What is IVF Pregnancy | Testube Baby Process

• IVF is an Assisted Reproductive Technology for pregnancy.
• IVF- an alternative to get pregnant in normal pregnancy failure
• IVF is an option for patients with fail to undergo conception
• Get the best Doctors to discuss your fertility problems with us.
• We offer all fertility solutions under our roof, no traveling cost
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First Understanding the Terminology of IVF

IVF stands for In-Vitro Fertilization. The term ‘in-vitro’ means outside the living organism, as eggs mature in vivo (inside) in the ovary and embryos develop into pregnancy in the uterus, but the eggs are fertilized in a petri dish in the laboratory.

Why should one undergo IVF treatment?

IVF is widely applied for the treatment of infertility due to a variety of conditions which includes, 

• Endometriosis, 
• If both fallopian tubes are blocked
• Having a high risk of genetic disease
• When cryopreserved eggs are used
• Women with the missing uterus, either from birth or removed for medical reasons
• Male factor and 
• Unexplained infertility. 
• Women who cannot use their oocytes due to primary ovarian insufficiency (POI) or age-related decline in oocyte number can now become successfully pregnant utilizing donor oocyte IVF.

Let’s understand…

How IVF pregnancy is Achieved?

Infertile Individuals planning for IVF undergo several evaluations before the start of the treatment cycle. The woman’s ovarian reserve is evaluated using either cycle day three follicle-stimulating hormone (FSH) and estradiol (E2), anti-Mullerian hormone (AMH), or antral follicle count. If the woman is determined to have poor ovarian reserve based on any of these values, she can still pursue IVF but may need to consider the use of donor oocytes.

The male partner has a semen analysis to decide whether ICSI is indicated, based on sperm morphology, count, and motility. Uterine cavity imaging identifies any anatomical issues, including endometrial polyps or fibroids, adhesions, or septa that may interfere with embryo implantation. Infectious disease screening for HIV, hepatitis B, and C, and syphilis is recommended for both partners.

IVF pregnancy is achieved by undergoing five steps process mentioned here step-wise:

1. Ovarian Stimulation:

The first steps of IVF treatments begin with ovarian stimulation. The woman is injected with fertility hormones to stimulate healthy egg development. These hormones help her to produce more eggs than she would produce in a normal month. In IVF cycles, gonadotropin-releasing hormone (GnRH) analogs are utilized to eliminate the woman’s LH surge allowing our doctors to time oocyte retrieval. Follicular growth is monitored by transvaginal ultrasonography, and blood levels of E2 help determine any changes in the stimulation protocol. Ovarian stimulation is done in the vast majority of IVF cycles so that approximately 10 to 20 oocytes are retrieved. There are two main protocols:

• long luteal GnRH agonists (GnRHa)- 0.1 mg GnRHa daily starting on cycle-day 21 in the preceding month
• a GnRHant cycle- (75 to 450 IU) starting on cycle day 2 or 3.

2. Oocyte Retrieval: Mostly, mature oocytes are retrieved 34 to 36 hours after hCG administration. Oocyte retrieval is performed using ultrasound-guided transvaginal aspiration and intravenous sedation. The ovaries are visualized using a vaginal ultrasound probe, and an attached needle guide helps the physician direct the needle into each follicle and aspirate the oocyte and follicular fluid.

3. Sperm collection from the husband or a Donor:

During the removal of the egg, the partner is asked to provide a sperm sample via masturbation or through different means or collected from Donors. The collected sperms are then put through a high-speed wash and spin cycle and concentrated to find the healthiest sperm. 

4. Fertilization: Insemination or ICSI is used to fertilize the oocytes. The semen sample is prepared by isolating the sperm by density centrifugation and washing it in media with a high protein concentration to promote capacitation, a process that is necessary for sperm to become fertilizable to the egg. 50k t0 100k sperm are incubated with an egg for 12-18 hours and an embryo is formed. 

Male factor infertility may require ICSI, where one immobilized sperm is directly injected into the oocyte/egg. This bypasses the need for the sperm to penetrate the zona pellucida, the glycoprotein matrix that surrounds the egg.

5. Embryo Transfer/Implantation: 3 days (cleavage stage)/5 days (blastocyst stage) after fertilization are selected to transfer into the uterus. The blastocyst stage transfer offers higher live births per cycle and is achieved with fewer embryo numbers and thus lower multiple gestation rates. However, the downside of the blastocyst stage transfer is that fewer embryos may be available for transfer due to the loss of embryos that did not survive in culture until the 5th day.

Embryos are transferred under transabdominal ultrasound guidance into the uterus by a catheter passing through the cervix. The embryo(s) are placed 1 to 2 cm from the uterine fundus. After the transfer, the catheter is checked under the microscope to ensure no embryos are retained in the catheter and that all embryos were successfully placed in the uterus. The number of embryos transferred will depend on the embryo stage, embryo quality, maternal age, and patient preference. 

Note: 

not more than two blastocysts to be transferred in women 37 years old or less, no more than three blastocysts in 38 to 40 year-olds as well as in women 41 to 42 years of age.

A higher number of cleavage stage embryos can be transferred due to the lower likelihood of successful implantation; no more than two embryos in women < 35 years of age, no more than three embryos in women 35 to 37 years of age, no more than four embryos in women 38 to 40 and women 41 to 42 years of age, five or fewer embryos.

To optimize embryo implantation and a continuing pregnancy, progesterone supplementation is initiated on the day of oocyte retrieval or embryo transfer. Excess good quality embryos are cryopreserved for future use. Regular monitoring is carried out to confirm positive pregnancy. If an embryo successfully implants, the woman becomes pregnant. She will need to wait two weeks for a pregnancy test.

The IVF clinical Significance, at the Fertility World IVF center

Today, Infertility affects approximately 1 in every 6 couples across the world. Since 1978, over 5 million children worldwide have been conceived via IVF. On average, every time a woman has a cycle of IVF, she has about a 1 in 3 chance of becoming pregnant and having a baby. That chance is higher for women younger than 35 years old, and lower for older women, decreasing with age. By age 44, the chance of success is less than 1 in 10. IVF live births rates per intended egg retrieval by age group were as follows:

1. Women below 35 years

• Singleton percentage of live births- 99.4% (with Donor gametes).
• Twins percentage of live births – 50.4%
• Triplets percentage of live births – 5.2% 

2. Women between 35-37 years:

• Singleton Percentage of live births – 90.3%
• Twins percentage of live births – 39.5%
• Triplets percentage of live births- 3.2%

3. Women between 38-40 years:

• Singleton Percentage of live births – 85.9%
• Twins percentage of live births – 38.9%
• Triplets percentage of live births- 2.1% 

4. Women between 41-42 years:

• Singleton percentage of live births – 80.6%
• Twins Percentage of live births- 28.3%
• Triplets Percentage of live births) – 1.2% 

5. Women above 42 years:

• Singleton Percentage of live births – 70.9%
• Twins percentage of live births – 17.1%
• Triplets percentage of live births – 0%

Costs of IVF, at the Fertility World

IVF is time-consuming. Repeated cycles can take an emotional and physical toll on people going through them. Financial costs vary a lot, but each cycle of IVF may cost several lakhs of rupees in India. However, the fertility world offers IVF at a lower cost than others, it starts from Rs. 1.5 lakhs and up to Rs. 2.5 lakhs depending on the fertility conditions and the type of standard treatments required. 

We regarded every IVF patient to enjoy the same happiness as other fertile couples. So, we offer IVF at the lowest cost possible. If you are considering IVF, we are here to help you, guide you, and lead you in such a way you achieve pregnancy. 

For detailed information about IVF or personal professional consultation. Book an appointment with us and receive free consultations.

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Dr Nidhi Sharma