When IVF Is An Option
Have you been trying to conceive naturally for some time and it seems not to be happening? Don't get frustrated, there are fertility treatment options that can help you have this dream come true. One of such is IVF. What exactly is this procedure? What should you expect? Are there risks? Keep reading for answers to these questions.
WHAT IS IVF?
IVF is the process by which eggs are removed from a woman's ovaries and mixed with sperm in a laboratory culture dish. Fertilisation takes place in this dish, "in vitro", which means "in glass".
Thousands of IVF babies have been born since the first in 1978. In 2009, nearly two per cent of all the babies born in the UK were conceived as a result of IVF treatment.
How might we benefit from IVF?
IVF is likely to be recommended for the following fertility problems:
WHAT TO EXPECT
1. The intake interview.
If initial fertility treatments such as fertility drugs or surgery have failed and a couple decides to move forward with IVF, the obstetrician/gynaecologist will refer them to a reproductive endocrinologist. During their initial meeting with the doctor, they'll discuss medical and fertility histories of both parties, to determine which treatment protocols will work best for them, as well as what they can do to improve the odds of a healthy birth.
2. Preliminary tests and talks.
The woman will undergo ultrasound and blood tests to determine the number and quality of her eggs. She will also meet with a nurse to learn how to self administer fertility drugs, a financial counselor to work out payment, and a psychologist to discuss coping with any stress that might arise.
3. Drugs to induce egg growth.
To stimulate the follicles to grow as many eggs as possible during her cycle, for about two weeks the woman will give herself one to three daily injections of fertility medications (such as GonalF, a follicle stimulating hormone, and Repronex, a luteinizing hormone) in her thigh or stomach. Either before her cycle or midway through, she'll also inject a gonadotropin releasing hormone (GnRH) drug such as Lupron, which prevents her from ovulating too early. Around day 12, she'll inject the drug human chorionic gonadotropin (hCG) to stimulate ovulation and precisely time the final burst of egg growth. During these two weeks, she'll visit the clinic about five times for blood and ultrasound tests to monitor her progress.
4. Egg harvesting.
In a carefully targeted window of time — shortly before doctors calculate that her eggs will be released through the fallopian tubes during ovulation — she'll be heavily sedated, and, using ultrasound as a guide, the doctor will pull eggs out of her ovaries with a hollow needle inserted through the wall of the vagina. In the meantime, her partner, in a nearby room, will ejaculate into a cup to obtain sperm, which the lab will then quickly process to extract the most robust ones. The sperm and eggs are then mixed together in an incubator so insemination can occur. If necessary — for instance, when sperm count is low or the sperm are having difficulty penetrating the egg — the lab embryologist might also perform intracytoplasmic sperm injection (ICSI), a procedure in which sperm are injected directly into an egg. If the woman is over 40 or a previous IVF attempt failed, he might also puncture the outer shell of a resulting embryo shortly before transferring it into the uterus so it can implant itself more easily, a process called assisted hatching.
5. Embryo transfer.
Three days after harvesting the eggs, the doctor will use a thin catheter to insert two or three embryos into the woman's uterus via the vagina. "This is a painless procedure that feels like a Pap smear", explains Mark Perloe, M.D., medical director at Georgia Reproductive Specialists in Atlanta. If genetic diseases are a concern, this step might occur on day five, after lab biopsies have been performed to select the healthiest embryos.
6. The outcome.
The partner (or a friend or a family member) will give her daily injections of progesterone, a hormone that aids implantation, in the buttocks. In two weeks, she'll take a pregnancy test at the clinic; someone there will call to give you the results.
IVF RISKS
Medication side effects
Many women will have some reaction to the medications used during IVF. Most of the time, the side effects are mild and may include:
Contact the fertility clinic if you experience persistent or worrying side effects during treatment.
Multiple births
If more than one embryo is replaced in the womb as part of IVF treatment, there's an increased chance of producing twins or triplets. Having more than one baby may not seem like a bad thing, but it significantly increases the risk of complications for the woman and the babies.
Problems more commonly associated with multiple births include:
The babies are also more likely to be born prematurely and/or with a low birthweight, and are at an increased risk of developing life-threatening complications such as neonatal respiratory distress syndrome (NRDS) or long-term disabilities, such as cerebral palsy.
NICE guidelines recommend that double embryo transfers should only be considered during treatment in women aged 40-42. Younger women should only be considered for a double embryo transfer if there are no top-quality embryos to choose from.
Ovarian hyperstimulation syndrome
Ovarian hyperstimulation syndrome (OHSS) is a rare complication of IVF. It occurs in women who are very sensitive to the fertility medication taken to increase egg production. Too many eggs develop in the ovaries, which become very large and painful. OHSS generally develops in the week after egg collection. The symptoms can include:
Severe cases can be dangerous. Contact your clinic as soon as possible if any of these symptoms is experienced. It may be necessary to cancel the current treatment cycle and restart with a lower dose of fertility medication.
Ectopic pregnancy
If you have IVF, you have a slightly higher risk of an ectopic pregnancy, where the embryo implants in the fallopian tubes rather than in the womb. This can cause pain in the tummy, followed by vaginal bleeding or dark vaginal discharge. If you have a positive pregnancy test after IVF, you'll have a scan at six weeks to make sure the embryo is growing properly and that your pregnancy is normal.
Tell your doctor if you experience vaginal bleeding or stomach pain after having IVF and a positive pregnancy test.
Risks for older women
IVF treatment becomes less successful with age. In addition, the risk of miscarriage and birth defects increases with the age of the woman having IVF treatment. The doctor will discuss the increased risks that come with age, and can answer any questions you may have.
WHAT IS IVF?
IVF is the process by which eggs are removed from a woman's ovaries and mixed with sperm in a laboratory culture dish. Fertilisation takes place in this dish, "in vitro", which means "in glass".
Thousands of IVF babies have been born since the first in 1978. In 2009, nearly two per cent of all the babies born in the UK were conceived as a result of IVF treatment.
How might we benefit from IVF?
IVF is likely to be recommended for the following fertility problems:
- If a woman has blocked or damaged fallopian tubes or any other problem where IVF has been identified as the only treatment likely to help get pregnant.
- If a man has a minor problem with his sperm. Major problems are better treated using ICSI.
- If a woman has tried fertility drugs, such as clomiphene, or another fertility treatment such as IUI, without success.
- If a couple has been trying to conceive for at least two years and a cause hasn't been found to explain why they have not become pregnant.
WHAT TO EXPECT
1. The intake interview.
If initial fertility treatments such as fertility drugs or surgery have failed and a couple decides to move forward with IVF, the obstetrician/gynaecologist will refer them to a reproductive endocrinologist. During their initial meeting with the doctor, they'll discuss medical and fertility histories of both parties, to determine which treatment protocols will work best for them, as well as what they can do to improve the odds of a healthy birth.
2. Preliminary tests and talks.
The woman will undergo ultrasound and blood tests to determine the number and quality of her eggs. She will also meet with a nurse to learn how to self administer fertility drugs, a financial counselor to work out payment, and a psychologist to discuss coping with any stress that might arise.
3. Drugs to induce egg growth.
To stimulate the follicles to grow as many eggs as possible during her cycle, for about two weeks the woman will give herself one to three daily injections of fertility medications (such as GonalF, a follicle stimulating hormone, and Repronex, a luteinizing hormone) in her thigh or stomach. Either before her cycle or midway through, she'll also inject a gonadotropin releasing hormone (GnRH) drug such as Lupron, which prevents her from ovulating too early. Around day 12, she'll inject the drug human chorionic gonadotropin (hCG) to stimulate ovulation and precisely time the final burst of egg growth. During these two weeks, she'll visit the clinic about five times for blood and ultrasound tests to monitor her progress.
4. Egg harvesting.
In a carefully targeted window of time — shortly before doctors calculate that her eggs will be released through the fallopian tubes during ovulation — she'll be heavily sedated, and, using ultrasound as a guide, the doctor will pull eggs out of her ovaries with a hollow needle inserted through the wall of the vagina. In the meantime, her partner, in a nearby room, will ejaculate into a cup to obtain sperm, which the lab will then quickly process to extract the most robust ones. The sperm and eggs are then mixed together in an incubator so insemination can occur. If necessary — for instance, when sperm count is low or the sperm are having difficulty penetrating the egg — the lab embryologist might also perform intracytoplasmic sperm injection (ICSI), a procedure in which sperm are injected directly into an egg. If the woman is over 40 or a previous IVF attempt failed, he might also puncture the outer shell of a resulting embryo shortly before transferring it into the uterus so it can implant itself more easily, a process called assisted hatching.
5. Embryo transfer.
Three days after harvesting the eggs, the doctor will use a thin catheter to insert two or three embryos into the woman's uterus via the vagina. "This is a painless procedure that feels like a Pap smear", explains Mark Perloe, M.D., medical director at Georgia Reproductive Specialists in Atlanta. If genetic diseases are a concern, this step might occur on day five, after lab biopsies have been performed to select the healthiest embryos.
6. The outcome.
The partner (or a friend or a family member) will give her daily injections of progesterone, a hormone that aids implantation, in the buttocks. In two weeks, she'll take a pregnancy test at the clinic; someone there will call to give you the results.
IVF RISKS
Medication side effects
Many women will have some reaction to the medications used during IVF. Most of the time, the side effects are mild and may include:
- hot flushes
- feeling down or irritable
- headaches
- restlessness
- ovarian hyperstimulation syndrome
Contact the fertility clinic if you experience persistent or worrying side effects during treatment.
Multiple births
If more than one embryo is replaced in the womb as part of IVF treatment, there's an increased chance of producing twins or triplets. Having more than one baby may not seem like a bad thing, but it significantly increases the risk of complications for the woman and the babies.
Problems more commonly associated with multiple births include:
- miscarriage
- pregnancy-related high blood pressure and pre-eclampsia
- gestational diabetes
- anaemia and heavy bleeding
- needing a caesarean section
The babies are also more likely to be born prematurely and/or with a low birthweight, and are at an increased risk of developing life-threatening complications such as neonatal respiratory distress syndrome (NRDS) or long-term disabilities, such as cerebral palsy.
NICE guidelines recommend that double embryo transfers should only be considered during treatment in women aged 40-42. Younger women should only be considered for a double embryo transfer if there are no top-quality embryos to choose from.
Ovarian hyperstimulation syndrome
Ovarian hyperstimulation syndrome (OHSS) is a rare complication of IVF. It occurs in women who are very sensitive to the fertility medication taken to increase egg production. Too many eggs develop in the ovaries, which become very large and painful. OHSS generally develops in the week after egg collection. The symptoms can include:
- pain and bloating low down in the tummy
- feeling and being sick
- shortness of breath
- feeling faint
Severe cases can be dangerous. Contact your clinic as soon as possible if any of these symptoms is experienced. It may be necessary to cancel the current treatment cycle and restart with a lower dose of fertility medication.
Ectopic pregnancy
If you have IVF, you have a slightly higher risk of an ectopic pregnancy, where the embryo implants in the fallopian tubes rather than in the womb. This can cause pain in the tummy, followed by vaginal bleeding or dark vaginal discharge. If you have a positive pregnancy test after IVF, you'll have a scan at six weeks to make sure the embryo is growing properly and that your pregnancy is normal.
Tell your doctor if you experience vaginal bleeding or stomach pain after having IVF and a positive pregnancy test.
Risks for older women
IVF treatment becomes less successful with age. In addition, the risk of miscarriage and birth defects increases with the age of the woman having IVF treatment. The doctor will discuss the increased risks that come with age, and can answer any questions you may have.
Culled and edited. Images: Google
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