Category Archive In-Vitro Fertilization (IVF)

Step-by-Step through an IVF cycle

IVF is a boon for those who are not able to conceive there baby and looking for there biological child. Below mention steps will describe the actual process followed for this procedure. For egg donation, either self egg or donor egg are used. Below mention graph will explain the rate of decrease of conceiving with self egg and this result also let you know why to freeze your own egg earlier.

Egg fertility with age

Men younger than 40 have a better chance of fathering a child than those older than 40. The quality of the sperm men produce seems to decline as they get older. Their food habits and living also determines there sperm quality. When you include healthy diets on day to day life then it increases fertility to a massive level.
Most men make millions of new sperm every day, but men older than 40 have fewer healthy sperm than younger men. The amount of semen (the fluid that contains sperm) and sperm motility (ability to move towards an egg) decrease continually between the ages of 20 and 80.

Step 1: Control Ovarian Hyperstimulation (COH)

COH is done using different protocols. The most common one is a long GnRH-Agonist (Lupron) protocol where the secretion of gonadotropin hormones is suppressed to prevent premature ovulation. Once optimal suppression is achieved, the next step is the recruitment of multiple follicles by daily injections of gonadotropins. Ultrasound imaging and hormone assessments are used to monitor follicular development. When the lead follicles have reached the appropriate size, the final maturation of eggs is completed by HCG administration. Egg retrieval is scheduled 34 – 36 hours after HCG injection.

Step 2: Egg Retrieval

It is a very important procedure as different doctors have the different condition for retrieval ( From egg donor). Many doctors don’t work with virgin egg donors. Since the sharing of egg donor profiles is not legal so we will only share their details if there will be assurance and after donor price paid. Egg retrieval is performed in a surgical suite under intravenous sedation. Ovarian follicles are aspirated using a needle guided by transvaginal ultrasonography. Follicular fluids are scanned by the embryologist to locate all available eggs. The eggs are placed in a special media and cultured in an incubator until insemination.

Step 3: Fertilization and Embryo Culture

  • If sperm parameters are normal, approximately 50,000 to 100,000 motile sperm are transferred to the dish containing the eggs. This is called standard insemination.
  • The ICSI technique is used to fertilize mature eggs if sperm parameters are abnormal. This procedure is performed under a high-powered microscope. The embryologist picks up a single spermatozoon using a fine glass microneedle and injects it directly into the egg cytoplasm. ICSI increases the chance that fertilization will occur if the semen sample has a low sperm count and/or motility, poor morphology, or poor progression. If there are no sperm in the ejaculate, sperm may be obtained via a surgical procedure. ICSI is always used to achieve fertilization if the sperm is surgically retrieved.
  • Fertilization is assessed 16 – 18 hours after insemination or ICSI. The fertilized eggs are called zygotes and are cultured in a specially formulated culture medium that supports their growth. They will be assessed on the second and third day after retrieval. If sufficient numbers of embryos exhibit good growth and development, they may be selected to grow to the blastocyst stage in a specially designed culture medium. Blastocyst culture has several advantages. Embryos at this stage have a higher potential for implantation, therefore fewer embryos can be transferred on day 5 to reduce the chance of multiple pregnancies. Low numbers of embryos and poor embryo quality reduce the chances for good blastocyst development. A day 3 embryo transfer is recommended for cycles with low numbers and/or poor quality.

Step 4: Embryo Quality

Embryo fertility is determined by PGS ( Pre-implantation genetic screening. After PGS testing we freeze the most fertile embryos and after first fresh embryo if the process failed then we use the remaining frozen embryos. There are several criteria used to assess the quality of the embryo. This is especially important when trying to decide which embryos to choose for embryo transfer. Early in the morning on the day of your transfer, the embryos are evaluated and photographed by the embryologist. The embryologist and your physician will decide, based on the rate of development and appearance of the embryos, which and how many embryos are recommended to be transferred. Typically, embryos are transferred at the cleavage stage (day 3 after oocyte retrieval) or at the blastocyst stage (day 5). In the lab, a grading system is used to asses the quality of the embryos.

 

egg with maturety

Cleavage Stage: Day 3 Transfers

Day three embryos are called cleavage stage embryos and have approximately 4 – 8 cells. When analyzing these embryos, we not only look at the number of cells but also how symmetrical they are and whether there is any fragmentation. Fragmentation occurs when the cells divide unevenly, resulting in cell-like structures which crowd the embryo. No fragmentation is preferable but some is acceptable. In our lab, we classify embryos into grades 1 through 4. Grade 4 represents the best quality embryos.


Day 5 Blast: Day 5 Transfers

Day 5 embryos are called blastocyst embryos. At this stage, the embryos have increased in size and are even more developed. They resemble a ball of cells with fluid inside. One of the things we look for at this stage is how expanded these embryos are. The more expanded, the better the quality of the embryo. These embryos are also classified by a number scale, 1 through 6. Grade 6 represents the best quality blastocyst.

Step 5: Embryo Transfer

Embryos are transferred on day 3 when they are at the cleavage stage (6 – 8 cells) or on day 5 when they have reached the blastocyst stage. Embryo transfer is a simple procedure that does not require any anesthesia. Embryos are loaded in a soft catheter and are placed in the uterine cavity through the cervix.

Source : 1. https://www.urmc.rochester.edu/ob-gyn/fertility-center/services/infertility/ivf/ivf-step-by-step.aspx
2. https://academic.oup.com/humrep/article/20/2/433/603283

How much IVF is useful with self EGG

Each month in a natural menstrual cycle, your body withdraws one gumball (egg) from the machine (your ovaries). That egg is either healthy or unhealthy. As you age, you have fewer gumballs in the machine, and a higher percentage of the gumballs are unhealthy, lowering the chances that the one you get in a given month will be able to result in a healthy baby. That’s why it can take much longer—many more menstrual cycles—for older women to get pregnant.

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Even when fertility medicine comes into play, the relationship between age, fertility, and egg quality affect chances of success. Fertility treatments like in vitro fertilization use hormone medications to prompt the ovaries to produce multiple eggs in one cycle, but some of those eggs will still be abnormal (how many are abnormal will depend on your age). So while IVF can help increase the chances of finding some healthy eggs, it can’t make more of your eggs healthy. If a woman in her 40s retrieves 10 eggs in an IVF cycle, it’s likely that only 10–20% of those eggs will be normal. If she retrieves 20 eggs in two IVF cycles, still only 10–20% of those eggs will be normal—but she’ll have more to work with because she retrieved more.

That’s why we see declining success rates as women age, even when using advanced reproductive technology like IVF. If there are very few healthy eggs to work with, the chance of success is low.

What happens during IVF

IVF involves 6 main stages:

  1. suppressing your natural cycle – the menstrual cycle is suppressed with medication
  2. boosting your egg supply – medication is used to encourage the ovaries to produce more eggs than usual
  3. monitoring your progress and maturing your eggs – an ultrasound scan is carried out to check the development of the eggs, and medication is used to help them mature
  4. collecting the eggs – a needle is inserted into the ovaries, via the vagina, to remove the eggs
  5. fertilizing the eggs – the eggs are mixed with the sperm for a few days to allow them to be fertilised
  6. transferring the embryo(s) – 1 or 2 fertilized eggs (embryos) are placed into the womb

Once the embryo(s) has been transferred into your womb, you’ll need to wait 2 weeks before taking a pregnancy test to see if the treatment has worked.

Read more about what happens during IVF.

Chances of success

The success rate of IVF depends on the age of the woman undergoing treatment, as well as the cause of infertility (if it’s known).

Younger women are more likely to have a successful pregnancy. IVF isn’t usually recommended for women over the age of 42 because the chances of a successful pregnancy are thought to be too low.

Between 2014 and 2016 the percentage of IVF treatments that resulted in a live birth was:

  • 29% for women under 35
  • 23% for women aged 35 to 37
  • 15% for women aged 38 to 39
  • 9% for women aged 40 to 42
  • 3% for women aged 43 to 44
  • 2% for women aged over 44

These figures are for women using their own eggs and their partner’s sperm, using the per embryo transferred measure.

The Human Fertilisation and Embryo Authority (HFEA) has more information on in vitro fertilization (IVF), including the latest success rates.

Maintaining a healthy weight and avoiding alcohol, smoking and caffeine during treatment may improve your chances of having a baby with IVF.

What are the risks?

IVF doesn’t always result in pregnancy, and it can be both physically and emotionally demanding. You should be offered counselling to help you through the process.

There are also a number of health risks involved, including:

  • side effects from the medications used during treatment, such as hot flushes and headaches
  • multiple births (such as twins or triplets) – this can be dangerous for both the mother and the children
  • an ectopic pregnancy – where the embryo implants in the fallopian tubes, rather than in the womb
  • ovarian hyperstimulation syndrome (OHSS) – where too many eggs develop in the ovaries

Source: https://www.nhs.uk/conditions/ivf/

IVF Pregnancies Raise Death Risk for Mothers?

According to research, it is believed that the increased risk of death for mothers opting IVF may occur from the body that is rejecting donation of eggs. This may also occur because of the underlying health problems that may come to the fore during the artificial conception i.e via IVF treatment.IVF pregnancies may raise death risk for mothers as it increases vigilance so that the exact nature of the risk can be calculated easily. According to the statement of a professor at Radboud University in the Netherlands, “Women should be counseled and should be made aware of the risks she is taking and the deaths should be properly reported. ” The professor also stated that the deaths of women opting for IVF treatment between the years 1984 and 2008. It was found that 17 women died in pregnancy who had opted for IVF treatment. The death rate of death women is 12.1 in every 100,000 or women who have conceived normally. The rising age of mothers can be the increasing rate of complications. Last year nearly 27000 of women over the age of 40 gave birth there has been a rise of 50 percent died in a decade. There are about 13000 of IVF births in a year.

Reasons which can raise death risk for mothers in IVF treatment:

  • Ovarian Hyperstimulation Syndrome – Ovarian hyperstimulation syndrome (OHS) can occur as a result of fertility drugs which are used to stimulate the development of eggs in the ovaries of a woman. If in case, the ovaries are overstimulated then they can become enlarged. The symptoms of having OHS are such as abdominal pain, nausea, and vomiting can occur. In most of the cases, fluid may accumulate around the lungs or heart of a woman.
  • Age of a woman – Age is the main factor that can raise the death risk of a woman in an IVF pregnancy. It is observed through research that women who conceive via IVF treatment tend to be older as compared to the women who conceive naturally. In fact, the chances of miscarriages and death of a mother increase to above 60%. The risk can be chromosomal birth defects like down syndrome that increases from up to 1:100 women. This may be due to an increase in egg chromosomal defects along with advancing maternal age.
  • Multiple Pregnancies – IVF is a major cause of resulting in multiple births. While twin pregnancies are related with increased perinatal morbidity and high order multiple pregnancies. This may also impact the well being of a woman undergoing IVF treatment.