Generally, an egg and sperm are fertilized inside a woman's body. If the fertilized egg attaches to the lining of the womb and continues to grow, a baby is born about 9 months later. This process is called natural or unassisted conception. However when there is a glitch anywhere in the process the woman would not be able to conceive.
IVF or In Vitro Fertilization is one of the widely preferred forms of Assisted Reproductive Technology (ART) and has been used successfully since 1978 to help women conceive. This is the process of fertilization by combining a sperm and an egg in a laboratory. When the fertilization is successful this is combined with a procedure known as Embryo Transfer through which the fertilized egg is physically placed into the women's uterus.
The Basic Steps involved are:
1. Prep Phase:
As IVF is a long and demanding process we start with a preparation Phase where a detailed Schedule will be handed over to you for your reference. In many cases Oral Contraceptive Pills will be administered to you for the regulation of your hormonal cycle for the procedure. Also you will be administered a Uterine Assessment to rectify any complications, if present.
2. Stimulation Protocol:
The success rate of an ART procedure (Test Tube baby) is better when there are multiple oocytes available for use. A woman produces one egg per month. Medicines or hormone injections on a daily basis help her produce more than one egg by systematic stimulation and regular tests by the fertility expert. This starts with a Baseline Ultrasound which will check for any complications once the ultrasound is normal the hormone injections are administered. This will support the ovary to make several follicles to develop together. Once this is started it is important to avoid intense physical exercise as it may mar the follicle development. Once the follicle reaches the size of 18mm approx an hCG injection is administered, the timing of which is very critical.
3. Egg Retrieval:
The follicles within the ovary are now to be removed for which a minor surgery called follicular aspiration is performed approximately 35 hours after the hCG injection is administered. The patient would be advised not to indulge in any intense physical strain or eat or drink before the surgery. The patient is sedated so she will know no pain. A thin needle is inserted through the vagina into the ovary and follicles containing the eggs and is removed with the help of a suction device. This surgery takes about 30 - 40 minutes and the patient would be asked to take rest. Most women feel pelvic heaviness, soreness and spotting. Abstinence from vaginal intercourse will help heal the vagina faster. Also a Semen Sample from the male partner will be collected on the day of the egg retrieval. He would be advised to abstain from ejaculation for 2 - 5 days before the scheduled day of egg retrieval.
4. Fertilization Phase:
After the retrieval of eggs they are incubated for a few hours while the given sample of semen is prepared for fertilization. The most motile sperms are then allowed to fuse with the egg. Mostly they are injected into the egg through Intra-Cystoplasmic Sperm Injection or ICSI as fertility experts believe the chances of a normal fertilization are slim. Once the embryo reaches a blastocyst stage which should happen within 6 days of retrieval, the best embryo is then transferred by the suggestion of the fertility expert.
5. Embryo Transfer:
Once the best embryo is recognized you will be scheduled for an embryo transfer. When there are a large number of embryos of good quality your consultant will recommend the number of embryos to be transferred based on several factors like age, IVF history and availability of embryos. The embryos are loaded into a small catheter and inserted through the cervix into the uterus. If there are a good number of superior quality embryos they are frozen for future use. The patient will be advised to wear comfortable clothing. Also your bladder should feel full as it helps gain a better picture in the abdominal ultrasound. Once the transfer is over the patient is asked to relax as utmost care is supposed to be taken that the walking or the any other activity does not lead to dislodgement of the embryo from the uterine wall. The major factors that determine the embryo implant are viability of the embryo and the quality of the uterine lining.
6. Luteal Support Phase:
Intake of progesterone is necessary as it increases chances for a successful cycle of IVF. Progesterone is the natural hormone that is produced by the human body to support the uterine lining. Spotting, sensation of heaviness and cramping is common after egg retrieval but under no conditions is the intake of progesterone to be stopped. A pregnancy test would be administered after 2 weeks of the egg retrieval. If the test turns out to be positive you will be asked to return for further follow up tests. If unfortunately the test turns out to be negative then you can expect your period within 5 days. If the cycle was unsuccessful a follow up visit is scheduled for counseling on further steps. The next cycle can be begun as soon as a month.