Acme Fertility & HealthCare Centre is widely acclaimed as one of the best fertility centres in the Manipur for the treatment of infertility and reproductive problems. We understand the sensitive nature of dealing with IVF patients and our specialists strive to provide the best support services for patients.
What is In Vitro Fertilisation (IVF)?
IVF is a technological process where several eggs are retrieved from a woman’s ovaries and then fertilised by the husband’s sperm outside the body in a highly specialised and controlled environment of the Laboratory. The fertilised eggs then develope into embryos and these are returned to the woman’s uterus by a procedure called embryo transfer (ET).
Who will benefit from IVF (Indications)?
- Both Fallopian tubes are absent, blocked or hopelessly diseased
- The husband has a reduced motile sperm (Asthenozoospermia), increased abnormal sperm (Teratozoospermia)
- Decreased number of sperm (<10 million/ml.) in semen (Oligozoospermia)
- No sperm in the semen (Azoospermia)
- Sperm antibodies in the wife’s and /or husband’s serum
- Endometriosis i.e. the presence of endometrial lining of the womb outside the uterus
- PCOS cases who have failed conception with ovulation induction and lUI
- Unexplained Infertility (refers to couples in whom no obvious pathology is found but who cannot conceive naturally).
- Women who have absent ovaries or where there are no eggs in the ovaries (see Oocyte Donation).
Eligibility
- The Couple must be legally married
- The wife must be in the reproductive age group in conventional INF programme.
IVF Programme (Step-by-Step)
Initial Consultation
The couple should bring along their records of infertility workup that they possess, such as hysterosalpingogram films, semen analysis report, blood & hormone reports, previous laparoscopy test results. The IVF team physician will counsel couple about the programme, and some further investigations may be necessary to establish the chances of success. The women may have to be scheduled for a screening laparoscopy, hysteroscopy & ultrasonography and trial E.T., if needed, to assess the pelvic anatomy and accessibility of the ovaries for eggs retrieval.
IVF Involves Several Steps
- Temporary Pituitary Inactivation or Down-Regulation
- Ovarian Stimulation (Ovulation Induction)
- Monitoring the Maturity of Eggs/Follicular development
- Egg Collection (Oocyte Retrieval)
- Semen Specimen Collection, Sperm preparation and insemination
- Fertilization and Cleavage
- Embryo Transfer (ET)
- Blood Tests for Pregnancy
1. Temporary Pituitary Inactivation
Down regulating injections are given to inactivate the pituitary in the menstrual cycle previous to IVF cycle. By inactivating pituitary, woman’s own hormone production is temporarily “switched off”. Patient should report to the Centre on 2nd day of the menstrual cycle. At that time Hormone assays for E2, LH, PRG are done to confirm the down regulation of pituitary. A baseline sonography of uterus and ovaries is done to rule out presence of any functional cyst in ovaries. A cyst measuring 10cm or more requires aspiration.
2. Ovarian Stimulation
Female is born with 2 million eggs into her ovaries. After 1st menstruation (Menarche) every month about 500 eggs comes out of ovaries for maturation. Pituitary gland produces that much hormone where only one egg matures and ovulates and remaining eggs gets destroyed (atretic). By giving some extra hormones from outside we can mature more number of eggs. IVF, with one egg. will have a very low success rate. Hence ovaries are stimulated to produce multiple eggs for better results. The injections can be started on 2nd or 3rd day of menstrual cycle.
3. Monitoring the maturity of Eggs
This is done by periodic examination of blood for hormones and ultrasound examination of the ovaries. Patient has to report to the clinic every day from 2nd day of menstrual cycle till the eggs are aspirated and the embryos replaced. The number of injections to be given each day will depend on the number and size of follicles in ovaries seen by ultrasonography and hormone assay. Maturation of eggs may require 7 to 15 days of ovarian stimulation.
4. Egg Retrieval
When follicles are mature, an ovulating dose of HG or Leuprolide Acetate is injected. This causes final maturation of the eggs. Ovulation occurs 36 to 40 hrs after HCG injection. Therefore eggs are collected 34 – 36 hrs after HCG injection i.e just before ovulation. HCG is to be taken at the prescribed time. Any change in time should be informed to the clinic. If by any chance injection is not taken properly, eggs will not mature and therefore not a single egg will be found during retrieval procedure.
Eggs are retrieved transvaginally under the guidance of sonography through a needle inserted in backwall of vagina and into the follicles. The eggs, thus obtained. are placed into a culture dish containing special nourishing fluid (Culture media).
Egg retrieval procedure is done under general anesthesia. It can also be done under local anesthesia and sedation. The Egg collection process is the main surgical procedure involved in the IVF cycle. It is sometimes also called egg harvesting, egg pick up, OPU or oocyte pick-up.
This is a day-care procedure and requires rest for a few hours only. Some patients may experience vaginal spotting and mild lower abdominal pain. Complications of the procedure occur in less than 1% of the cases and include infection, hemorrhage, and lower bowel or bladder injury that may require additional surgery. If an attempt at the ultrasound retrieval is unsuccessful, laparoscopic retrieval is performed.
You should not drive yourself home or travel alone even if you just had sedation and/or general anaesthesies. Critical activities are discouraged for 24 hours after the procedure. These include driving, signing documents or operating machinary.
5. Sperm Separation & Insemination
(In Vitro Fertilization of Eggs)
After the retrieval, eggs are placed in the incubator for 3 to 6 hours and then inseminated with washed motile sperms which have been collected and prepared after the egg collection or taken from a frozen semen sample (Backup Arrangement). The eggs and sperms are placed in the incubator (at a body temperature le. 37 degree centigrade and 5-6% CO2 + 5% O2 + 89-90% N2).
This types of modern triple gas incubation of embryos decreases the chances of abortions. If husband has low sperm count, then ICSI procedure will be performed.
6. Fertilisation and Cleavage
Fertilisation is the process of a sperm penetrating the egg. The egg, being fertilised, is now called an embryo. These embryos are observed further to be certain that they are dividing (cleaving) normally.
7. Embryo transfer
The embryos are placed into the uterus by means of a thin tube (catheter) through the mouth of the womb (Cervix). The procedure is done on an outpatient basis. The patient leaves the IF centre within two hours following the transfer procedure.
8. Blood Tests
Blood test (Serum b-HCG) is performed for evidence of pregnancy approximately 15 days after egg collection.
How much will IVF cost?
The main cost of IVF is for hormone injections used to stimulate ovaries. The cost of IVF varies from INR 1,85,000/- to 2,50,000/- per cycle of the treatment depending on the type of medicine used for ovarian stimulation. The charges includes:
- Baseline sonography
- Hormone estimation during IVF cycle (If Required)
- Ovarian Stimulation Drugs
- Sonographic monitoring
- Egg recovery under anesthesia (general or local)
- Anesthesia medicines
- OT charges for egg recovery & embryo transfer.
- Embryologist Charges
- IVF specialist Fees
- Anesthetist Fees
Drugs for pituitary down regulation (Lupride/ buseriline etc), progesterone injections, medicines pre & post IVF cycle will cost another IN 10000/- to 15000/-.
Special medicines (Inj. Heparine, Cortisons, Ostrogens, Progesterone inj/ cap etc.) used in some cases will cost extra.
- CSI Procedure will cost INR 40,000/- extra
- TESA procedure (done in AZOOSPERMIA cases) will cost IN 30,000/-extra.
- Freezing charge 6 monthly/annually = 35,000 to 65,000/-
What are the risks of IVF procedure?
- The stimulated cycle is very carefully monitored. However in any cycle there is a small risk (3-5%) of hyperstimulation (OHSS).
- Chances of twin and triplet pregnancies are about 20% and 3% respectively.
- Pregnancies following IVF-ET have higher miscarriage rates (20%) than normal (10%-15%).
- Ectopic pregnancy chances are same (2-3%) as in natural conception.
Your IVF cycle may have to be cancelled before ovum pickup
The aim of the intensive monitoring of IF cycle is to obtain good number of healthy mature eggs. If the cycle is unsatisfactory, it may have to be cancelled at any stage. The reasons for cancellations are:
- Too few follicles are developing which would decrease the chances of obtaining at least one mature egg.
- There are no follicles developing at all. This is rare but may occur.
- The follicles may have ovulated before pickup. Occasionally some women ovulate earlier than expected.
- Sometimes the patient gets signs of developing ovarian hyperstimulation (OHSS) and cycle may have to be cancelled or your embryos have to be stored in bank and transferred (ET) lateron in unstimulated cycle.
How many times IF can be repeated?
IF can be repeated as many times as a couple can afford / desire.
ICSI – Intracytoplasmic Sperm Injection
In this technique, a single sperm is injected in an egg with the help of highly sophisticated microscope. ICSI has revolutionised the treatment of male infertility. ICSI is used when husband’s sperm count, motility or normal form are very low (Oligozoospermia, Asthenozoospermia or Teratozospermia). ICSI is helpful when patient fails in standard IF procedure due to fertilisation problem.
TESA-ICSI
TESA is testicular sperm aspiration. When there are no sperm in semen (Azoospermia), few sperms are extracted from any of the testes with the help of a needle. ICS can be done with these extracted sperms. Most of the patients with Azoospermia can be benefited by TESA-ICSI. TESA can be done under local anaesthesia or general Anaesthesia without any discomfort and is an OD procedure.
Cryopreservation of embryos
Your extra embryos after embryo transfer (E.T.) can be cryopreserved in our bank at minus 196 C and later transferred in the uterus in a natural (unstimulated) cycle if the woman doesn’t become pregnant in the original IVF cycle. Only very good embryos (Grade-I) are to be cryopreserved. Some of embryos may die during freezing and thawing procedure. Egg recovery after freezing and thawing is about 50%. The pregnancy rate after frozen embryo transfer (FET) is good (35-40%).
Success Rate
The results of IF in the best centres of the world are (20 – 35 years):
- 30% in first cycle
- 40-45% in second cycles
- 50-55% in three cycles 60-65% in four cycles 65-70% in five cycles
- 70-73% in six cycles.
It varies with the age of the patient and decreases as the patient’s age increases. It is 5% to 10% in patients above 38 years and only 2% above the age of 40 years. After 38 years chances of abortion and abnormal pregnancies also increase to 40-50%.
IVF in Older Women
The best chance for a female to conceive is when she is less than 30 years of age. A gradual fall in fertility occurs between 30 and 35 years. However after 35 years of age a sharp decline in pregnancy chances occurs. Natural pregnancy is rare after 40 years of age.
The major factor that determines fertility rates is the quality of eggs. The quality of eggs diminish with age. The defect lies in the inability of the older egg to allow correct separation of chromosomes as the embryo divides. An extra chromosome is then added in the normal complement that causes the Down’s abnormality. Other defects of similar types are also more common in older women. These embryos are less likely to implant or do not develop and so explain a lower pregnancy rate. In addition, with IVF in women over 35 years, the ovaries are generally less responsive to medication indicating a fall in the total number of eggs, which also lessens the chances of success. Eggs of older women when exposed to sperms, have a lower chance of fertilisation.
All women above 35 years, should get their ovarian reserve checked. Women with very low ovarian reserve should opt for IVF with donor oocytes.