IVF Procedure

Ph: +91 9810 968 739

Email: dr.richa.katiyar@gmail.com

What is IVF/Test Tube Baby?

IVF (test tube baby) stands for in vitro fertilization. IVF (test tube baby) refers to the process of achieving fertilization between the sperm and ovum in the laboratory under artificial conditions, and placement of the dividing zygote into the uterus of the mother.

In vitro literally means 'in glass' and with this form of assisted conception, fertilization takes place in a glass (or more commonly, plastic) dish in the laboratory. (At one early stage, scientists used test tubes for fertilization, hence the term "test tube baby".) IVF (Invitro fertilisation) was originally devised to overcome infertility caused by blocked or absent fallopian tubes. Today, IVF(Invitro fertilisation) is used to treat many more reproductive problems, including irregular ovulation, low sperm count or motility, and unexplained infertility.

Who should be treated with IVF (in vitro fertilization)?

IVF(Invitro fertilisation) can be used as an effective treatment for infertility of all causes except for women with infertility caused by an anatomic problem with the uterus, such as severe intrauterine adhesions. It is generally used in couples who have failed to conceive after at least one year of trying who also have one or more of the following:

• Blocked fallopian tubes or pelvic adhesions with distorted pelvic anatomy. Women who have had tubal ligation and are considering tubal reversal surgery as well as men that are considering vasectomy reversal surgery might also consider IVF(invitro fertilisation).

• Male factor infertility (low sperm count or low motility). ICSI is an IVF(Invitro fertilisation) procedure that can fertilize eggs even with poor sperm quality.

• Failed 2-4 cycles of ovarian stimulation with intrauterine insemination.

• Advanced female age - over about 38 years of age. Reduced ovarian reserve, which means lower quantity (and sometimes quality) of eggs. A day 3 FSH and estradiol test, antral follicle counts and AMH hormone levels are often done as screening tests for egg quantity. Reduced egg quantity and quality is usually treated with either IVF(invitro fertilisation), or with IVF(invitro fertilisation) with egg donation.

• Severe endometriosis.

• Unexplained infertility when inseminations have failed. Unexplained infertility means standard fertility tests have not found the cause of the infertility issue.

How does IVF(in vitro fertilization) treatment work?

Below is a step-by-step explanation of the IVF process, from preparation through embryo transfer.

In Vitro Fertilization process includes combining a woman’s eggs (oocytes) with a man’s sperm in a laboratory setting. The resulting fertilized egg (embryo) is then placed into a woman’s uterus. Below is a step-by-step explanation of the IVF process, from preparation through embryo transfer.

STEP 1: Ovarian stimulation for egg retrieval

Certain factors will need to be evaluated before a woman is deemed a suitable candidate for IVF. Once she has been approved, the first step in the process is ovarian stimulation. Normally, a woman’s ovaries produce one mature egg for each menstrual cycle. Ovarian stimulation uses medication to increase the number of eggs produced from one to as many as twenty or more. Generally, the more eggs produced and retrieved, the higher likelihood of IVF success.

Types of Ovarian Stimulation

In a natural cycle, a woman forms one egg, but during IVF we amplify the body’s natural process of egg production in order to make multiple eggs available. There are several different types of ovarian stimulation protocols that can be used to accomplish this task. Choosing the correct protocol can be the single most important step in achieving a successful outcome for IVF. Dr Richa Katiyar uses her vast experience and training to choose the appropriate protocol for each individual patient.

Some general categories of stimulation protocols include:

Long Protocol with Lupron Down Regulation

Short Protocol with GonRH Antagonist

Mini Protocol

Natural Protocol

Ultra Long Protocol

If a woman does not release mature eggs on a regular basis, gonadotropins or clomiphene may be used in conjunction within IVF to induce ovulation.

STEP 2. Clinic Visits for Monitoring

Each protocol requires a regimen of daily injections of medication (gonadotropins) to stimulate the ovaries to produce eggs. While on these medications, you will undergo monitoring and your number of visits will vary depending on the protocol and your response to the medication. You can take the injections yourself, after being trained by our staff, or you can take them close to wherever you stay. Using ultrasound and blood tests, Dr. Richa will monitor the effectiveness of the protocol and adjust the doses of the injections, if needed. When it appears that the egg follicles are at an appropriate, mature size, you will be instructed to take a “trigger” injection of human chorionic gonadotropin (hCG) or leuprolide (lupron) to induce the final maturation of the eggs and to prepare for the egg retrieval.

STEP 3: Oocyte retrieval (Egg Retrieval)

After successfully stimulating the body to produce eggs, a simple outpatient procedure is performed to remove the eggs from the ovaries, this is known as an egg retrieval procedure. The egg retrieval procedure is performed under general anesthesia, anaesthesia is given by an experienced and specialized anesthesiologist to ensure your comfort and safety. Assisted by vaginal ultrasound guidance, a needle will be inserted into the egg follicles and the eggs will be extracted safely. The egg retrieval process generally takes about 15-20 minutes, but you will be kept in the Hospital for around three hours. After you are completely comfortable, have had some water to drink and a light snack to eat, and once you have passed urine, you can go home.

STEP 4: Fertilization of the Egg

After the egg retrieval procedure is complete, the next step in the IVF process is insemination of the eggs

Traditional IVF vs. Intracytoplasmic Sperm Injection (ICSI)

In traditional IVF, eggs are exposed to sperm when they are combined in a specially designed culture dish and left to incubate overnight in the laboratory. In some circumstances, simply mixing the eggs and sperm outside the body will not result in fertilization and the production of an embryo. When there is reason to believe that fertilization may not occur with mixing, ICSI (intracytoplasmic sperm injection) is utilized to improve the chance of fertilization.

Laboratory Events & Milestones

After the egg has been successfully fertilized, a series of embryonic milestones unfold:

Day 1: Pronuclear Stage

Day 2: 4 Cell Stage

Day 3: 8 Cell Stage

Day 4: Morula

Day 5: Blastocyst

These are the same steps that normally occur in nature (within the fallopian tube) and similarly, these events take place in the Incubator.

STEP 5: Embryo Transfer

The transfer of viable embryos most commonly occurs 5 days following the egg retrieval, when the embryos are at the blastocyst stage but sometimes day 2 or day 3 transfer may also be done. Dr. Richa will discuss with you the best day to transfer the embryos and the number of embryos to transfer. Deciding on the day and the number of embryos to transfer depends on several variables. Age of the egg source, embryo quality, preimplantation genetic diagnosis (PGD) results, transfer day, medical history, patient preference and more, all go into the decision. Further, the American Society of Reproductive Medicine(ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) have published guidelines recommending the appropriate number of embryos to transfer based on patient age and history. With this in mind, Dr. Richa ultimately strives to work with her patients to decide on a safe and appropriate number for each individual circumstance.

The embryo transfer is an elegant and simple procedure that is designed to place the embryo(s) into a receptive endometrial environment. It is done under ultrasound guidance to ensure that the embryos are positioned into the perfect place in the uterus. To begin the transfer, the patient is positioned on a specially designed bed with a full bladder. The optimum filling of the urinary bladder ensures easy transfer of the embryos and perfect vision of the uterus is ensured, by the trans abdominal view by an Assistant. The end of an empty catheter is placed into the uterus using ultrasound guidance. Once the empty catheter is perfectly positioned, the embryology staff is instructed to load the embryo(s) into another identical catheter. The loaded catheter is then brought to Dr Richa who simply replaces the empty catheter with the loaded one. The embryos are then gently advanced into the uterus where they will eventually implant and begin to grow. Approximately 9 to 12 days later a pregnancy test called Beta HCG is done to (hopefully) confirm that the patient is pregnant.

Summary of Steps of IVF:

IVF(Invitro fertilisation) procedure step by step involves : -

• Stimulating the ovaries with injections of FSH

• Preventing premature ovulation (the LH surge) by shutting down communication between the brain and the ovaries by giving another set of injections (GnRH agonists or antagonists) so that the eggs are not lost before they can be collected

• 'Triggering' ovulation by replacing the LH surge at mid cycle with an injection of hCG

• Collecting the eggs under general anaesthesia transvaginally using ultrasound guidance.

• Fertilising the eggs with the sperm in the laboratory.

• Culturing the embryos in the laboratory

• Transferring the embryo into the womens uterus (normally not done under anaesthesia )

• Supporting the endometrium after IVF(in vitro fertilization) with hCG injections or progesterone

• Checking for a pregnancy on approximately Day 10 after embryo transfer.

What are risk or concerns involved in IVF (in vitro fertilization)?

• Risk of Ovarian Hyperstimulation Syndrome (OHSS)

• Failure to recover eggs

• Eggs recovered may not be normal

• Sometimes male partners may not be able to produce semen specimen but this problem is treated by semen freezing as "back up"

• Fertilization failure in spite of normal eggs

• Abnormal development of embryos which are then not transferred.

• Embryos transfer may be difficult or there may be implantation failure

• Congenital malformation, genetic abnormalities, mental and other birth defects occur in 3% of spontaneously conceived children, may also occur IVF babies(Invitro fertilisation)

What to expect in an IVF (in vitro fertilization) pregnancy?

An IVF (in vitro fertilization) pregnancy is a very precious pregnancy so a lot of precautions are taken to ensure that the pregnancy does well. These involve oral medicines/ injections to relax the uterus. Also since many IVF (Invitro fertilisation) pregnancies may be twins or even triplets, early onset of labor can be anticipated. Many patients prefer to have an elective Caesarian section for the birth of their IVF children but normal delivery can also be done for IVF (Invitro fertilisation) pregnancies.

How many attempts of IVF (in vitro fertilization) can be undertaken?

Minimum three attempts would be a reasonable number for a couple to undertake. However, more attempts can be undertaken if the couple wants or if the IVF centre(in vitro fertilization) has something positive to add in the subsequent cycle.

What is the success rate of IVF (in vitro fertilization)?

Success rates in IVF depend on many factors such as the age of the lady, the quality of the eggs and the sperm, blood flows to the uterus etc. They range from 35 to 50% in self egg cycles.

History Of IVF

IVF (in vitro fertilisation) was pioneered in the 1980’s by Dr. Edward and Dr. Steptoe, and it has come a long way since then. IVF (test tube baby) is among the most successful infertility treatments and gives good successful results. Children born from IVF (test tube baby) are as normal as normally conceived children. In fact, the first IVF child ever in the world, Louise Brown, got married, conceived naturally,and a son was born to her in 2006, laying to rest all doubts about the fertility of children conceived by IVF (test tube baby).

Why Delhi?

Delhi is the capital of India and one of the most modern cities. Delhi boasts world class medical schools and hospitals. The medical facilities in Delhi are the best in Asia. Here you can take advantage of the cheaper services cost and superior doctors.

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Questions to Dr. Richa Katiyar about IVF:

Dear Dr Richa,

Thank you so much for your concern and personalized assistance.

On related issues, I would like to extend few more questions regarding the ivf (test tube baby) procedures.

1- on the ovarian stimulating process, which protocol do you use? Long or short protocol?

2- do you provide assisted hatching and frozen Embryo transfer services?

3- DO you have PDG-fish (gender selection) Pdg 5 probes (chromosome x,y, 13, 18, 21 & ACGH 24 chromosomes tests?

4- on collecting the mature eggs, the only available option is to take a general anesthesia? or local anesthesia like pethedin is also available?

5- is it possible to get assistance from your stuff , about finding information for accommodation around your clinic area and visa processing letter from your clinic ?

Will be waiting to hear from you.

Regards

Dear Guest,

To reply to your queries,

1. I prefer to do long protocol if your schedule permits, else short protocol.

2. We do provide assisted hatching (at no extra cost) and frozen embryo transfer.

3. Gender selection of any type is illegal in India.

4. Prefer to use general anaesthesia but local can be given for egg collectio

5. Can help with processing of visa by sending across necessary documents and arranging accomodation.

Regards,

Dr. Richa

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Good Morning Dr,

I am Asaf Zardoi. l want information about ivf. Its been 8 years of marriage. We could not blessed with a baby. We have gone through many tests once laproscopy and once IUI have done. Could not get success. I have read a lot about you. Seeking hope. Please tell me the total cost because i do not have to much money but i will do anything. Because without a baby we can not survive in this society. My wife is 28 years old and i am 32 years old. Please suggest me.

Regards,

Asaf

Hello Mr. Asaf,

Sorry to learn that you and your wife are having difficulty in having a baby.

You are welcome to come to New Delhi to get IVF-ISCI treatment done.

The IVF treatment starts on day 1-2 of the periods so you will need to plan to come accordingly.

The charges for IVF depend on the no. of injections we use and that depends on the ovarian reserve of your wife. We can test this by doing a blood test called AMH. Please get this test done and let me know the report.

Feel free to contact me for any further queries.

Best regards,

Dr Richa Katiyar