What is IVF?
If you are struggling to become pregnant after a year of trying, you might be considering the risks and benefits of in vitro fertilisation (IVF). Dr Alex Polyakov is a skilled and experienced physician in Melbourne regarding the IVF process.
IVF is a complex clinical procedure that helps to achieve conception by treating existing infertility or genetic problems. IVF is a time-consuming, expensive and invasive procedure, which takes around 2 weeks for the completion of a single fertilisation cycle. The IVF process involves collecting matured eggs from the ovaries and combining them with sperm in the laboratory. After fertilisation, the eggs are implanted into the woman’s uterus.
The IVF process can be completed with eggs and sperm from the bodies of the couple trying to get pregnant, but eggs and sperm from donors, or eggs that have been frozen or preserved at a fertility clinic, can be used as well.
What is the normal reproductive process?
The normal process of reproduction involves a chain of events. The woman releases an egg from one of her ovaries (ovulation). The egg travels through a fallopian tube toward her uterus (womb). A man’s sperm is introduced into the vagina through intercourse and travels up the uterus and into the fallopian tube to join with (fertilise) the egg along the way. The fertilised egg then attaches to the inside of the uterus, initiating pregnancy.
What is the anatomy of a normal reproductive system?
The female reproductive system is made up of the following parts:
- Vagina: opening of the reproductive system, which allows the entry of sperm
- Cervix: narrow region that connects the vagina to the uterus
- Uterus: womb, where a fertilised egg implants and grows to develop into a baby
- Ovaries: organs on either side of the uterus, which release an egg each month in the prospect of a pregnancy
- Fallopian tubes: narrow tubes that open out at the ovaries to pick up the released egg for fertilisation
The male reproductive system consists of the following:
- Testicles: produce and store sperm
- Epididymis and vas deferens: ducts that transport the sperm from the testicles
- Scrotum: sac of skin that contains the testes and epididymis outside the pelvic cavity in order to maintain the optimal temperature needed for sperm to survive
- Accessory glands: seminal vesicles and prostate gland lubricate and form a part of the semen, which is the liquid part of the ejaculate that contains sperm
- Urethra: carries sperm to the outside. It is also a part of the urinary system.
- Penis: muscular organ containing the urethra that is responsible for the ejaculation of sperm into a woman’s uterus
What is infertility?
Infertility is a condition characterised by the inability to achieve pregnancy and a healthy live birth. It occurs when one or more of the processes of a normal reproductive cycle fail to occur.
What is the percentage of population affected by infertility?
According to the World Health Organization (WHO), one in every four couples suffer from infertility, with male and female factor infertility equally contributing to the failed pregnancies.
How does infertility affect you?
Male and female infertility affects the respective reproductive processes and ultimately affects the ability to conceive and give birth to a baby.
What are the causes of infertility?
Some of the causes of female fertility may include:
- Problems with ovulation due to
- Stress, diet, being underweight or overweight, or being involved in extensive athletic training
- Polycystic ovarian syndrome (PCOS): multiple cysts in the ovaries
- Hypothalamic dysfunction
- Premature ovarian failure: ovary stops producing eggs at an early age
- Excess prolactin produced by the pituitary gland
- Pituitary gland tumour
- Age: being older than 35 years old
- Structural deformities such as
- Blocked fallopian tubes
- Cervical mucus problems
- Extra growths, such as polyps and fibroids
- Abnormally shaped uterus
- Sometimes the cause of infertility is unknown and may be governed by a combination of many minor factors.
When should I seek help for my infertility?
You may have reason to be concerned if you have been trying to get pregnant for at least one year and:
- You are in your late 30s and have been trying to get pregnant for six months or longer
- Your menstrual cycles are either irregular or absent
- You have painful periods
- You have a known history of fertility problems
- You have a history of pelvic inflammatory disease or endometriosis
- You have had multiple miscarriages
- You have been treated for cancer with drugs and radiation
How is infertility diagnosed?
When you visit the clinic for infertility problems, your doctor will review your medical and sexual histories, sexual habits, sexual development during puberty, chronic health problems, medications and surgeries that could lead to infertility, and perform a thorough physical examination.
To diagnose female infertility, the first step is to find out if you are ovulating each month. This can be done by keeping a track of changes in your morning body temperature and texture of your cervical mucus, using a home ovulation test kit, blood tests or ultrasound imaging.
Some common female tests include:
- Hysterosalpingogram: An X-ray of the fallopian tubes and uterus after they are injected with a dye. It shows if the tubes are open and the shape of the uterus.
- Laparoscopy: An exam of the tubes and other female organs for disease.
- Biopsies: A sample of the inner lining of the uterus may be obtained for evaluation.
- Ovarian reserve testing: This test may be performed to determine the number and quality of eggs ready for ovulation.
Some common male tests include:
- Semen analysis: This is a laboratory test carried out to assess the sperm count and quality from a semen sample ejaculated into a sterile bottle.
- Transrectal ultrasound of the prostate: It is an investigation carried out to evaluate the prostate gland and detect any obstruction in the ducts that transport the sperm.
- Scrotal ultrasound: This is an imaging test to diagnose abnormalities of the scrotum or testicles.
- Testicular biopsy: A small piece of tissue is removed from the testicle using a sterile needle and evaluated under a microscope.
- Anti-sperm antibody tests: This test is performed to trace the antibodies that attack sperm.
What are the consequences of not treating infertility?
Left untreated, you may not be able to get pregnant.
What are the treatment options for infertility?
Some of the common treatment options for infertility may include:
- Surgery: to treat obstructions of the sperm duct or fallopian tube, backward ejaculation of sperm, damage to ovaries or uterus
- Medications: to treat infections of the reproductive system or ovulation problems
- Hormone replacement therapy: to treat hormonal imbalances
What are the alternative treatments for infertility?
Some of the alternative treatments for infertility can include:
- Gestational surrogates, if pregnancy poses a high health risk or if you have a nonfunctional uterus
- Counselling, for sexual intercourse problems and relationships
- Lifestyle modifications, including changing habits such as illegal drugs, smoking and alcohol intake, and using stress reduction techniques
Am I candidate for IVF?
The most common indications for IVF include:
- Damaged or blocked fallopian tubes
- Ovulation problems
- Premature ovarian failure (loss of normal function of your ovaries before the age of 40)
- Severe endometriosis (presence of endometrial tissue outside the uterus)
- Presence of uterine fibroids (benign tumours in the wall of the uterus)
- Male factor infertility, including low sperm count and low sperm motility
- Presence of a genetic disorder
- To preserve fertility for patients with cancer or other health conditions
- Unexplained infertility
How do I prepare for IVF?
IVF involves a series of steps that are performed in accordance with your monthly menstrual cycle. Before starting IVF, you will be screened for ovarian reserve and infectious diseases, and your uterine cavity will be examined. Your partner will be examined for sperm count and quality. Your doctor may even perform a mock embryo transfer to determine the technique that will best suit your condition.
It can be a long a laborious process for some, so it is best for you to be physically and mentally prepared for each stage of treatment as well as its outcomes. Get a clear understanding of the process so that you are aware of the risks and side effects of the treatment, and that you may need more than one cycle for positive results.
Eat a healthy balanced diet, take supplements such as folic acid on a regular basis, exercise regularly, avoid excess caffeine and alcohol, and get ample amount of sleep.
How is IVF performed?
The steps involved in an IVF treatment are:
- Ovulation induction: The doctor will administer fertility drugs to boost the production of your eggs. Transvaginal ultrasounds will be conducted to monitor the development of the eggs and blood tests obtained to check hormone levels.
- Egg retrieval: Your doctor will perform a follicular aspiration, a minor surgical procedure to remove the eggs from your ovaries. An ultrasound probe is inserted through the vagina and into the follicles under ultrasound guidance. Each follicle in the ovary is pierced in order to retrieve the egg.
- Insemination and fertilisation: The eggs are mixed with the sperm in an environmentally controlled chamber to facilitate the process of insemination. The egg is fertilised a few hours after insemination. If the chance of fertilisation is low, intracytoplasmic sperm injection (ICSI) may be used, where the sperm is directly injected into the egg.
- Embryo culture: Division of the fertilised egg forms an embryo. The development of the embryo is monitored and within 5 days, a normal embryo has several actively dividing cells.
- Embryo transfer: Embryo transfer is performed 3 to 5 days after egg retrieval and fertilisation. A thin tube containing one or more embryos is inserted into the vagina through the cervix and into the uterus. After transfer, if an embryo attaches or sticks to the womb lining, it results in pregnancy.
What can I expect after IVF?
As the embryo transfer is carried out under the guidance of ultrasound, you will have a full bladder during the procedure. You will be able to empty the bladder after the procedure.
What are the advantages of IVF?
The primary advantage of IVF is the achievement of a successful pregnancy and a healthy birth. It allows couples who are otherwise unable to get pregnant, to have a baby.
Other advantages include:
- It is more successful than other assisted reproductive technology methods and these success rates have been increasing since its conception.
- It is especially useful in single women and same-sex couples.
- It can help identify fertilisation problems in those with unexplained infertility.
- It can help screen for inherited diseases.
The disadvantages of IVF include:
- You may have to undergo many cycles before you can become pregnant and have a healthy live birth.
- It is associated with side effects such as ovarian hyper-stimulation syndrome (OHSS), multiple pregnancies and ectopic pregnancy.
- IVF can cause a lot of stress and affect your emotional and psychological wellbeing.
- It can be expensive.
- The act of discarding extra embryos may pose ethical issues of destroying a potential life.
Describe the stages of recovery and care plan?
For the first two days after an embryo transfer you should refrain from heavy lifting, physical activity like running or aerobics, swimming, alcohol, smoking and intercourse. You can do a pregnancy test 10 days after embryo transfer to confirm pregnancy.
What are the outcomes of IVF?
IVF success is not only restricted to the attainment of pregnancy, but also the birth of a healthy child without any related complications. According to the Centers for Disease Control and Prevention (CDC), IVF results in an average of 29.4% pregnancy and 22.4% live births.
What are the potential complications of IVF?
As with any surgical procedure, risks and complications can occur. The possible complications associated with specific steps of an IVF include:
- Risk of multiple births
- Risk of premature and low birth weight
- Ovarian hyperstimulation syndrome (OHSS): a condition of ovarian enlargement accompanied by fluid accumulation in the abdominal cavity
- Risks of egg retrieval include bleeding, infection, and damage to the bowel, bladder or blood vessels
- Possibility of ectopic or tubal pregnancy
What is the downtime of IVF?
IVF is performed in cycles, with each cycle lasting for about 6-9 weeks until you confirm your pregnancy. You are suggested to wait 3 months for you to physically and emotionally recover from a failed pregnancy before you start with the next cycle. Some would require 3 cycles for a positive pregnancy. However, you will be able to continue with your normal activities after the procedure, with caution against vigorous activities.
What is the cost of IVF?
Any costs involved will be discussed with you prior to your surgery.
How can infertility be prevented?
Some forms of infertility cannot be prevented, but there are a few factors that may increase your chances of becoming pregnant:
- Avoid smoking, drugs and excessive alcohol intake.
- Limit your intake of caffeine.
- Avoid high temperatures such as hot tubs and steam baths.
- Avoid exposure to environmental and industrial toxins.
- Discuss with your doctor on the use of certain medications that may affect your fertility.
- Exercise regularly in moderation.
- Avoid being overweight or underweight.
- Practice safe sex and limit the number of sex partners.
- Consider ways of protecting your fertility from cancer treatment.
What is the current research regarding IVF?
Extensive research is being done to find better treatment outcomes of IVF. Some of the recent studies are listed below:
- Kofod L, Lindhard A, Bzorek M, Eriksen JO, Larsen LG, Hviid TVF. Endometrial immune markers are potential predictors of normal fertility and pregnancy after in vitro fertilization. Am J Reprod Immunol. 2017 Apr 25. doi: 10.1111/aji.12684. [Epub ahead of print]
- Kosteria I, Anagnostopoulos AK, Kanaka-Gantenbein C, Chrousos GP, Tsangaris GT. The Use of Proteomics in Assisted Reproduction. In Vivo. 2017 May-Jun;31(3):267-283.