacy is also a choice that numerous families discover to be more reasonable or conceivable to go with while adopting embryos.
Embryo donor program
Embryo donation is a type of third-party reproduction. It is generally defined as the donation, generally without any form of compensation, of fetuses that remain behind after In-vitro fertilization and successful implantation, or for research. In the cases, where it is given with the end goal of implantation, the donation is trailed by the implantation of those embryos into the receiving lady’s uterus to encourage pregnancy and labor in the receiver. The subsequent child is considered to be an offspring of the woman who gives birth to that child, and not of the donor. It is the same principle that applies to egg donation or sperm donation. Frequently, the fetuses are given away after the lady, for whom they were initially made, has effectively conveyed at least one pregnancy to delivery.