In vitro fertilization
Which patients need in-vitro fertilization treatment?
Infertile patients who have been trying to get pregnant unsuccessfully for at least 1 year could opt for simpler treatments (depending on the cause of their subfertility) or could also choose to undergo the more invasive, but more efficient IVF treatment. IVF could be indicated for different reasons such as female factors (tubal occlusion, advanced maternal age, low ovarian reserve, endometriosis) or male infertility factors (diminished sperm concentration or motility), but also in cases of unexplained infertility (no apparent causes are found, and previous simpler treatments were unsuccessful).What tests are needed before in-vitro fertilization?
Before starting IVF treatment an initial consultation is done together with the evaluation of the female patient’s ovarian reserve through ultrasound scanning and hormone tests (AMH) and a detailed sperm analysis. A simple bloodwork such as blood count, clotting screen, and infectious screening is also requested for partners (if applicable) before starting treatment. Patients with pre-existing health conditions should be evaluated thoroughly to estimate the risks of undergoing IVF treatment.
What is the process of in-vitro fertilization?
IVF treatment involves the process of a 10-12 day long ovarian stimulation with subcutaneous injections and serial ultrasound monitoring culminating in the egg collection which is a short 10-minute procedure performed under sedation. Retrieved eggs are checked by the embryologist in the lab and those that are mature will available fertilised conventionally or using the ICSI procedure. Resulting embryos cultured with prolonged embryo culture and will be transferred back to the womb or frozen for future use. A pregnancy test 10-14 days after embryo transfer will confirm whether the embryo implanted or not.
What methods are used to fertilize eggs during in-vitro fertilization treatment?
Eggs harvested following egg collection could be fertilised using conventional IVF (when a significant amount of sperm is incubated together with each egg in a dish) or with the intracytoplasmic sperm injection or ICSI procedure (when a single selected sperm cell is injected under the microscope by the embryologist into each mature egg). ICSI is usually used in the case of a significant male factor but could be also applied when the sperm has normal parameters with the aim of optimising fertilization.
What are the side-effects and risks of in-vitro fertilization?
The main side effects of IVF treatment are temporary and reversible and could include bloating, lower abdominal discomfort, breast tenderness which is related to the growth of ovarian follicles. The risks involve ovarian hyperstimulation syndrome (OHSS), which nowadays could be practically prevented by using specific hormonal drugs and safe ovarian stimulation protocols. Egg collection could carry a small surgical risk (<0.5%) such as internal bleeding, the injury of anatomic structures, or pelvic infection. If the embryo has successfully implanted there is always a risk of suffering an early pregnancy loss and/or subsequent pregnancy complications during the later stages.
Is in-vitro fertilization a safe procedure?
In fertilization is largely considered a safe procedure. The risk of ovarian hyperstimulation syndrome could be greatly diminished and there is only a very small surgical risk (<0.5%) related to egg collection procedure itself. There are no reported long-term side effects and if needed IVF cycles could be repeated several times.
Are there any significant risks for the offspring following in-vitro fertilization?
Children born from an IVF treatment generally are healthy and only in some cases could have a higher risk of congenital abnormalities related to genetic issues in their parents’ gametes. This could be diminished by the application of preimplantation genetic testing for aneuploidies (PGT-A) or preconceptional genetic testing of the parents (such as carrier genetic tests and matching).What is the success rate of in-vitro fertilization?
The success rate of IVF treatment largely depends on the female age, but also on the quality of sperm and factors related to the womb and embryo implantation. Usually, in younger patients (<35 years) pregnancy rates per embryo transfer could be as high as 50-55%, whereas during the late 30s and early 40s they gradually decline to a minimum of 10 to 5%. Expected cumulative success rates could be higher if embryos resulting from a single stimulation cycle are transferred one-by-one.