Infertility has always been a major issue for couples.
Science has however made it possible for a lot of women to be mothers thanks to IVF (In Vitro Fertilization).
In vitro fertilization (IVF) is a type of assistive reproductive technology (ART). It involves retrieving eggs from a woman’s ovaries and fertilizing them with sperm. This fertilized egg is known as an embryo. The embryo can then be frozen for storage or transferred to a woman’s uterus.
Major reasons people consider IVF is because of reduced fertility in women over the age of 40, blocked or damaged fallopian tubes, reduced ovarian function, endometriosis
uterine fibroids, male infertility such as low sperm count or abnormalities in sperm shape.
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Before IVF, you’ll have an evaluation of your uterus and fallopian tubes to make sure there are no issues that require surgical repair. Pre-cycle testing includes a hormonal evaluation to assess thyroid function and ovarian reserve, screening both partners for sexually transmitted infection and semen analysis of the male partner.
IVF usually involves the five major steps and procedures,
1. Ovarian Stimulation
This is the first step and is usually called the Stimulation phase which is used to mature multiple eggs for egg retrieval. Naturally, women produce one egg during each menstrual cycle but for IVF to work, they need to produce multiple eggs to increase the chances of developing a viable embryo.
You’ll take medication for 8-14 days to encourage the follicles in your ovaries (where the eggs live) to produce more eggs.
These fertility drugs usually contain the fertility hormone follicle-stimulating hormone (FSH). It’s usually in the form of injections, which can vary from 1-2 for the cycle or 1-2 per day. try to obtain the maximum number of eggs while protecting against development of ovarian hyper-stimulation syndrome (OHSS).
Fertility drugs for IVF are usually injected, and you’ll be frequently monitored using hormonal testing and vaginal ultrasounds for the best result. Once an ultrasound determines you have a sufficient number of large enough follicles and your estrogen level is at the right level, you’ll receive a trigger shot of hCG also known as trigger injection or other medication.
The trigger injection gets the eggs ready for ovulation – the natural process where eggs are released and you have your period. Your fertility nurse tells you exactly when to do the trigger injection. Your fertility specialist will schedule the egg retrieval before you ovulate.
2. Retrieving the eggs
The eggs are collected through a minor surgical procedure known as “follicular aspiration.” A very thin needle is inserted through your vagina and into your ovary.
Thirty-four to thirty-six hours after receiving the trigger shot – before the eggs ovulate – you’ll have a surgical procedure to remove the eggs from follicles in your ovaries.
You’ll be asleep and the procedure takes about 20-30 minutes.
For this egg retrieval procedure, an ultrasound is used to visually guide a small needle through the top of the vagina into one ovary and then the other. You shouldn’t experience any pain or discomfort during the process as you’ll be under sedation through an IV while closely monitored by an anesthesiologist.
Follicles are entered with the needle and the follicular fluid contents are removed using gentle suction that brings the egg along in the fluid; the entire process usually takes less than 30 minutes.
The fluid from the follicles – that contains the egg – is suctioned by the IVF physician through small tubing and into a test tube. The test tube is then handed to an embryologist who uses a microscope to find the egg in each test tube of follicular fluid. All the details of the eggs are carefully recorded. The average number of eggs collected is 8-15.
3. Insemination and fertilization
The eggs collected and mixed together with the male sperm and kept in an environmentally controlled chamber. After a few hours, the sperm should enter the egg.
Once eggs reach the lab, experts examine them to determine maturity and quality. Mature eggs are placed in an incubator and within a few hours of egg retrieval are fertilized with sperm.
The sperm can sometimes be directly injected into the egg. This is known as an intracytoplasmic sperm injection (ICSI). Here, one sperm is injected into the cytoplasm of the egg using a needle and a sophisticated operative microscope.
Frozen sperm that were collected through testicular biopsy, can be used because it is as effective as fresh sperm in achieving a successful pregnancy.
For the conventional method, sperm is placed in the culture medium in a small petri dish containing an egg; the sperm and eggs are incubated together in the dish in the lab, allowing the sperm to enter the egg on its own.
The scientists use powerful microscopes to find the eggs in the fluid so they can be removed.
4. Embryo Transfer
If the sperm fertilises the egg, it becomes an embryo.
Embryo transfer will take place – anywhere between 1 and 6 days but usually 3-5 days after egg retrieval. The embryos may undergo testing for genetic conditions at this time.
After receiving the genetic test results, the selected embryo(s) is chosen, thawed, and transferred into the uterus, usually within 1 to 2 months after the egg retrieval.
Your doctor will monitor the fertilized eggs to ensure that they’re dividing and developing.
More than one embryo can be placed in the womb. It is important that the doctor and the couple talk about how many embryos should be transferred. Normally, a doctor will only transfer more than one embryo if no ideal embryos are available.
If your embryo develops in the lab, you’re ready for it to be transferred into your uterus.
The embryo transfer is a very simple process, like a pap smear. It takes about 5 minutes, you’ll be awake, there’s no anaesthetic, and you can get up straight away.
Your fertility prepares your embryo by placing it in a small tube called a catheter. He then places the catheter through your cervix and into your uterus. When the embryo sticks to the lining of the womb, healthy embryo growth can begin.
5.Final test/Pregnancy Test
Approximately two weeks after your embryo transfer, you’ll have a blood test to measure your levels of the hormone hCG (human chorionic gonadotropin). hCG in your bloodstream usually means a positive pregnancy test. If a pregnancy is confirmed, you’ll be followed with blood tests and eventually, ultrasounds, to confirm viability and whether there is multiple pregnancies.
IVF is very expensive and costly. The average cost of one cycle of IVF treatment in Nigeria is between N850,000 and N900,000 excluding the cost of drugs, diagnosis and other ancillary services that might be required. The cost of IVF drugs usually ranges between N400,000 and N800,000 depending on the treatment plan.
Side Effects of In Vitro Fertilization
As with any medical procedure, there are risks associated with IVF. Complications include:
- multiple pregnancies, which increases the risk of low birth weight and premature birth
- miscarriage (pregnancy loss)
- ectopic pregnancy (when the eggs implant outside the uterus)
- ovarian hyperstimulation syndrome (OHSS), a rare condition involving an excess of fluid in the abdomen and chest
- bleeding, infection, or damage to the bowels or bladder (rare)