Dr Bhavna Banga

In Vitro Fertilization is the most popular Artificial Reproductive Technique which is recommended and carried out globally. In this process, eggs are fertilized using sperm of partner or donor and then the embryo is injected in the wall of uterus for further development under ultrasound guidance.

  • Blocked fallopian tube.
  • Multiple failed IUI cycles (Six).
  • Unexplained infertility.
  • Poor Ovarian reserve.
  • Severe Male Factor (needs advanced treatment like ICSI).
  • Poor Fertilization in the previous cycle.

In a natural cycle, the process of fertilization (union betw egg & sperm) occurs in to the fallopian tubes.

After fertilization, the resultant embryo grows in to the fallopian tubes for 5 days and during this period the internal linning of cells of the tube, provide nutrition to this microscopic growing embryo, which is latter propelled towards the uterus by the wave like movements of the Fallopian tubes.

For the process of successful fertilization to occur, the fallopian tubes should be patent as well as functionally healthy, so as to provide nourishment to the growing embryo as well as to propel, it towards the uterus timely and also the biochemical changes which occur after the union of egg & sperm should be optimal and last but most important the sperm count and motility should be optimum.
In cases when the fallopian tubes are blocked ( due to infections, surgical etc) or the tubes are patent but functionally unhealthy, this process is carried out artificially in to an Embryolgy laboratory, and the resultant embryo is transferred back in to the uterus.

Thus IVF procedure, by passess the fallopian tube functioning and it mimics the natural fertilization process outside the body.

In Vitro Fertilization, a highly successful Artificial Reproductive Technique that closely mimics the natural fertilization and reproduction process in human. Some of the major steps followed for an IVF process include the following:

  • Patient Selection.
  • Controlled Ovaraian Hyperstimulation (COH) by using injectable hormones daily for 10 to 12 days for multifollicular growdth (8-12).
  • Egg collection under short acting general anaethesia, as a day care procedure.
  • Fertilization in the Embroyology lab.
  • Embryo transfer under ultrasound guidance with or without anaethesia.

The incidence of complication is minimized, due to the individualization of protocols, use of ultrasound machine for egg collection as well as embryo transfer and careful selection of the no. of embryos transfered.
However there can still be the foll complications.

  • Injury to bowel, urinary bladder blood vessels, uterus.
  • Haemorrhage (bleeding).
  • Multifetal pregnancy.
  • Ovarian hyperstimulation syndrome (OHSS).
  • Ectopic Pregnancy.

In Vitro Fertilization is considered a highly successful process of artificial reproduction.However, the success of the process depends upon a lot many things. Age of female partner is an important factor determining the success of IVF. Further, it is a lengthy process and everything during the complete process requires to be carried out with precision, failure to do so, can cause IVF failure. But, when the same procedure is carried out by and under guidance of fertility treatment expert with years of field experience, then success rate mounts as high as 30-50% in cases of couple who are not above 38-30 years old. Nonetheless, even at a success rate of 30-50%, In Vitro Fertilization happens to be most successful process and has changed lives of millions by helping them achieve parenthood.

  • What is the difference between IVF & ICSI ?Basically both are forms of invitrofertilization, differing in only the method of fertilization in the the embryology lab.Mainly in IVF, the sperms and the egg are allowed to fertilize in a small petridish and this method is very similar to natural form of fertilization. IVF is mainly indicated when sperm parameters are normal.ICSI, is the form of Fertilization, mainly for Male Factor fertility, where each egg is injected with the help of a fine needle with the sperm.

    Indicated when the sperms parameters are deranged in count, motility, morphology.

  • How many times one can try IVF?There are many parameters which decide this, like the age of the female partner, clinical profile of the patient, previous response to IVF cycle, financial implications.In most of the cases 3-4 attempts can be attempted, if all the parameters are in range as mentioned above.
  • Is IVF harmful ?Basically any surgical procedure has its inherited risk, but overall the rate of surgical complication during egg collection is minimal, as it is done ultaraound guided.
    As far as the egg making injections are concerned, they are excreated daily in urine and stools, provided the renal and kidney parameters, are normal.

As far as the OHSS is considered, the incidence of severe form is only 1-2%, which req hospitalization. The mild and moderate cases can be handled on OPD basis.

  • Are the incidence, of multifetal preg high ?
    On an average the twin preg rate is 20%, triplet is 5%, and singleton is 75%, when day 3 embryos (3), are transferred.
  • Is the incidence of birth defects high ?
    Till date millions of baby have been born across the globe, through this technology and the evidence is backing that there is no statically significant increase in the incidence of the the defects.
  • How much gap one must give betw 2 unsucessful cycles ?
    In case of fresh cycles, at least 2 months and in case of frozen cycle, 1 month.
  • It is said that the sucess is difficult in the first attempt ! Is it true ?
    The overall pregnancy rate is 30-50%, across the globe, which means around 30 -50 pts per 100 get pregnant in the first attempt.
  • Is complete bed rest adviced after embryotransfer ?
    The recent evidence is not backing this, however we advice rest for 2-3 days after which they can carry their routine non strenous activity.
  • How much of rest is required immediately post transfer, before one leaves the hospital ?
    Usually 10-15 mins.
  • When does the treatment start and how long does it take ?
    There are 2 commonly used protocols, long and the short (antagonist). The short protocols start within first 3 days of the menses and the conventional long protocol starts on day 21 of the previous cycle.
  • Which protocol is better ?
    Depending on the clinical case, short protocol is preferred in donar cycle, and PCOS.
  • Can embryo transfer be done under anathesia ?
    Yes, we do have the provision to be done under anethesia.
  • Does one need to take many injections even post transfer ?
    This depends on clinic to clinic, in our clinic, we do not routinely encourage injections, except in selected cases.
  • How many times I need to visit the hospital for ultrasounds ?
    On an average 4 times.