In Vitro Fertilization

4.12 Assisted Reproductive Technology (ART)

4.12.1 Introduction to ART

Assisted Reproductive Technology (ART) encompasses various medical techniques aimed at helping couples with infertility issues conceive a child. ART is primarily used when infertility problems in either partner prevent natural conception.

4.12.2 In Vitro Fertilization (IVF)

In Vitro Fertilization (IVF) is a widely used Assisted Reproductive Technology (ART) that involves fertilizing an egg with sperm outside the body in a laboratory setting. IVF is primarily used to treat infertility when other methods fail.

Step-by-Step Process:

1. Ovulation Stimulation: Fertility drugs are administered to stimulate the ovaries to produce multiple eggs instead of one. Regular ultrasound and blood tests monitor the ovarian response and hormone levels.
2. Egg Retrieval (Follicular Aspiration): Minor surgery is performed to remove eggs from the ovaries using a thin needle guided by ultrasound. The procedure is typically outpatient, and medications are given to minimize pain.
3. Sperm and Egg Insemination: Semen is combined with the retrieved eggs in a controlled environment. This process is called insemination. In cases where fertilization chances are low, Intracytoplasmic Sperm Injection (ICSI) may be performed, where a sperm is directly injected into an egg.
4. Embryo Development: The zygote undergoes division, forming an embryo. Lab technicians monitor its development. If needed, Pre-implantation Genetic Diagnosis (PGD) can be performed to screen embryos for genetic disorders.
5. Embryo Transfer: 3 to 5 days after fertilization, the embryo is transferred into the woman’s uterus using a catheter. If the embryo implants into the uterine lining, pregnancy occurs. Any unused embryos can be frozen for future use.
6. Post-Transfer Care: After the embryo transfer, the woman may need progesterone supplements for 8-10 weeks to prepare the uterus for implantation and avoid miscarriage.

4.12.3 Advantages of IVF

Treatment of Infertility: IVF can help women become pregnant in cases of:

Advanced age. Damaged fallopian tubes. Endometriosis.

Male infertility (e.g., low sperm count).

Unexplained infertility.

Gestational Surrogacy: IVF can be used in surrogacy cases where the fertilized egg is implanted into a surrogate mother.

4.12.4 Risks and Disadvantages of IVF:

Physical and Emotional Strain: IVF involves emotional stress, time commitment, and financial burden. Many couples suffer from stress and depression during treatment.

Side Effects of Fertility Drugs: Common side effects include bloating, abdominal pain, mood swings, and headaches. In rare cases, Ovarian Hyperstimulation Syndrome (OHSS) can occur, leading to fluid accumulation in the abdomen and chest.

Multiple Pregnancies: Transferring multiple embryos increases the risk of twins, triplets, or higher-order multiples, which raises the chances of premature birth.

High Costs: IVF is expensive, costing 6-9 lakh rupees per cycle, including medicines, surgery, and embryo storage. Some insurance plans may not cover infertility treatments.

4.12.6 Post-IVF Care and Success Rates

Post-IVF Care: After the embryo transfer, patients are advised to take rest, though complete bed rest is not necessary unless there's a risk of OHSS. Progesterone supplements are prescribed for 8-10 weeks after the transfer to support the uterine lining and prevent miscarriage.

A pregnancy test is conducted 12-14 days after embryo transfer.

IVF Success Rates: Success rates of IVF vary depending on age and clinic. According to the Society of Assisted Reproductive Technology (SART):

41-43% for women under 35 years.

33-36% for women aged 35-37 years.

23-27% for women aged 38-40 years.

13-18% for women 41 years and older.