The prevalence of Infertility in today’s scenario?
- Generally, worldwide it is estimated that one in seven couples have problems conceiving, with the incidence similar in most countries independent of the level of the country’s development.
- Women become less fertile as they get older. For women aged 35, about 94 out of every 100 who have regular unprotected sexual intercourse will get pregnant after 3 years of trying. For women aged 38, however, only 77 out of every 100 will do so. The effect of age upon men’s fertility is less clear.
- The incidence of infertility in men and women is almost identical. Infertility is exclusively a female problem in 30-40% of the cases and exclusively a male problem in 30-40% of the cases. Problems common to both partners are diagnosed in 10-15% of infertile couples. After thorough medical investigations, the causes of the fertility problem remain unexplained in only a minority of infertile couples (5-10%). This is called unexplained infertility.
What are the chances of success rates of IVF?
• Bilateral Tubal
• age of the partners
• reason for infertility
• type of ART
• if the egg is fresh or frozen
• if the embryo is fresh or frozen
• For women younger than 35, the percentage of live births per cycle is 39.6%.
• For women ages 35 to 37, the percentage of live births per cycle is 30.5%.
• For women ages 38 to 40, the percentage of live births per cycle is 20.9%.
• For women ages 41 to 42, the percentage of live births per cycle is 11.5%.
• For women ages 43, the percentage of live births per cycle is 6.2%.
• After age 44, little more than 1% of IVF cycles with non-donor eggs lead to live birth.
As you can see, IVF success goes down significantly after age 40. For this reason, most women 40 yrs and above use donor eggs. Success rates when using donor eggs are not as dependent on the woman’s age.
The percentage of live births per cycle when using donor eggs is 55.1% with fresh embryos. It’s interesting to note that IVF success rates with donor eggs are even higher than a woman younger than 35 using her own eggs. Donor eggs offer the best chance for success.
The average IVF cost is 1.3 lakhs, but it can be as much as 1.75lakhs. It may be as low as 1 Lakh, but it’s rarely lower than that. These prices are for one cycle of IVF.
What are the complications of IVF treatment?
Complications are very rare in IVF treatment other than the few listed below:
Ovarian hyperstimulation syndrome can only occur once ovulation takes place. If your doctor suspects that you’re at risk, he may cancel your treatment cycle. (Any fertilized embryos from an IVF treatment cycle may be frozen and saved for use during a future cycle.) Or your doctor may use medications to delay ovulation by a few days. She may prescribe a GnRH antagonist, which will prevent the body’s natural LH surge, preventing or delaying ovulation.
Another option may be that your doctor may simply delay administering the hCG trigger shot, a fertility drug that triggers ovulation. Delaying ovulation to lessen the risk of ovarian hyperstimulation syndrome is sometimes referred to as “coasting.” This delay of a few days can lower the risk and severity of ovarian hyperstimulation syndrome, without seriously decreasing your chances of successful pregnancy.
Symptoms of Ovarian Hyperstimulation Syndrome
As noted above, ovarian hyperstimulation syndrome can only occur after ovulation has taken place. Symptoms may occur a few days after ovulation or IVF egg retrieval or they may not show up for a week or more after ovulation.
Mild symptoms include:
Mild pain or discomfort in the abdomen
Mild weight gain
More serious symptoms include:
Rapid weight gain, more than 10 pounds in 3 to 5 days.
Mild pain or discomfort in the abdomen
Severe abdominal pain
Severe nausea (so much that you can’t keep down any food or fluids)
Trouble with urinating
Shortness of breath
If you experience mild symptoms, you should contact your doctor as soon as possible, so he or she can monitor the situation. If you experience any of the serious symptoms, contact your doctor immediately.
Prevention and Treatment of Ovarian Hyperstimulation Syndrome While you take fertility drugs, your doctor should monitor your body’s response to the medications with blood tests and ultrasounds. Rapidly increasing estrogen levels or ultrasounds that show a large number of medium-size follicles, are all possible indicators of ovarian hyperstimulation syndrome risk.
If you develop a mild case of ovarian hyperstimulation syndrome, you probably won’t need special treatment.
Here are some things you can do at home to feel better:
Don’t overexert yourself; take it easy while you recover
While you shouldn’t overexert yourself, you should maintain some light activity. Total bed rest can increase the risk of some complications
Put your feet up. This can help your body get rid of the extra fluid
Sex should be avoided until you feel better. Sexual activity may increase your discomfort, and in the worst case scenarios, may cause ovarian cysts to leak or rupture.
Do drink plenty of fluids, around 10 to 12 glasses a day.
Your doctor will give you instructions on what to watch for and when to contact him. If your symptoms get worse, you should definitely let them know. She may ask you to weigh yourself daily, to monitor weight gain. If you find yourself gaining 4 or more Kg per day, you should call your doctor.
In rare cases, you may need to be hospitalized. Hospitalization may include receiving fluids intravenously (through an IV), and they may remove some of the excess fluids in your belly via a needle. You may also be kept in the hospital for careful monitoring until your symptoms lessen.
Usually, symptoms will decrease and go away once you get your period. If you get pregnant, though, your symptoms may be prolonged, and it may take several weeks to feel completely better. Pregnancy can also make the symptoms worse, so your doctor will want to monitor your situation carefully.
Who is my egg donor?
Do I have to get any tests/blood work done by my gynecologist before we start the procedure?
We need the results of the following simple medical tests before starting an IVF cycle.
- Semen analysis for your husband to check his sperm count and motility.
- Blood tests for you for the following reproductive hormones – FSH (Follicle-Stimulating Hormone), LH (Luteinising Hormone), PRL (Prolactin) and TSH (Thyroid Stimulating Hormone) on Day 3 of your cycle to check the quality of your eggs.
What are the common causes for Infertility?
1. Ovulation problems
2. tubal age
3. male associated infertility
4. age-related factors
5. uterine problems
6. previous tubal ligation
7. previous vasectomy
8. unexplained infertility
What are the steps of IVF treatment?
You may be wondering how everything will come together. While every clinic’s protocol will be slightly different and treatments are adjusted for a couple’s individual needs, here is a step-by-step breakdown of what generally takes place during an IVF treatment cycle.
Step 1 : The Cycle before treatment
The cycle before your IVF treatment is scheduled, you may be put on birth control pills or may then have you start taking a GnRH antagonist or a GnRH agonist, such as Lupride. This is so they can have complete control over ovulation once your treatment cycle begins.
Step 2 : When you get your periods
The first official day of your treatment cycle is the day you get your period. (Even though it may feel like you’ve already begun with the medications you’ve started before in step one.) On the second day of your period, your doctor will likely order blood work and an ultrasound. (Yes, an ultrasound during your period isn’t exactly pleasant, but what can you do?) This is referred to as your baseline blood work and your baseline ultrasound.
In your blood work, your doctor will be looking at your estrogen levels, specifically your E2 or estradiol. This is to make sure your ovaries are “sleeping,” the intended effect of the Lupride shots or GnRH antagonist.
The ultrasound is to check the size of your ovaries, and look for ovarian cysts. If there are cysts, your doctor will decide how to deal with them. Sometimes your doctor will just delay treatment for a week, as most cysts will resolve on their own with time. In other cases, your doctor may aspirate, or suck, the cyst with a needle.
Usually, these tests will be fine. If everything looks OK, treatment moves on to the next step.
If your blood work and ultrasounds look normal, the next step is ovarian stimulation with fertility drugs. Depending on your treatment protocol, this may mean anywhere from one to four shots every day, for about a week to 10 days. (Ouch.)
You’ll probably be a pro at self-injection by now, as Lupride and other GnRH agonists are also injectables. Your clinic should teach you how to give yourself the injections, of course, before or when your treatment begins. Some clinics offer classes with tips and instruction. Don’t worry, they won’t just hand you the syringe and hope for the best.
During ovarian stimulation, your doctor will monitor the growth and development of the follicles. At first, this may include blood work every few days, to monitor your estradiol levels, and ultrasounds, to monitor the oocyte growth. Monitoring the cycle is important, as it helps your doctor decide whether or not the medications need to be increased or decreased in dosage.
Once your largest follicle is 16 to 18mm in size, your clinic will probably want to see you daily.
The next step in your IVF treatment is triggering the oocytes to go through the last stage of maturation, before they can be retrieved. This last growth is triggered with human chorionic gonadotropin (hCG).
Timing this shot is vital. If it’s given too early, the eggs will not have matured enough. If given too late, the eggs may be “too old” and won’t fertilize properly. The daily ultrasounds at the end of the last step are meant to time this trigger shot just right. Usually, the hCG injection is given when two or more follicles have grown to be 18 to 20mm in size and your estradiol levels are greater than 2,000pg/ML. This shot is typically a one-time injection (yeah!). The timing of the shot will be based both on your ultrasounds and blood work and when your clinic schedules your retrieval.
If not enough follicles grow or if you’re at risk for severe ovarian hyperstimulation syndrome, your treatment cycle may be canceled and the hCG shot will not be given. If treatment is canceled because your ovaries didn’t respond well to the medications, your doctor may recommend different medications to be tried on the next cycle. While not common, a cycle may also be canceled if ovulation occurs before retrieval can take place. Once the eggs ovulate on their own, they can’t be retrieved.
Cancellation happens in 10 to 20% of IVF treatment cycles. The chance of cancellation rises with age, with those older than age 35 more likely to experience treatment cancellation.
About 34 to 36 hours after you receive the hCG shot, the egg retrieval will take place. It’s normal to be nervous about the procedure, but most women go through it without much trouble or pain.
Before the retrieval, an anesthesiologist will give you some medication intravenously to help you feel relaxed and pain free. Short general anesthesia, is generally used at our clinic during pick up. Side effects and complications are less common.
Once the medications take their effect, your doctor will use a transvaginal ultrasound to guide a needle through the back wall of your vagina, up to your ovaries. She will then use the needle to aspirate the follicle, or gently suck the fluid and oocyte from the follicle in to the needle. There is one oocyte per follicle. These oocytes will be transferred to the embryology lab for fertilization.
The number of oocytes retrieved varies but can usually be estimated before retrieval via ultrasound. The average number of oocytes is 8 to 15, with more than 95% of patients having at least one oocyte retrieved.
After the retrieval procedure, you’ll be kept for a few hours to make sure all is well. Light spotting is common, as well as lower abdominal cramping, but most feel better in a day or so after the procedure. You’ll also be told to watch for signs of ovarian hyperstimulation syndrome, a side effect from fertility drug use during IVF treatment in 10% of patients.
While you’re at home recovering from the retrieval, the follicles that were aspirated will be searched for oocytes, or eggs. Not every follicle will contain an oocyte.
Once the oocytes are found, they’ll be evaluated by the embryologist. If the eggs are overly mature, fertilization may not be successful. If they are not mature enough, the embryology lab may be able to stimulate them to maturity in the lab.
Fertilization of the oocytes must happen with 12 to 24 hours. Your partner will likely provide a semen sample the same morning you have the retrieval. The stress of the day can make it difficult for some, and so just in case, your partner may provide a semen sample for backup earlier in the cycle, which can be frozen until the day of the retrieval.
Once the semen sample is ready, it’ll be put through a special washing process, which separates the sperm from the other stuff that is found in semen. The embryologist will choose the “best looking sperm,” placing about 10,000 sperm in each culture dish with an oocyte. The culture dishes are kept in a special incubator, and after 12 to 24 hours, they are inspected for signs of fertilization.
With the exception of severe male infertility, 70% of the oocytes will become fertilized. In the case of severe male infertility, ICSI (pronounced ick-see) may be used to fertilize the eggs, instead of simply placing them in a culture dish. With ICSI, the embryologist will choose a healthy-looking sperm and inseminate the oocyte with the sperm using a special thin needle.
Step 7 : Embryo Transfer
About two to three days after the retrieval, the fertilized eggs will be transferred. The procedure for embryo transfer is just like IUI treatment. You won’t need anesthesia.
During the embryo transfer, a thin tube, or catheter, will be passed through your cervix. You may experience very light cramping but nothing more than that. Through the catheter, they will transfer the embryos, along with a small amount of fluid.
The number of embryos transferred will depend on the quality of the embryos and previous discussion with your doctor. Depending on your age, anywhere from two to five embryos may be transferred..
After the transfer, you’ll stay lying down for a couple hours (bring a book) and then head home. If there are “extra” high-quality embryos left over, you may be able to freeze them. This is called “embryo cryopreservation.” They can be used later if this cycle isn’t successful, or they can be donated.
On or after the day of your retrieval, and before the embryo transfer, you’ll start giving yourself progesterone supplements. Usually, the progesterone during IVF treatment is given as an intramuscular self-injection as progesterone in oil. (More shots!) Sometimes, though, progesterone supplementation can be taken as vaginal gel or vaginal suppository.
Besides the progesterone, there really isn’t much going on for the next two weeks. In some ways, the two weeks after the transfer may be more difficult emotionally than the two weeks of treatment. During the previous steps, you will have visited your doctor perhaps every other day. Now, after transfer, there will be a sudden lull in activity.
All you can do is wait the two weeks and see if pregnancy takes place. It can help to keep busy with your life during this wait time and avoid sitting and thinking about whether or not treatment will be successful. I know, it’s much easier said than done.
About fifteen days after the embryo transfer, a pregnancy test is ordered. This is usually a serum pregnancy test (more blood work). The test may be repeated every few days.
If the test is positive (yeah!), you may need to keep taking the progesterone supplementation for another several weeks. Your doctor will also follow up with occasional blood work and ultrasounds to monitor the pregnancy and watch for miscarriages or ectopic pregnancies. During IVF treatment, miscarriage occurs up to 15% of the time in women under age 35, 25% of women age 40 and up and 35% of the time after age 42. Your doctor will also monitor whether or not the treatment led to a multiple pregnancy. If it’s a high-order pregnancy (4 or more), your doctor may discuss the option of reducing the number of fetuses in a procedure called a “multifetal pregnancy reduction.” This is sometimes done to increase the chances of having a healthy and successful pregnancy.
What to do when the treatment fails ?
Having a treatment cycle fail is never easy. It’s heartbreaking. It’s important, however, to keep in mind that having one cycle fail doesn’t mean you won’t be successful if you try again.You will have to discuss with your doctor what will be the best option