IVF

Assisted Reproductive Techniques ( ART ) such as In Vitro Fertilisation (IVF) pregnancy is on the rise. Assisted Reproductive Techniques ( ART ) such as IVF in vitro fertility pregnancy is on the rise. Delayed maternal age, changing lifestyles etc are being identified as the probable reasons why such an assistance is needed. Many women seeking such a treatment with me, always have been anxious and worried as to what is going to be the next therapy. Detailed counselling sessions are usually offered, nearly in all centres to make the couple understand the techniques and what they are supposed to expect throughout the treatment. But many still want to know some guidelines and steps which will be easy to understand. As is the norm today usually “google-it “ and find it, is the common act but many have confided saying that they didn’t get the answers so easily and this adds to their concerns. This writeup is especially written for those couples, who have chosen to undertake pregnancy by in vitro conception options. I have decided to divide the entire write up into three sections namely :

1. The common concerns and myths

2. Step-wise follow through : what do you accept

3. Dealing with the positive as well as the negative result

4. Common concerns and myths :Many couples consider IVF conceptions as

artificial and carry guilt that they have worked against nature. Yes the nature does go into denial of a pregnancy, it does not always mean that there is a serious consequence if you override the universe. Many times there are very simple reasons, which if would have been tackled earlier, the need for ART wouldn’t have surfaced. Delay in decision due to baseless guilt, can contribute to unsuccessful outcomes. In today’s modern era, it is important that smart and timely decisions are taken to achieve good outcomes. Unfortunate situations such as reduced ovarian capacity of making eggs, blocked tubes, less number of sperms in a man, inability to ovulate naturally, diseases such as endometriosis, need ART. Situations such as obesity, abnormal attitude leading to excessive stress, abnormal lifestyle are correctable and some amount of assistance may help bring about positive outcomes. The process involves some steps to be undertaken purposefully and outside the body and therefore is called as in vitro fertilisation and therefore is artificial. This is a

common concern. Certain physical or hormonal barriers interrupt the process of coming together of the female and the male gametes leading to inability to achieve a pregnancy. Therefore these gametes are retrieved from the woman and the man and brought together in a conducive environment created to mimic the internal natural environment. This bringing together can be just by placing them together at a peculiar time or by actual injection process called as ICSI ( intracytoplasmic sperm injection ). ICSI is a special technique requiring skill and equipments to actually inject the sperm into the egg and initiate the formation of the zygote to lead to the formation embryo, which can be transferred at various stages of development. Retrieval of the gametes also involves a special technique. The eggs from the woman body are aspirated under sonography guidance and is a highly specialised technique. Ovaries are stimulated to create eggs, to do so and then these oocytes are checked for the stage of development and quality and their capability to be fertilised. Sperms are retrieved through processing of the semen given by the man. In special situations, these sperms can be retrieved from the mans body by aspiration ( TESA ). Another concerns are possibility of a switch of the gametes the embryos and contamination in the labs. But all the labs that are licensed, follow strict regulations to avoid such mishaps. 1. Let us now understand what are the step wise walkthroughs you experience during a typical IVF treatment. 1. Pre-assessment : Hormonal, serological( for both ) and sonographic checks are done to plan the protocol and dosages of the stimulation medicines. These medicines help in stimulating the follicles to grow many of them and mature. 2. The growth and the quality is assessed by sonography the frequency is decided by the clinician and the retrievalplanned to acquire optimum eggs or oocytes. Sometimes hormonal tests may also be done to ensure the optimum time 3. Oocyteretrieval is a procedure in which the follicle are aspirated by a transvaginal sonography with a special technique under short anaesthesia. 4. Medications are given for pain relief( only if necessary ) and endometrial preparation, based on the plan of the Embryo Transfer(ET). Today many centres practice Frozen Embryo Transfer (FET) where in the embryos are frozen to be thawed and transferred in a subsequent cycle. 5. The oocytes are immediately checked under the microscope and studied for maturity, number and quality. These are hatched either by the classical method or ICSI based on this assessment and also the concomitant male factor. 6. Decision of Day 3 or Day 5 transfer is taken and communicated to the woman based on the cleavage and the endometrial response. 7. Embryo transfer is a day care procedure but sometimes done under anaesthesia and a procedure done to place the embryo in the prepared endometrial cavity under sonography guidance.

8. Instructions are given to take the support medications regularly, round the clock with correct dosing and to report in case of any pain or bleeding. Some bleeding can be there which mayn’t always be ominous. But heavy bleeding may be a sign of non-acceptance of the embryo. Implantation bleeding when the embryo is trying to stick is expected and shouldn’t be a cause of concern. 9. A fortnight from this procedure pregnancy can be detected. The confirmation can be done by sonography and /or laboratory. 10. FET can be considered in the subsequent cycle after endometrial preparation. 2. Failure leads to frustration : Many things can go wrong and one should be mentally prepared for the same

1. Improper response to stimulation

2. Retrieval of suboptimal oocytes

3. Improper suboptimal embryo formation

4. Indequate endometrial response

5. Failure to implant

6. Certain complications can occur which are taken care of by the

consultant, such as hyper stimulation syndrome, bleeding at the time of oocyte retrieval are rare events in standard labs. 3. Dealing with the positive as well as the negative result 1. Very early pregnancy can be a chemical pregnancy. Evidence of heart activity on ultrasound is a confirmed clinical pregnancy so one has to be patient 2. Possibilities of adverse outcomes are more in IVF pregnancies such as development abnormalities in the baby, preterm deliveries, growth restriction, metabolic diseases in the mother such as diabetes and hypertension are commoner, therefore proper pre-natal care is important with closer surveillance. Principles to follow

1. Have confidence in your doctor

2. Follow all the instructions and medications properly

3. Do not feel anxious and have confidence in your own self

4. Always be positive and happy

5. Take proper care once conceived, as advised by your clinician

6. Do not be dejected in case of an adverse outcome