IVF & Reproductive Health

IVF & Reproductive Health

In-vitro fertilisation (IVF) is a process by which an egg is fertilized by sperm outside the body.

The process involves monitoring a woman’s ovulatory process, removing ovum or ova (egg or eggs) from the woman’s ovaries and letting sperm fertilize them in a fluid medium in a laboratory and then transferring it to the patient’s uterus with the intention of establishing a successful pregnancy.

The reasons causing infertility include:

  • Endometriosis
  • Low sperm counts
  • Problems with ovulation
  • Problems with the uterus or fallopian tubes
  • Antibody problems that harm sperm or eggs
  • The inability of sperm to penetrate or survive in the cervical mucus.

 

All IVF treatments begin with a course of hormone therapy to stimulate the development of several follicles in the ovary. These are collected as eggs, which are then fertilized in a test-tube (‘in vitro’) to create several embryos. After up to five days in an incubator, one or two of these embryos are transferred through the vagina to the uterus, where implantation occurs and pregnancy begins. However, in IVF as in natural conception, not every embryo implants to become a pregnancy, which is why surplus embryos are frozen – so that a subsequent transfer might be tried if the first one fails.

 

FAQ on IVF:

How long does an egg retrieval take?

Egg retrieval is a fairly rapid procedure. The length of the procedure depends on how many follicles are present. Also the accessibility of the ovaries will determine how long the procedure will take. Accessibility means how easy is it to reach the ovaries with the ultrasound probe, whether they have a tendency to move away from the probe and so on. The typical egg retrieval will take from 20-30 minutes.

Is the egg retrieval painful?

Egg retrieval is done under anaesthesia; the patients are asleep. Anaesthesia specialists use medications which heavily sedate you. You will be “asleep” however; you will not require a breathing tube. The beauty of this approach is that you will feel absolutely nothing, remember absolutely nothing, and will have few of or none of the typical side effects of anaesthesia such as nausea and vomiting.

Will the egg retrieval damage my ovaries?

The data we have available tells us that it does not. There have been many women who have undergone multiple egg retrievals. The fact that they have responded to stimulation on subsequent occasions and produced eggs and pregnancies on these occasions implies that the ovaries are OK after egg retrieval. There have been some limited studies looking at the appearance of the ovaries in women who have had egg retrievals and subsequent laparoscopic surgery. In those patients, the findings were normal.

Is bleeding expected after the egg retrieval?

Vaginal bleeding is not uncommon after an egg retrieval. Usually this bleeding is from the needle puncture sites in the vaginal wall. It is usually minor and similar to a period or less. The bleeding experienced is analogous to the bleeding that will take place from an IV or from the arm after blood has been drawn.

Is it normal to retrieve an egg from every follicle?

Not necessarily. Although we will usually get an egg from most mature sized follicles, most women will have a mixed group of follicles after ovulation induction. Some of those follicles will have immature eggs or post mature eggs, which may not be identifiable so they will seem to have been “empty” follicles.

Is the embryo transfer painful?

The embryo transfer does not require any anaesthesia. It is performed using a speculum that allows the doctor to see the cervix, (like a Pap smear) and is very similar in technique to an intrauterine insemination (IUI). Usually the woman feels only the speculum and nothing else.

Is bed rest recommended after the embryo transfer?

It is really not clear that prolonged rest after transfer is helpful. In nature, the embryo floats freely in the endometrial cavity for a number of days before implantation and it will do the same in an IVF cycle. We do recommend that you take it easy following transfer for the rest of the day, but routine work activities can be resumed the next day. If there is an increased risk of Ovarian Hyperstimulation, we will recommend prophylactic bed rest.

Can anything be done to improve embryo quality?

Ultimately the answer is no. If an embryo is of poor quality because it is genetically abnormal, there is nothing that can be done to salvage it. However, there are procedures that we do that can improve the chances of a borderline embryo. These include use of Metformin and assisted hatching. It has been shown that procedures such as these can increase implantation rates in couples with a poor prognosis.


What is done with any “leftover” embryos?

Embryos which are not transferred in the retrieval cycle are maintained in culture to determine if they develop to the blastocyst stage. If they do, they will be cryopreserved, if that is your wish.

How long of a wait is recommended between a failed IVF cycle and trying again?

We would recommend at least one full menstrual cycle of waiting before undergoing IVF a second time. We know that it can take up to 6 weeks for inflammation to resolve; therefore, it is reasonable to wait a similar amount of time before restarting the process.

Are there limitations on the number of IVF tries per couple?

We find that most couples will get pregnant within 2 tries. Occasionally, there may be a reason to do a third attempt but that is not common. More than this would really require extenuating circumstances such as a miscarriage due to a non-recurring reason.

 

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