We have the privilege to accord fertility treatment to infertile couples from every state of India and from 60 countries around the world. Our associate IVF Centre has most recently been awarded the ‘Most Integrated IVF Team’ and the ‘Best IVF Clinic in India’. While there are many causes on infertility, the great news is that there are also many different treatment options available. At our partner IVF centre which is considered #1 in Mumbai and in India, we offer a comprehensive range of services to help couples overcome fertility and to fulfil their dream of parenthood.
Whether IVF – In Vitro Fertilization, ICSI – Intra Cytoplasmic Sperm Injection, LAH – Laser Assisted Hatching, Embryo Cryopreservation, Oocyte freezing and CAT – Cumulus Aided Transfer- a technique pioneered by our associated hospital for the first time in the world, we offer the best of medical expertise and quality of service to our patients, while maintaining the strictest confidentiality. Our multi-disciplinary team of Fertility experts are renowned for their dedication, expertise, empathy and a holistic approach to creating happy, healthy families.
What is In Vitro Fertilization (IVF)?
In vitro has its origin in Latin and means “in glass”. In medical terms, IVF involves the fertilization or fusion of male and female gametes outside the human body, in a laboratory capsule. Due to the nature of the process, the term “test tube baby” is used in common parlance to refer to the procedure.
IVF can be performed in two ways: autonomous cycle and donor cycle. In the autonomic cycle, the eggs and sperm of the female and male partner are collected respectively. The donation cycle involves using a donor’s egg or sperm or both; sometimes donor embryos can also be used in an IVF cycle. The female egg and the male egg are then fertilized under controlled, sterile laboratory conditions to give rise to an embryo. The embryo can develop to the blastocyst stage before being transferred to the partner’s or surrogate’s uterus. A beta-human chorionic gonadotropin (beta-hCG) test is then performed two weeks later to determine if implantation has occurred.
Why Is In Vitro Fertilization Performed?
IVF treatment is necessary in cases where patients have primary infertility, meaning the inability to conceive naturally, or secondary infertility, meaning the inability to have children after conceiving naturally in the past. It may be due to underlying conditions in the female or male partner or both. Some conditions for which IVF is recommended are as follows:
The fallopian tube is where fertilization takes place in the female anatomy. Damage or blockage here would mean that the mature egg cannot continue its journey through the fallopian tube and the fertilized product, the embryo, into the uterus.
Ovulation is the phenomenon by which a mature egg leaves the ovary, ready to be fertilized by a sperm. Ovulation-related disorders would mean the absence of an egg during the fertile period, so embryos are not formed naturally. This is one reason for infertility.
Endometriosis is the condition in which the endometrium, the tissue that lines the uterus, grows outside the uterus. This has been found in 10-15% of women of reproductive age and affects various fertility parameters, such as fewer viable eggs (low ovarian reserve), poor egg and embryo quality, as well as implantation barriers.
These are non-cancerous tumors that grow in the uterus of women of childbearing age. They can be found in various sizes and in different parts of the uterus. Higher levels of the hormones estrogen and progesterone can cause these growths. They increase the risk of pregnancy loss and contribute to infertility in women.
Poor egg quality may be the result of low ovarian reserve. After fertilization in the fallopian tube, the embryo moves downward and implants itself in the wall of the uterus. When the egg is of poor quality, genetically or not, implantation does not take place since the quality of the embryo is also compromised. This embryo with chromosomal abnormalities is discarded by the body and can cause a miscarriage. Poor egg quality is one of the main causes of infertility in women over 35 years of age.
The reproductive window in women extends from the duration of menarche (the onset of menstruation) to menopause (the cessation of menstruation). As we get older, and especially after the age of 35, fertility decreases significantly. This is because the quality and quantity of eggs contained in the ovaries decreases. Once you reach the age of 40, your ovarian reserve drops significantly and your chances of miscarriage increase. Since IVF treatment ensures that only genetically healthy embryos are used, health risks due to pregnancy at late maternal age can be avoided.
Sperm is the male gamete and a deterioration in its quality and/or a decrease in its quantity causes infertility in men. If the number of spermatozoa is lower or their functionality is not optimal, fertilization cannot take place and therefore it is a reason for infertility in men.
The cervix is the tunnel-like part of the female genitalia that connects the vagina and uterus. If the cervical mucus is abnormal, it can hinder sperm motility or even lead to sperm destruction. Therefore, fertilization would not occur and would indicate infertility.
In the event that one or both partners have genetic disorders that can be inherited by their offspring, an IVF cycle can establish checks to ensure that a genetically robust embryo is implanted. This can be done through tests such as preimplantation genetic testing and more advanced non-invasive preimplantation genetic testing that examines the chromosome content of the embryo. Subsequently, only embryos that do not have any abnormal genetic content are implanted, thus avoiding transmitting hereditary diseases to the baby.
In some cases, the exact cause of infertility is not easily determined. Such cases can be treated with the IVF technique as a deep dive into the health of the patients is done, the existing conditions are treated and then the rest of the procedure follows.
In Vitro Fertilization Procedure
Understanding the IVF procedure step by step is essential to align expectations with those of the success of the technique.
The first step is to see a fertility/IVF specialist to discuss your medical history. IVF does not guarantee 100% success and therefore it is imperative to understand the risks and side effects of the procedure.
This is followed by blood tests and scans where various parameters are checked, such as hormone levels in women, and an ultrasound is performed to determine ovarian reserve. These are also done to check for any pre-existing conditions such as diabetes or high blood pressure in the partner.
After the results are published, a follow-up consultation with Indira’s IVF specialist takes place. The treatment plan is discussed, the patient’s consent is taken, further screening tests are performed, and the patient is prescribed medication and injections for the next steps.
Semen analysis is performed on the semen sample from the male partner to check the number, morphology, and motility of the sperm.
After the basic scan, an injection of hormones is given to stimulate the ovaries to produce more eggs.
Regular monitoring is done through scans and blood tests to observe the response to medications.
Once hormone levels are at optimal levels, a booster injection is given to mature the eggs.
Egg retrieval or egg retrieval is done to collect eggs through a needle that is passed through the vagina; the patient is sedated for this procedure. A collection of sperm samples is performed the day the egg retrieval is performed.
For fertilization, eggs and sperm are placed in an incubator. Indira IVF embryologists monitor the further development of the embryo.
The healthiest embryos are placed in the uterus.
The Do's and Don'ts of In Vitro Fertilization
To Do
- Prioritize your health. Before you can work on having a healthy baby, it’s essential that you be fit, both physically and mentally.
- Manage stress and face any challenges you may encounter by seeking support.
- Stay physically active with moderate exercise.
- Get 8 hours of sleep each night.
- Monitor your nutrition: A balanced diet is key, as is keeping track of your vitamins.
- Pay attention to the advice of your IVF specialist.
- Take one step at a time and be positive.
What Not To Do
- Avoid drinking alcohol and smoking.
- Reduce caffeine intake.
Intracytoplasmic Sperm Injection (ICSI)
In males, sperm is produced in the testicles. It makes its way through the reproductive system and combines with fluid in the seminal duct. Semen and this fluid combine to form semen, which is the thick white ejaculation that comes out of the penis. When there is severe male factor infertility, such as: very low sperm count (also known as oligospermia), abnormally shaped sperm (also known as teratozoospermia), poor sperm motility (also known as asthenozoospermia); ICSI is performed.
In this process, the female’s egg is placed in a culture dish with numerous sperm from the male, and fertilization occurs when a sperm spontaneously enters the egg during traditional in vitro fertilization. ICSI is a safe and successful method for couples with male factor infertility and can increase the chances of fertilization for couples who have had poor fertilization in a previous IVF cycle.
Laser Assisted Hatching (LAH)
If you have undergone IVF treatment, you probably know that a fertilized egg does not guarantee a pregnancy. When the embryo is transferred to a woman’s uterus, it must implant itself in the wall of the uterus to achieve a successful pregnancy. Sometimes the embryo does not hatch and implant, leading to IVF failure.
If you are experiencing IVF failure due to unexplained reasons or poor prognosis with IVF treatment, you will be referred for laser assisted hatching. The goal of LAH is to overcome all odds that prevent a successful implantation or pregnancy.
During the IVF procedure, the fertilized eggs are stored in the laboratory for 2 to 5 days, allowing them to divide and develop into an embryo. A healthy embryo is then placed in a woman’s uterus to achieve a pregnancy.
During this development process, the embryo is surrounded by a protective layer called the zona pellucida. For implantation to take place, this protective layer breaks down naturally. But in some cases, the outer shell of the embryo becomes hard, making it difficult for it to hatch and implant. It becomes one of the reasons for infertility in women.
In laser-assisted hatching, a small slit is created before the embryo is inserted into the uterus in the hope that this hatching will aid in embryo implantation. This procedure aids in successful implantation leading to pregnancy.
FAQs on Infertility & IVF Treatment, Assisted Reproduction & Genetics
In vitro fertilization or IVF is a procedure in assisted reproductive technology. The eggs and sperm are fertilized in the laboratory and the developed embryo is implanted in the uterus for pregnancy.
For most patients, IVF is not painful. However, due to drug use and hormone injections, some patients may experience mild side effects. This can include cramping and bloating. Interventional processes such as egg retrieval and embryo transfer are performed with the help of anesthesia so that there is no pain.
Certain parameters must be taken into account to determine this, including the age of the female partner, existing health conditions, the result in previous IVF cycles, and even any financial implications this may have. It is suggested to do IVF 3-4 times as the above circumstances are under control.
If a patient is going to undergo a new cycle of ovarian stimulation, a minimum interval of two months is suggested. In case the patient uses stored frozen eggs/embryos from a previous cycle, an interval of one month is fine.
The duration from the first consultation to the administration of the medications can be from one week to 10 days. Subsequently, the treatment continues for two weeks until the eggs are retrieved. Embryos can develop to the blastocyst stage. The uterus is then the site of the implant.
While there is no statistically significant evidence for the same, associated procedures such as pre-implantation genetic testing ensure that only genetically robust embryos are used for implantation.
In some IVF cycles, more than one embryo can be transferred inside the uterus to increase the chances of pregnancy. If multiple embryos implant and develop, this leads to a multifetal pregnancy. However, research has found that when three embryos are transferred, only one child is born 75% of the time, while the incidence of twins and triplets is 20% and 5%, respectively.
The fundamental distinction between IVF and ICSI is the process by which the sperm fertilizes the egg. The egg and sperm (of which there are many) are left in a petri dish to fertilize during IVF. A sperm is directly inserted into the egg during ICSI.
ICSI is an in vitro fertilization used mainly for the treatment of severe cases of male factor infertility. ICSI consists of injecting a single sperm directly into a mature egg.
The inability of the sperm to activate the oocyte is the most common reason for failed fertilization after ICSI with round head sperm. Fertilization failure may also be caused by arrested nuclear decondensation and/or premature chromosome condensation in some types of globozoospermia.
Laser-assisted hatching requires less manipulation of the embryo than other methods, is faster than other methods, and as a result, the embryo spends less time outside the incubator. Obviously, this technique is only practiced on embryos destined for transfer.
- In elderly women with high FSH levels on day 3.
- If the embryos obtained are of poor quality (excessive fragmentation or slow cell division rate)
- Embryos that have a thick outer shell (the zona pellucida is swollen). • After several IVF failures.
Some published studies have shown that pregnancy rates for IVF procedures with assisted hatching are higher than for IVF procedures without assisted hatching. However, there are no formal studies demonstrating a benefit for the routine use of this process.
The purpose of hatching is to help the embryo shed its surrounding envelope to facilitate implantation. It can increase pregnancy rates, but it is not necessary in all cases. However, a doctor may recommend LAH, if multiple IVF cycles fail.
The most significant distinction between egg freezing and embryo freezing is that embryo freezing requires the use of sperm, while egg freezing does not. A woman’s eggs are retrieved and then stored for future use in egg freezing.
The developing baby inside the womb is called an embryo or fetus (womb). Gestational age is used to distinguish between an embryo and a fetus. An embryo is a stage of human development during which vital body structures, such as organs, are produced.
Frozen embryos are stored and maintained in hospital laboratories or in vitro fertilization centers. They can be safely stored for at least ten years, if not more.
The success of the egg freezing process depends on multiple factors since it is a complex process. As technology advances and the process improves over the years, varying success rates have been observed. Freezing your eggs at an early age and choosing Clinique also play a part in the success rate of egg freezing.
IVF is a very safe process aside from some side effects that some may experience due to certain medications or treatment processes. But they all slowly fade after the process is finished.
It is always recommended to freeze the eggs at a young age so that both the quality and quantity of the eggs are adequate enough to increase the success rate each time you fertilize.
Blood tests are performed to check a number of parameters on both partners. These include:
Feminine
- Hemoglobin
- Blood sugar
- Thyroid (T3, T4, TSH)
Male
- Blood sugar
- Thyroid (T3, T4, TSH)
In addition, an ultrasound is performed on the female partner to check the ovaries and egg supply. The sperm of the male partner is evaluated to verify the genetics, morphology and motility of the sperm.
The standard egg storage period is a maximum of 10 years, although it may vary in different cases. Your doctor/clinic will advise you best as it depends on multiple factors. It’s important to understand that currently, if you keep eggs for social reasons, they can only stay in storage for up to 10 years. Also, if you are going to store eggs for a longer period, you must inform the clinic of any changes in your address that you may have undergone.
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