Fertility Treatment (IVF)
Fertility Treatment options for couples
It can be harder than expected for a few couples to conceive. The natural doubt of being infertile creeps into the mind of these couples. The only way to really know what is keeping you from becoming pregnant is a thorough fertility evaluation.
While diagnosing infertility, the specialist looks at the reproductive health of both the male and female partner. Testing both partners is critical as the cause of infertility may be evenly divided between men and women. It is strongly advised to see a physician for an evaluation before starting treatment whether with your OB/GYN or a fertility specialist. Without a thorough evaluation of both husband and wife, you may be wasting critical time on treatments that may be ineffective at addressing your problem.
Diagnosing the female partner
A physician can assess the woman's reproductive system with two simple tests:
- Hysterosalpingogram (HSG)
- Hormone evaluation
Diagnosing the male partner
A physician can assess the male partner's reproductive system with one simple test:
- Semen analysis
Once the cause of your infertility has been isolated by the physician, it is time to determine the best treatment options. This decision is made in agreement with your physician that satisfies the desired outcome as well as your desires. Our physicians take a stepped-care approach to treatment. They use the least invasive and cost effective options first and only if necessary, move to more advanced options such as in vitro fertilization (IVF).
Some of the commonly used treatment options include:
- Timed Intercourse
- Intrauterine Insemination (IUI)
- Ovulation Induction
- Donor Egg Treatment
- In Vitro Fertilization (IVF)
Basic infertility treatment
When you go for a checkup, you may be surprised to know that the in vitro fertilization (IVF) is not necessarily the first treatment. This is an advanced form of treatment and you may not even go there as there are several other basic treatment options. These include ovulation induction and intrauterine insemination (IUI), which require less medication and fewer appointments to monitor your health.
The basic treatments aim to develop 1-4 eggs, with the fertilization taking place within the female partner's body instead of a lab. The caring staff at Mathrutva truly believes in and practices personalized care. We adapt each treatment to meet the unique requirement of our individual patient.
Timed intercourse is a very simple treatment for infertility. It can be a good point to start for couples trying to conceive. When you don't know the cause of your infertility or you may have a cervical factor, irregular or absent ovulation, and you seek a low intervention treatment, you can work with our team to correctly time intercourse.
The goal of the treatment is to mature and ovulate a single egg for helping women who are not ovulating regularly.
Ovulation with Seophene or commonly known as Clomiphene Citrate, is a commonly used ovulation induction method. It is used to treat women having ovulation disorders, which reflects as infrequent or irregular menstrual cycles. Clomiphene citrate works at the brain and pituitary gland level to facilitate the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These in turn stimulate the ovaries in order to produce eggs, progesterone (P4) and ovarian hormones estradiol (E2).
Intrauterine insemination (IUI)
This is another simple treatment for infertility besides ovulation induction and timed intercourse, and a starting point for several individuals and couples trying to conceive. Intrauterine insemination (IUI) is usually the first line of treatment in couples with conditions such as cervical factor, unexplained infertility, and irregular or absent ovulation, or mild male factor infertility. IUI may also be recommended in cases where a woman needs donor sperm. You will undergo a standard infertility diagnosis before determining whether or not IUI is right for you.
- Unexplained infertility
- Blocked fallopian tubes
- Unsuccessful with conception in spite of fertility drugs or IUI
- Minor forms of male subfertility (for the more severe one, an Intra-Cytoplasmic Sperm Injection is suggested)
When infertility in couples cannot be treated with simple methods, we look towards advanced treatment options to treat them. Advanced procedures are known to have excellent success rates. However, they require additional effort and can be a bit stressful. Hence, patients should freely ask their physician questions to learn more about these procedures. They should also read up and watch other educational resources such as our blogs and videos so that they don't have to go through unnecessary stress. We at Mathrutva Fertility Centre are known to have high success rate with these advanced procedures. Not only this, but we are also known to take utmost care of our patients so that they don't go through any stress during their treatment.
In Vitro Fertilization (IVF)
In vitro fertilization (IVF) is an advanced treatment used when a simple treatment does not help you with infertility. IVF is a procedure in which one or more eggs from the woman's ovaries are taken by the physician. It is then fertilized by sperm inside the embryology laboratory. IVF is one of the most successful treatments, which uses your own eggs and sperm. In recent years, IVF has become widely accepted and continues to grow in popularity due to the significant advances in technology.
Common indications for IVF treatment
A diagnosis of infertility by your physician may lead to IVF. Here are a few of common indications that indicate a requirement for IVF treatment:
- Unexplained infertility
- Recurrent pregnancy loss
- Fallopian tube damage/tubal factor/tubal ligation
- Advanced maternal age
- Male factor infertility
- Genetic abnormalities
What you can expect?
The IVF timeline
In a regular ovulation cycle, one egg matures per month. The aim of an IVF cycle is to have several mature eggs available since this will improve your chances of success with treatment. Stimulation of the ovaries needs to occur so that there are more eggs available. It should be noted that stimulating the ovaries does not deplete eggs for the future. So, you can rest assured.
Part I: Stimulation of the ovaries
During the stimulation phase of the IVF cycle, you will be administered injectable medications for about 8 to 14 days in order to stimulate the ovaries to produce eggs. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH), both produced naturally within the body, comprise the medications. You will be visiting our physician approximately 7 to 8 times for morning monitoring. This helps the physician to track the progress of your cycle and make necessary adjustments in the medication dosages if required.
The final step of this stimulation phase is the trigger shot. Depending on the requirement, you will be either given a Lupron or a (HCG) trigger shot. This shot helps in the completion of maturation process of the developing and sets the ovulation in motion. Timing is of extreme importance here, as the physician should perform egg retrieval before the expected time of ovulation.
Part II: Egg retrieval
The next phase of the treatment is the egg retrieval procedure, which will be done at our Mathrutva centre. On the day of your egg retrieval, our physician will meet you before the procedure. You will then meet our anaesthetist to review your medical history. He/she will then administer the intravenous fluid to you before beginning the procedure to induce sleep.
i) Obtaining the sperm
If you are using a fresh sperm sample, our lab technician will collect the sample. If you are using a frozen sperm or donor sperm collected earlier, they will verify those details with you. Our laboratory will wash and prepare the sperm to make sure that the healthiest sperm are brought together with the eggs for fertilization.
ii) Obtaining the eggs
The egg retrieval takes about 20 to 30 minutes. Recovery will take about 30 minutes and once you have recovered, you will be able to walk out on your own. However, we advise that someone accompanies you or drive you home after the procedure, as the effect of anesthesia wouldn't have worn off yet.
Part III: Fertilization
Once the egg is retrieved, our embryologist will sort and prepare the sperm and eggs. There are two ways fertilization can take place:
- Conventional insemination or
- Intracytoplasmic sperm injection (ICSI)
Our physician will discuss with you about the method to be used based on sperm quality. This is usually planned in advance. Your medical team keep you informed if they recommend an unanticipated ICSI procedure.
In this form of fertilization, our embryologist takes the prepared sperm and isolates the healthiest sperm. He/she will then incubate this sperm with the eggs. This provides the egg and sperm an opportunity to find one another and fertilize.
ICSI: Learn more about ICSI.
Part IV: Embryo Development
Developing the embryo is the next step after fertilization. In this step, our embryologist examines each developing embryo over the following 5 to 6 days. The goal here is to see progressive development. After the 8-cell stage, rapid cell division continues and the embryo enters the blastocyst stage on the 5th or 6th day. Our physician's goal is to transfer the highest-quality embryo(s) to give you the greatest chance of reproductive success.
Part V: Embryo Transfer
This is a simple procedure that takes only 5-10 minutes to complete. Moreover, you do not need any anaesthesia or recovery time. Our nurse will notify you when your transfer is scheduled and provide instructions for you to get prepared. You should have a full bladder for the procedure, since a full bladder will ensure good visualization of the uterus lining and proper placement of the embryos. Hence, it is important to drink the specified amount of liquid 30-40 minutes ahead of time.
You will then review your cycle with our physician and the number of embryos recommended for the transfer. Once you enter your procedure room, the embryologist will transfer the embryo through with a small amount of fluid. The external abdominal ultrasound will provide visual guidance to the physician throughout the procedure.
Once our physician transfers the embryo, he or she will examine the catheter under a microscope in the lab to ensure the complete release of the embryo. The nurse will then give you instructions for the next 2 weeks until it is time for the beta pregnancy test.
Part VI: Beta Pregnancy Test
Two weeks after the embryo transfer, our clinical assistant or nurse will perform a blood pregnancy test. This is usually called a "beta" as it measures the beta chain portion of the hCG hormone which emitted by the developing embryo.
Frozen embryo transfer (FET) is done when you wish to use embryos you have frozen at an earlier stage. You can opt for this either after the delivery of a child or in case of an unsuccessful stimulated IVF cycle in which you had embryos cryopreserved.
What you can expect
An FET cycle requires few tests in advance comparison to a fresh stimulated IVF cycle. You just need to have recent (within a year) blood test for infectious diseases. On certain occasions, our physician may require an updated hysterosalpingogram (HSG) and MET (mock embryo transfer) if you have recently returned after a delivery or any kind of gynecological surgery. You can easily finish both these tests once cycle commencement dates have been finalized and you have started the cycle of oral contraceptives. You and your husband will need to update your informed consents for FET cycles once every 6 months.
The FET process
When you decide to begin a frozen cycle, inform us about your decision. We will review your records to ensure that your pre-screening is up to date. If needed, we will ask you for any repeat screening tests. If there has been a long gap since you last consulted with our physician, we shall schedule a follow-up consultation with our physician.
A FET cycle typically starts with 3 to 4 weeks of daily contraceptive pills to suppress the normal ovarian cycle, as it would lead to ovulation. After the course of treatment, you will require a baseline assessment which involves blood test and ultrasound. Depending on the test results, our physician may direct you to commence sequential injections of estrogen to build the uterine lining. After a stipulated time period on estrogen injections, you will again undergo a blood test and a transvaginal ultrasound lining check. If the lining check shows that your hormone levels are suitable, and your endometrial lining has thickened, our physician will instruct you to add vaginal suppositories of progesterone or daily injections to your medication regimen. Our nurse will then confirm an FET date when you will have to come in for your transfer. Progesterone and Estrogen will continue after the transfer and throughout the blood pregnancy test. The entire FET cycle takes about 6 to 8 weeks.
Genetic testing of embryos
Once we have created embryos through in vitro fertilization (IVF), you have two different types of preimplantation testing you can choose to look for chromosomal abnormalities or specific problems within the embryos. These two types of testing are:
- Preimplantation Genetic Diagnosis
- Preimplantation Genetic Screening
Preimplantation genetic diagnosis (PGD)
Our fertility specialist may recommend a genetic diagnosis of embryos known as preimplantation genetic diagnosis (PGD) to see if you or your partner are at the risk of transferring certain genetic disorders such as myotonic muscular dystrophy, cystic fibrosis or fragile X syndrome to your offspring. PGD is also recommended to patients with infertility due to chromosomal abnormalities such as repeated unsuccessful IVF cycles or recurrent pregnancy loss.
What happens in PGD?
The following is what you may expect under PGD.
- An embryologist will take a cell group biopsy from each embryo once fertilization occurs and embryos develop over five to six days to the blastocyst stage.
- He then analyzes the biopsy in a genetic testing laboratory in order to determine if these cells are affected with the genetic disorder you are carrying.
- The blastocysts are cryopreserved till the results of the analysis are available.
- An embryologist can then unfreeze the unaffected embryos that are normal.
- The physician can transfer one or more of these embryos to the uterus in a subsequent frozen embryo transfer (FET) cycle.
Preimplantation Genetic Screening (PGS)
PGS is a technique which is used in addition to PGD to identify embryos at risk. It looks for abnormalities in your chromosomes. Here, an embryo biopsy is taken and all 24 chromosomes are examined in time for embryo transfer. For example, trisomy 21 (an extra copy of chromosome 21) can cause Down Syndrome. PGS looks at improving your pregnancy by screening embryos for chromosomal abnormalities.