In Vitro Fertilization/ Intracytoplasmic Sperm Injection (IVF/ICSI)
What is IVF (In vitro Fertilization) ?
In Vitro Fertilization is process in which male and female gametes are fertilized outside the body and once the embryo is formed it is then transferred in to the uterine cavity.
Fertilization of sperm and egg can be done in two ways :
Conventional IVF : The egg and sperms are incubated in a petri dish and fertilization checked after 22-24 hours. Advantage of this method is that sperm is selected naturally. Disadvantage, if semen parameter is poor, especially functional defects, there are high chances of fertilization failure.
Intracytoplasmic Sperm Injection (ICSI)
Is a specialised form of In Vitro Fertilisation (IVF) that is used for the treatment of severe cases of male-factor infertility. Intra-cytoplasmic sperm injection (ICSI) differs from conventional in vitro fertilisation (IVF) in that the embryologist selects a single sperm to be injected directly into an egg, instead of fertilisation taking place in a dish where many sperm are placed near an egg.
ICSI is commonly recommended if:
There is very low sperm count
Sperm abnormalities have been identified, such as poor morphology (abnormal shape) or poor motility (not moving normally)
Failure of fertilisation or an unexpectedly low fertilisation rate in previous IVF cycle.
Surgically collected from the testicles or epididymis
Frozen sperm are used in the treatment which is not of optimum quality More Sperm reach the Oocyte and improves chances of Fertilization
When does one have to proceed for IVF/ ICSI (Intracytoplasmic sperm injection) as a means to achieve a pregnancy?
Most common conditions where IVF is recommended are as follows:
- Tubal Factor : Patients with one or both tubes blocked are unable to conceive in view of failure of the gametes to meet. IVF/ICSI becomes the ideal management for them with a good success rate.
- Male Factor : Patients with low sperm count/Azoospermia, where other treatments options do not work or fail, IVF gives them a good chance to have their own baby
- Failed IUI treatments: Patients who have undergone multiple cycles of IUI where wife has developed follicle and ovulation is documented with reasonable good semen parameters may proceed to IVF.
- Endometriosis
- Advanced age
- Poor Ovarian Reserve
- Premature ovarian failure
What happens during an IVF cycle
The first part of IVF deals with helping the woman develop follicles resulting in matured eggs.
For this you are called during periods , a baseline ultrasound done following which hormone injections are given on a daily basis for growth of follicles. Frequent monitoring with ultrasound is done to assess response. Minimum of 4-5 ultrasound are done during this period.
Once follicles reach of appropriate size, trigger injection is decided. 36hours following this injection, oocyte retrieval is performed.
On the day of oocyte retrieval, the partner is asked to give his semen sample. The semen sample is washed and sperms of good quality separated.
During oocyte retrieval, woman is anaesthetized or put to sleep. Through the vagina a needle is inserted and the follicular fluid is aspirated. This follicular fluid is scanned or searched for eggs in the lab.
IVF/ICSI is performed on the mature oocyte retrieved.
On Day 1, oocyte is checked for fertilization or the 2PN stage.
Now, the resultant embryo starts dividing into 2 cell stage to 4 cell staged to 8 cell stage.
On day 3 embryos are rechecked, to understand the total number and their quality. This is the stage where the doctor in consultation with you decides about fresh embryo transfer, freezing or culturing further up to day 5 (blastocyst stage)
Luteal Phase support is started post Embryo Transfer for 14 days
Blood test for pregnancy (Beta HCG ) is done 14 days after transfer of Embryo