Friday, 8 August 2014

Steps in IVF

                                                                    Steps in IVF



The procedure in which the eggs are fertilized outside the body with husband’s sperm to obtain an embryo is known as IVF

Indications:-

When the tubes are blocked due to diseases like endometriosis, pelvic infections, ovarian cyst etc, the eggs and sperm will not meet and fertilisation does not take place. Surgical correction may not be possible or successful in some patients and IVF is done for them.Sometimes, even with normal tubes, fertilisation does not happen,specially in women with PCOS. IVF procedure is done, when other treatments do not work. Even in unexplained cases of infertility, IVF can be done. 
ICSI is done for male infertility.
 
 Steps:-

Initial consultation for detailed evaluation, fitness tests with blood and urine tests, Mock Embryo Transfer (MET), Counseling, Consent form completion etc are done in O.P setting

Consultation & Counselling:-

About procedure, method, duration, cost, side effects, success, frequency of visits etc. are given

Fitness Tests :-

Detailed history of husband & wife, medical examination of both partners ,Lab tests for blood routine, sugar levels, hormone levels like LH, FSH, TSH, prolactin, infection screening HIV, HCV ,hepatitis B, syphilis, USS(Scan) is a must to check pelvis , and is done by Gynecologist herself.

MET (Mock Embryo Transfer):-  
  
Trial of embryo transfer, without actual embryo is conducted to check the position, length and ease of E.T. This helps doctor to decide how to perform E.T. Some time , sedation is given if patient is anxious.Dilation (D&C) is done with GA if Cervix is tightly closed.Different type of harder cannula is used if cervix is curved.  Infections detected in Cervix/Vagina are treated accordingly.

Ovarian Stimulation:- Ovaries are stimulated by daily injections (FSH) starting D2 or D3. They are small injections given just under skin or IM and needs to be taken daily for 9-12 days.

Doctors will check the growth of follicles by scan on and off. When the eggs are matured , that is when it is around 20 mm, a final injection with  hcg is given.Egg collection (OR) is done under sedation/GA after 36 hours of hcg injection.

Egg Collection (OR)


The doctor uses a small long needle guided through the vaginal scan probe, to collect the fluid from the follicles. This is done with extreme precision, with the doctor watching the needle on scan, all the time, to avoid  injury to other internal organs.

 Embryology:-

All the follicles are tapped using suction force, and the eggs are identified by the embryologist under specialized microscope in the IVF lab. The eggs are then mixed with washed sperms from husband, to fertilise on its own.

The embryologist will keep monitoring the embryos for growth  and will provide media for its growth and keep it in an incubator,  which provides set temperature & PH for the growth.


  Embryo Transfer (ET):-


They are transferred on day 3 or day 5 into the uterus by Embryo transfer(ET). The technique of ET is highly skilled procedure. As they are very delicate, the  embryos need to be handled in a very gentle manner and they are loaded in very soft,  non toxic cannula. Difficulty, or presence of blood suggest high chances of failure. So the ET is  performed with great concentration and high precision. 

Luteal Support:-

Medicines are given to support the growth of the baby as Vaginal preparations , called Luteal support.

Pregnancy Test:-

UPT is done by 14th day to check result. Blood test (bhcg) can also be done.Depending on the result, doctors will give further advises.

FET (Frozen Embryo Transfer):-

Embryos can be frozen if there are excess embryos. They are transferred (FET) in the later months according to cycle.

Counseling:- 

In cases if pregnancy does not occur due to failure of implantation or poor embryo quality, doctors will counsel to provide further options and to clarify your doubts.

Success Rate:-

Depends on quality of egg and sperm and physicians skill also plays a part. Generally we have 60% success in young healthy couple, 30% success in aged (more than 35 years) 




Dr. Anita Mani
Infertility& Surrogacy Specialist at Gift IVF Centre
anitadane@gmail.com
 

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