KOCHI: Infertility is a major problem affecting young couples, but the good news is there has been significant strides in the treatments available. Of these, the most complex and advanced treatments include assisted reproduction treatments - namely IVF and ICSI. These are usually offered when other simple treatments fail or are not possible.
How does natural pregnancy occur?
When couples try naturally, the man releases sperms (contained in semen) in the woman’s vagina during sex. The sperms then travel through the uterus to reach the tubes, where it meets the egg to create a pregnancy (fertilisation). This pregnancy passes to the uterus where it attaches (implants) and grows. If all goes well, a child is born approximately nine months later.
What is IVF?
In vitro fertilisation (IVF) involves treatment where a man’s sperms and a woman’s eggs are mixed in the laboratory to create embryos (early pregnancies). These embryos are then transferred back into the woman’s uterus to help her get pregnant.
What is ICSI?
Intra cytoplasmic sperm injection (ICSI) is a technique where the sperm is injected directly into the egg as part of IVF treatment. ICSI is indicated in couples when the man’s sperm count is very low or there have been previous problems with fertilisation.
What does the treatment involve?
The woman is administered medications to stimulate the ovaries to produce multiple eggs. This process takes between 10-14 days. Prior to this, your doctor might give you medications to suppress the ovaries. You would need regular scans and blood tests to monitor your response to treatment.
Once these tests show an appropriate response, a ‘trigger’ injection is given which helps the eggs to mature before they are collected. The eggs are collected under a light anaesthetic, by passing a needle through the vagina under ultrasound guidance. The mature eggs are then fertilized by sperms by IVF or ICSI by the embryologist to create embryos. These embryos are transferred between 2 to 6 days after egg collection into the woman’s uterus by using a fine plastic tube (catheter). This procedure is usually painless. Any spare embryos left over from the treatment can be frozen and used in the future.
Medicines to ‘support’ the pregnancy are given for two weeks after the embryo transfer. A blood test is then performed to check for pregnancy. If you are pregnant, an ultrasound scan will be arranged to check the pregnancy.
What are the success rates after IVF?
Pregnancy rates depend on many factors, the most important being age. The chance of becoming pregnant is different from the live birth rate - which is the chance of you having a child after treatment. International data show that the live birth rate for each IVF cycle started is approximately 35-40 % for women under age 35; 25 % for women ages 35 to 37; 15 % to 20% for women ages 38 to 40; and 6 to 10% for women over 40.
What are the risks of IVF?
The most common risk of IVF is multiple pregnancies. Carrying twins /triplets can lead to more problems during pregnancy. This risk can be minimized by transferring optimal number of embryos.
Ovarian hyperstimulation can occur if the ovaries produce too many eggs. The ovaries become large in size and there may be accumulation of fluid inside the abdomen. Women with moderate to severe hyperstimulation may need hospitalization.The risk of birth defects is similar to those pregnancies conceived naturally. It might be higher in older women, in men with low or absent sperms or if there is a genetic problem in the family.
Dr Aby K Koshy, MS, DNB, MRCOG (UK),
Fellow - Reproductive Medicine (London) is a consultant gynaecologist Specialist in Reproductive Medicine Sunrise Hospital, Kochi