Conceiving a child has long been a concern for many couples over the last hundred years. The only difference is now, with the latest advancements in science and technology, backed up by years of hard work and research, procedures with greater success rates and fewer side effects are now readily accessible to help address specific and individual challenges of couples that are trying to get pregnant.
Where it all begins
Biologically speaking, conception or fertilization occurs when a sperm cell from a male breaches the egg from a female and is the initial stage for human growth. For some, this process can be fairly easy to achieve, but can be quite challenging and frustrating for others. A lot of factors can affect conception, and each one should be carefully considered when a couple is trying or is unable to get pregnant. By definition, infertility is the inability to conceive or get pregnant after having regular unprotected intercourse of at least 12 months. In some cases, it may also refer to the biological inability of an individual to contribute to conception, or to a female who cannot carry a pregnancy to full term.
In Vitro Fertilization or IVF is one of the latest developments to help address infertility. Although relatively well known, very few people know what really happens and that it actually entails a lot of preparation prior to the procedure itself.
Preparing for IVF
Because each step is both meticulous and exciting, the reproductive or fertility specialist may ask for certain tests in order to provide better chances of conception.
- Ovarian Reserve Testing
It’s a test wherein blood samples are taken from the women to check the levels of their follicle stimulating and luteinizing hormones or their FSH LH levels. This usually indicates the quality of the eggs and determines which medications are needed prior to the procedure.
- Transvaginal ultrasound
The uterus and all the other female reproductive organs are further assessed to determine the presence of any abnormalities involving the uterus, ovaries and fallopian tubes. This test does not only determine the condition of the reproductive organs, but also helps decide the most effective way to implant the embryos.
- Sperm analysis and testing
Men are asked to submit a semen sample in order for them to analyze and determine any abnormalities found in the sperm, including effective sperm production and movement.
- Hysteroscopy, hysterosalpingograpy and sonohysterography
Prior to any IVF treatment, the following procedures may be advised in order to determine the viability of the uterus and even diagnose and treat findings encountered during the procedure. Hysterocopy is performed to visualize the uterus, by inserting a tube with a telescope at its end. Through this procedure, abnormalities may be seen and addressed early. Although this is the gold standard in evaluating the uterine cavity in the workup of infertile couples, the sonohysterography is gaining popularity in evaluating patients, as well. In a study published in the International Journal of Fertility and Sterility, entitled Sonohysterographic Screening Before In Vitro Fertilization, not only was it proven to be more sensitive, more specific and more accurate in its evaluation, but was also associated with higher chances of conception after it was used diagnostically and operatively.
Does it work
Much like conception, infertility arises from several causes wherein in vitro fertilization may not always be indicated. Factors such as age, cost and underlying medical conditions should be carefully considered before taking any measures. Based on clinical studies, IVF seems to work best for women ages 40 and above, and in those with the following health concerns:
- Fallopian tube conditions such as anatomical damage, deformities, blockage or sterilization
- Ovulation disorders that lead to fewer egg production such as premature ovarian failure
- Endometriosis and other uterine conditions that hinder implantation and pregnancy
- Impaired sperm production or function even abnormalities in shape, size and mobility of the sperm
- Fertility preservation for cancer or other health conditions. Some women opt to have their eggs harvested and frozen for future occasions wherein she may need them to be fertilized. Examples would be those needing chemotherapy or radiotherapy in the near future that can greatly decrease the number of eggs left for conception.
How it works
The Mayo Clinic defines IVF as a complex series of procedures used to address infertility or genetic problems, and assist with the conception of a child. In vitro means that a process is performed in a test tube, culture dish or in any environment outside a living organism, as opposed to in vivo, which occurs inside.
Prior to an IV procedure, the woman may be placed on hormone therapy to stimulate the development of several follicles in the ovary to help facilitate collection of her eggs. Once these are collected, they are fertilized in a laboratory setting, using the sperm coming from the man to create several embryos. These are often placed in an incubator for 2 to 5 days, after which one or two of them are transferred to the uterus to help facilitate implantation and pregnancy. Because not all implanted embryos lead to a successful pregnancy, other fertilized eggs are kept frozen until further need for them arises. The whole cycle often lasts two weeks, and may be repeated two or more times before a desirable outcome is achieved. Below is a step-by-step description of what actually goes on during in vitro fertilization.
Step 1: Induction of Ovulation
As what was briefly described earlier, a woman may be given hormones in order to stimulate multiple egg production. Medications for ovarian stimulation, egg maturation and uterine preparation are just some examples of the medications administered prior to collection. Before retrieving the eggs, useful tests, which can determine the health or viability of the eggs are often requested.
Step 2: Egg Retrieval
Before ovulation, or before eggs are released from the ovaries, egg retrieval may already be performed in the doctor’s clinic or in an operating room or laboratory setting. Once the eggs have been identified using an ultrasound probe, a needle is inserted through the vagina into the follicles in order to collect the eggs. In difficult or in complicated cases, for better visualization, surgery or laparoscopy may be done in order to retrieve the eggs effectively. Mature eggs are then incubated and saved for fertilization.
Step 3: Sperm Retrieval
Sperm taken from semen samples of the male are often taken on the same day as the egg retrieval. This may be done through natural methods within a clinic or doctor’s office or through testicular aspiration.
Step 4: Fertilization
Fertilization can be achieved through insemination, by mixing the sperm and mature egg in an incubator overnight or through intracytoplasmic sperm injection or ICSI, wherein a healthy sperm is directly injected into the mature egg.
Step 5: Transfer of Embryo
Prior to transferring the embryo into the uterus, assisted hatching may be performed on the fertilized egg, which means the outer layer of the embryo is removed in order for it to be implanted effectively into the lining of the uterus.
After two to six days of egg retrieval, the embryo may be transferred directly into the uterus. This is done by inserting a long, flexible tube all the way to the uterus wherein a syringe containing one or more of the embryos is suspended at the end. Using the syringe, the doctor firmly plants the embryo or embryos into the uterus for possible implantation.
Risks and expectations
In vitro fertilization is a process, which may carry risks every step along the way. Commonly encountered side effects include:
- Multiple pregnancy
Because more than one embryos are often implanted into the uterus, the chances of having multiple pregnancies is very high. Although this may be good for some who prefer to have big families, the risk of preterm deliveries and low birth weight infants is increases directly with the number of pregnancies or babies.
- Ovarian hyperstimulation syndrome
As previously mentioned, the ovaries are often stimulated in order to produce more than one egg that can be collected for insemination. Abdominal pain, nausea and vomiting, and diarrhea are often experienced in the presence of this syndrome and can last for several weeks at a time.
- Instantaneous abortions or miscarriages
Although the rate of miscarriage is similar to that of women who conceive naturally, implanting frozen embryos seems increase this risk even more.
- Ectopic pregnancy
- Ovarian cancer has been associated because of the medications given to stimulate multiple egg ovulation, but are still currently being studied further
- Complications associated with surgical extraction or collection of eggs and sperm
- Frustration and emotional burden
Just like in any natural method of conception, there is no guarantee of a successful pregnancy. Having a good moral support system and a good open relationship as partners, and with the specialists or doctors can help ease the burden and pressure on the couple.
What happens next
Two weeks after implantation, the doctor may already ask for blood tests that will help determine a successful pregnancy. Once pregnant, the couple will be directly referred to an obstetrician for prenatal care. Certain factors though, may still affect one’s ability to carry the child to term. These include the mother’s age, the health and status of the embryo even prior to implantation, the underlying cause of infertility, especially those that affect the uterus, and lifestyle habits that affect both the health of the mother and the child.
To find out more about In Vitro Fertilization, and to learn more about it, visit your Obstetrician Gynecologist or see a Fertility expert to help answer all your concerns.
COMMON FORMS OF ASSISTED REPRODUCTIVE TECHNOLOGY
- In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman’s fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man’s sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman’s uterus.
- Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.
- Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman’s fallopian tube. So fertilization occurs in the woman’s body. Few practices offer GIFT as an option.
- Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube.
American Society for Reproductive Medicine (ASRM)
- Acholonu UC MD, Silberzweig J MD, Stein DE MD, Keltz M MD, Hysterosalpingography versus sonohysterography for intrauterine abnormalities, JSLS. 2011 Oct-Dec; 15(4): 471–474, doi: 10.4293/108680811X13176785203923; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340954/
- Kim AH, McKay H, Keltz MD, Nelson HP, Adamson GD. Sonohysterographic screening before in vitro fertilization. - PubMed – NCBI Fertil Steril. 1998 May;69(5):841-4.