We perform IVF procedure under guidance of Dr. Meenakshi and her team consisting of reproductive endocrinologist, sonologist, and embryologist. Detail plans and protocols will be explained to you before undergoing this procedure.
What is IVF ?
In Vitro Fertilization, refers to the treatment in which a woman’s eggs (also called as oocytes) are mixed and fertilized with the sperm, outside the body, usually in a laboratory dish. The fertilized eggs are cultivated for a few days and then transferred into the woman’s uterus where it is hoped that they will implant and lead to pregnancy. While the process of fertilization is now a days done in the dish, the term “test tube babies” has also been used for this process.
How do we do IVF ?
Broadly, the process of IVF that we do at Delhi, starts from an adeqaute education and detail councelling. The procedure consists of several steps:
- Our team will discuss and give you hormone therapy to stimulate your ovaries to produce several eggs.
- Eggs will be retrieved
- Eggs are fertilized in “test tube” actually a dish with sperm.
- The sperm and egg together are incubated to form a resulting embryo for few days
- The embryo is then transferred to the uterus via vagina where it will implant and result in pregnancy.
What are steps of IVF
Ovulation Induction / Ovary stimulation:
As an example of hormonal therapy and steps, the following may be done, as part of IVF ovary stimulation protocol that we do at our clinics at Delhi:
- You may be given contraceptive pills before IVF, in order to time the onset of menses.
- An injectable hormone (called as GnRH agonist) may be started after giving contraceptive pill. This is given so as to prevent your body from releasing your natural hormones that may lead to premature ovulation.
- To stimulate the ovaries, we then give FSH, after properly ensuring the timing post your periods. The timing of when to start such injection is an important medical decision that you will be taking with our team.
- Your dose of FSH hormone therapy will be modulated depending on the hormonal tests and the ultrsound scan. We will monitor your response by ultrasound, in which we will check for the number and size of developing follicles. We will also be looking at your endometrial thickness.
- Dr. Sahu’s team generally will aim to have at least two follicles that are 15 to 18 mm in size, before giving you a final hCG (human chorionic gonadotropin) hormone injection. This injection leads to maturation and release to eggs, which can then be retrieved after 36 hours.
The above procedure is a generic suggestion. The exact procedure, timing of injections, will all be individualized depending on your reproductive cycle, past success or failure story in terms of previous IVF protocols if any was done for you.
Your eggs will be collected vaginaly using ultrsound guidance. You will be sedated, and an ultrasound proble will be inserted vaginally, and then under ultrasound guidance we will precisely put a needle to pick up eggs from the follicle. The entire procedure will take somewhere around 10 – 30 minutes depending on how many eggs are picked up. Fertilization outside body. Test tube fertilization. After the eggs are picked up from you, they will be combined with sperm from your partner or donor as discussed, in a laboratory dish so they will fertilize. Providing that the semen quality is good, approximately 50 % of eggs may fertilize. The confirmation of fertilization is done by observation of two pronuclei within the zygote. The individual cells of each embryo will dividie
ICSI, otherwise called as intra- Cytoplasmic Sperm Injection, may be a part of your IVF process, if there is associated male factor infertility. This is an option for those with low sperm count. In this process we inject a single sperm directly into the egg, using a specially prepared needleThe fertilized embryos are allowed to develop and embryo transfer then done as per standard IVF guidelines. We are regularly doing IVF with ICSI at Delhi, and it is Dr. Sahu’s opinion to go for ICSI if the sperm count of your partner is substantially low and especially so if there has been history of failed IVF in the past.
Embryo Transfer (ET)
The fertilized eggs are called as embryos. After approximately day 2 / day 3 from the egg pick up day, depending on how the embryos look like, these embryos will be placed inside the uterus using a catheter that goes via cervix. In most, this procedure unlike the egg pick up procedure does not require sedation. How many embryos we transfer, depends on variuos factors that include age of individual from whom egg was picked (this includes age of egg donor as well), qualities of embryo, previous IVF success or failure etc. You may be asked to take some bed rest after the process of embryo transfer.
To prepare your endometrium, so as to be receptive for embryos that were transferred is also an important part of the IVF protocol that we follow. You may be asked to adminsiter yourself progesterone hormone supplements during your IVF treatment.
Can IVF fail ? Why IVF fails in some cases ?
Our team does not reach to the desired 100 % success rate despite our best possible intentions and efforts. In some of her public lectures, as well as personalized councelling, Dr. Meenakshi T. Sahu, explains that it is important for every person involved in IVF be it patient, doctors or technicians to appreciate that this is a laboratory –cum- patient procedure, where the success and failure will depend on variety of dynamic patient – medicine – laboratory – and skill factors. In the vast majority irrespective of where you get your IVF from, every lab and IVF experts will claim that embryos are produced. But what is critical as per Dr. Sahu, is to identify and thus take some adequate steps to try ensure that the embryos attach and implant to the uterus.
IVF can fail due to:
- poor embryo quality – in turn due to decrease ability to produce good quality eggs; decrease dose of medicine or decreased response of ovary to adequately stimulate itself; or improper laboratory techniques and culture where egg is fertilized with sperm
- poor embryo transfer techniques- such as incorrect placement of embryos, or trauma to embryo during transfer
- poor reception by endometrium: If the endometrium (uterus lining) is not healthy it will not be receptive and thus embryos will not be able to plant itself – It is the most simplex logic !!
Dr. Sahu, feels that unfortunately the concept of ‘endometrial uterus health’ is ignored by many in the zeal to complete a IVF cycle. While catering to both national and international patients who come for IVF treatment at Delhi, Dr. Meenakshi Sahu has come across many patients that don’t have suitable endometrium to receive embryos, and that could have been the reason for past IVF failure.
Our team will try to understand and help identify factors in your case that influence health of endometrium. Some of the known and talked about factors are infection, tuberculosis, fibroids, myoma, anatomical irregularity with uterus etc.
Dr. Sahu also believes in identifying and taking care of many other nutritional, hormonal, metabolic factors that influence and impact overall health of endometrium.
We approach endometrial and uterine health in a holistic way !
Side Effects of IVF
Ovarian hyperstimulation syndrome (OHSS): Hyperstimulation of ovary in a severe form can rarely occur. Its may present with ovary enlargement and multiple cysts with fluid accumulation around abdominal cavity. While some form of mild stimulation to the ovary is the intent of IVF protocols and occurs in vast majority, fortunately the severe form of hyperstimulation is rare (~ 0.2 percent). Because USG monitoring is done for follicle number and size, adequate steps can be taken to prevent the rare side effect of ovary stimulation
Vaginal bleeding post IVF: This can occur in some patients. Especially since cervix is swabbed and cleaned during the procedure(s), some may complaint of passage of small amount of blood or clear fluid from the vagina shortly after any such procedure.
Hormone side effects in IVF: Because of variety of hormones are used in IVF cycles, in some they may cause general side effect symptoms such as breast engorgement, breast tenderness, feeling of bloating, crampy abdomen, constipation etc.
Multiple pregnancy: One of the undesirable effect is when all the implanted more than two embryos lead to success, thus resulting in multiple pregnancy. This side effect can be countered by single embryo transfer.
Pros and cons of therapy at each stage will be explained to you while you are undergoing IVF treatment at Delhi at our centers.
Who needs IVF InVitroFertilization ? Whom do we offer IVF ?
Dr. Meenakshi Sahu and her team, will typically offer this therapy, if they feel from their diagnostic work up, that your fallopian tubes are blocked or damaged; ovaries are not responding well naturally or to routine medication in releasing eggs; male factor infertility in terms of low sperm count, or poor quality of sperms.