If you decide to try IVF, or What you need to know about the procedure of in vitro fertilization
IVF, or in vitro fertilization, has been used around the world for almost 40 years. For many couples, this is the only way to finally have children. IVF can help even in cases where natural conception is almost impossible. What is this procedure, is it safe, how is IVF preparation going and how much does it cost?
What is IVF?
IVF is a fertilization outside the body: egg cells and spermatozoa are retrieved from the body, fertilization occurs in the laboratory. Then, the fertilized egg cells are placed in the incubator for 5-6 days and in the process of division are transferred into the uterus.
Not so long ago, in the context of the IVF procedure, a moral and ethical question was very controversial. The thing is that the previous level of technology put the participants of the artificial insemination program before the choice: to become pregnant with high probability after the transfer of 3-8 embryos or to abandon the idea at all. Almost all chose the first option. As a result of this tactic, there were a lot of multiple pregnancies. Usually happy parents left all the embryos that had survived, that is why 10-15 years ago the result of IVF was almost always twins or triplets. Nevertheless, there were cases when couples decided to remove “extra” embryos, which is unacceptable from the point of view of morality.
Because of development of cryopreservation technologies in the last 10 years, the survival percentage of embryos has increased to 99.8%, which means that the need for transferring of several embryos has disappeared, same, as does the risk of possible resection. Although this approach is not yet applied in all clinics, the trend is clearly visible. Today in Ukraine, in 7 out of 10 cases, only one embryo is transferred. This tactic allows you to almost completely avoid multiple pregnancies. And the point here is not only in moral and ethical norms, but also in medical precautions. With twins the risk of premature birth increases, children can be born prematurely, and as a result, the incidence, disability and mortality rate of infants are higher. In particular, the risk of infantile cerebral palsy in twins is 9 times higher than that of children, who were born as a result of single pregnancy.
IVF is indicated in many cases of infertility, which cannot be cured in any other way – with serious pathologies of the fallopian tubes causing their obstruction and even with their complete absence, a small number of full-fledged spermatozoa in the partner, immunological infertility, endometriosis.
In IVF, there are contraindications. The procedure is not carried out in the following cases:
- Mental diseases, in which pregnancy and childbirth are contraindicated;
- Pathologies of female genital organs, excluding normal gestation;
- Any tumors of the organs of the reproductive system and malignant neoplasms in general, as well as acute inflammatory processes in the female body.
In IVF there are several varieties, and the specialist selects the method for the procedure depending on the cause of infertility.
The basic IVF technique described above is often supplemented by assistive technologies.
ICSI – this method involves the artificial injection of a sperm into the egg cell with a very thin needle. ICSI is used if the partner’s spermatozoa is immobile and unable to fertilize an egg cell by itselves. ICSI is also performed with a very small number of spermatozoa and even with their complete absence in the ejaculate. In the latter case, the sperm is obtained by puncture of the testicle. ICSI is indicated for women over 40 years of age..
PICSI is a modification of the ICSI method, for which only mature spermatozoa are selected. If in case of ICSI they are selected only on visual grounds, then in case of PICSI a special test is conducted.
IVM involves the removal of unripe oocytes. So they ripen in vitro, under laboratory conditions. Allows to avoid hormonal stimulation, and also is used in the event that the stimulation does not give a result.
Assisted Hatching is a technology that facilitates the implantation of an embryo into the uterus. Normally, the embryo is surrounded by a thin shell, which destroys before implantation. Assisted Hatching – the artificial destruction of this shell.
Preparation for IVF, procedure and follow-up after IVF
Preparation for IVF takes about 2-3 weeks and includes analyzes for both spouses. Women undergo gynecological examination, ultrasound of the pelvic organs, examine blood for HIV, hepatitis, syphilis, level of hormones, a smear for infection. Men are also assigned blood and smear tests for infection, as well as spermogram.
After receiving the results of the tests, the doctor will have all the necessary information, and therefore, reliably detect the cause of infertility and select the appropriate method of IVF.
IVF procedure usually begins with hormonal stimulation – a woman takes hormones, due to which several eggs ripens in one cycle. Usually the duration of this stage is 2 weeks.
At the time of onset of ovulation, egg cells are retrieved from the ovaries with a puncture. The process is controlled by ultrasound.
Then the egg cells are fertilized with the sperm of partner or with the donor’s one. Sperm for fertilization undergoes certain preparation – spermatozoa are separated from seminal fluid. Sometimes for receiveng sperm testicular puncture is required.
The process of fusion of egg cell and sperm takes place in the laboratory in the usual way or by ICSI and transferred to the incubator for 5-6 days. If fertilization has occurred, the embryo is checked for vitality and absence of pathologies: Down’s syndrome, hemophilia, etc. Today it is possible to conduct such testing even at the stage when the embryo consists of only 6-8 cells. However, it is much safer for an embryo to do this when it consists of 60-150 cells: this is what conducted in modern laboratories.
If the embryo meets the requirements, it is implanted into the uterus by means of a catheter. It is allowed to transfer several embryos, but modern clinics in most cases carry one, and the rest are frozen for the case if the first attempt of IVF will fail. We discussed this in detail at the beginning of this article.
After implantation, the woman sometimes undergoes a course of hormone therapy again, whose task is to support pregnancy and minimize the risk of miscarriage. But there’s not always necessity in such procedure, in 60-70% of cases, the doctors transfer the embryos in the natural cycle of the woman that goes next to the month when the eggs were stimulated and taken. This allows us to get a pregnancy, which in physiology does not differ from the natural one..
The flow of pregnancy after IVF does not differ from usual pregnancy, and the process of delivery will be exactly the same.
Evaluation of effectiveness
The effectiveness of IVF is very high. Every year hundreds of thousands of IVF protocols are carried out all over the world, and many of them end succeed from the first attempt. On average, the chances of becoming pregnant after the first IVF are 25-50% – the statistics vary from country to country, from clinic to clinic. The age of the future mother is important, as well as the “experience” of infertility. With the infertility diagnosed at an early stage, the chances of becoming pregnant after IVF are higher than 10-15 years from the date of diagnosis. That’s why delaying with IVF is not worth it.
The average success rate after the first attempt of IVF is about 30%. With the use of frozen embryos, oocytes and spermatozoa, statistics vary. So, with frozen embryos on average in Ukraine, the chances of survival of one embryo are 20%, in good clinics this percentage is higher – 35-42%. When using frozen oocytes, the situation is similar. In the case of cryospermatozoids, there is no difference with the usual program.
The IVF protocol in the natural cycle, that is, without hormonal stimulation, is effective in approximately 18% of cases.
The perfect age for IVF in women is up to 35 years. If successful pregnancy in young mothers after IVF occurs in almost every third case, then in women over the age of 40 the appearance of the long-awaited baby ends with only one of the eight IVF protocols. After 45, pregnancy is unlikely, but there is still a chance. In most cases, success is achieved with the use of donor oocytes, the chances of success are the same as those at the age of 35 years.
Safety for mother and child health
The good news is that IVF can be held as many times as it takes and how much finance allows. In the absence of contraindications, the procedure is harmless and less traumatic. In fact, we are talking about the procedure of IVF without preliminary hyperstimulation – non-stop hormone therapy is fraught with consequences: here, safety depends on the chosen tactics and on the professionalism of doctors. Today, the risk of complications in IVF programs can be minimized.
It is also safe for children conceived in this way. A research conducted by the Human Reproduction Association, during which a long-term monitoring of 27,000 “test tube children” was conducted, clearly showed that they are no different from their peers conceived without help of medicine. There is evidence that such children show more impressive academic success, but are more often sick. This correlation is easily explained. Most of those who decided on IVF were women over the age of 30 with an income above the average. “Toddlers from a test tube” are long-awaited children from well-to-do families, and parents often show an overcare seriously worried about every small and even imaginary ailment. In addition, such families can afford to give children better education, which explains their academic successes.