IVF- InVitro Fertilization is a process which involves mixing the eggs and sperms in a culturedish in the laboratory and the embryo formed is put back into the uterus resulting in pregnancy. First IVF baby was born in UK in 1978 and the creators being Dr Robert Edwards & Dr Patrick Steptoe. It gives immense pride to share that the second IVF baby was born in India under the guidance of Dr Subash Mukherjee in October 1978. IVF involves a series of steps which will be explained in detail below.
After doing investigations for both the partners, the couple are counseled regarding thesteps involved in the procedure, the pregnancy rates & the financial implications.
- Ovarian Stimulation : At the outset, the treating specialist decides what protocol will be used for the procedure. The most commonly used one is called the “Antagonist Protocol”. In this protocol, the female partner is called on the second or third day of the cycle to start the ovarian stimulation. Gondotropin injection with a predecided dose is started daily maintaining the same time. At regular intervals patient is monitored with the help of transvaginal ultrasound. Sometimes blood tests are done to help in better monitoring. The dose of gondotropin injection is adjusted according to the growth of the number and the size of follicles(egg containing sacs). Another injection called antagonist is started usually after first five /six days to prevent premature follicular rupture. Once the follicles reach the optimal size, trigger injection is given and egg pick up is done.
- Oocyte Retrieval (Egg Pick up) : After around 34-36hrs after the trigger injection, egg retrieval is done by the clinician in the operation theatre using ultrasound scan, under anaethesia. The retrieved eggs are handed over to the embryologist for the further process. Care is taken to optimize the egg collection by maintain the optimal timing.
- Lab Procedure-IVF/ICSI : In the embryology laboratory, the retrieved eggs are mixed with the partners sperm in the petri dish and allowed to fertilize naturally.This is the main procedure which is called IVF- InVitro Fertilization. Sometimes, especially when the sperm count is compromised the best sperms are selected and injected into the eggs by the embryologist. This is called ICSI-Intracytoplasmic sperm injection.
- Lab procedure-Embryo culture : The eggs fertilize after a day and these are allowed to grow in the incubators in the embryo culture dishesfor around three to five days. Day 3 embryos are usually 8 celled.The day5 embryo is called a blastocyst. The embryos are graded by the embryologist in the lab. The best quality embryos give maximum pregnancy rates.
- Embryo Transfer : Thus formed embryos be it day 3 or 5 are transferred into the womb of the female partner vaginally by the clinician. This procedure does not require anaesthesia and is usually done under trans abdomen ultrasound guidance. The patient will have to wait for a period of 12 to 15 days thereof to get to know whether pregnancy has occurred. Pregnancy rates , specifically live birth rates mainly depend on the age of the patient . According to data collected from Monash clinics Australia between 1 January and 31 December 2020 IVF resulted in live births for 43.8% of women aged 30 years or younger, 32.9% of women aged 30-34, 24.1% of women aged 35-39, and 8.3% of women aged 40-44.
IVF has helped in the birth of more than 12 billion babies worldwide in the past 47 years. It has grown leaps and bounds, reaching childless couples in almost all the countries world wide. For this we need to be grateful for pioneers of the procedure. For his unparalled role in establishing the IVF process Embryologist Dr Robert Edwards was conferred the Nobel prize in the year 2010.
