This guide to IVF in India goes beyond IVF being just another acronym. But for those fighting infertility and struggling to conceive naturally despite several years of marriage, IVF is the Brahmastra, the all-powerful last resort. Sometimes, it is made to sound as the sure-shot method to those desperate to become parents. There are several myths and jargons surrounding the 3 alphabets (IVF) and here we try to help break it up to help women take an informed decision. This is a basic guide to IVF in India and touches upon the important aspects of it. For detailed understanding and help with process, connect with our fertility consultant.
Let me confess that when I was trying to conceive and consulted specialists based on references, I always muttered a prayer under my breath before meeting/talking to specialists. I would always hope that the doctors should suggest anything but not an IVF. To my limited knowledge, IVF= pain and meant for those women who have reached the dead end and left with no more options to try. My story thereafter is an interesting one and I would rather save it for another day. But for now, let’s get down to demystifying the three-lettered demon (is it?), IVF.
The Basic Guide To IVF In India
- IVF is the acronym for In Vitro Fertilization and is one of the most commonly practiced and highly successful assisted reproductive techniques.
- It’s a boon to women experiencing difficulties in natural conception.
- It follows four simple steps: Use of fertility medication to develop eggs, removal of eggs from the ovary, its fertilization in the lab and placing the fertilized embryos in the uterus.
Procedures Involved During IVF in India
I’m sure many women fighting infertility have rigorously browsed internet to understand the various options available and what exactly is IVF that many doctors refer to. Here’s a look at the procedures involved that make up IVF. It is not simply fertilizing the eggs and placing them in the uterus. It’s a long procedure that takes place over several weeks.
Most Important: Take time to get properly educated and prepare for IVF—the process, its cost, its complexity, benefits and possible risks involved, techniques and injections given. Only when you and your spouse (and of course the immediate family, where they are closely involved) are convinced and are ready to go ahead, then start the IVF process.
- First, doctors prescribe intake of birth control pills for one or more weeks (depending upon the need) before starting the process. These pills are intended to prevent release of hormones that could cause natural ovulation.
- The first day of menstrual bleeding is considered as day 1 of the cycle. Doctors usually ask you to call on day 1 or day 2 of the cycle to schedule an appointment for blood test and ultrasound. The pelvic ultrasound is done between day 3 to 5 to evaluate the ovaries and blood test is done to check the hormone levels. If all is ok, then you are scheduled to start on FSH hormone injections that stimulate the growth of egg follicles.
- Blood test and ultrasound is repeated several times during a cycle to measure follicle growth and check hormone levels, so that dosage of FSH can be increased/decreased accordingly.
- The whole purpose of this process is to control the timing of the egg ripening and increase the chances of having multiple eggs. While more eggs are good, but more than 10-15 increases the chances of a complication called Ovarian Hyper-Stimulation Syndrome.
- Once the follicles have reached a certain size, a trigger injection of hCG allows the eggs to undergo a final step of maturation. 36 hours after the trigger injection, egg collection is normally scheduled.
- To retrieve the eggs, the doctor inserts an ultrasound probe into the vagina and then with the help of a needle withdraws eggs from the follicles. The patient is under sedation in this procedure which takes approximately 15 to 30 minutes depending on the number of follicles present. Due to this procedure, the patient may have light bleeding, vaginal discharge and pelvic cramping. These are normal unless they become severe. The patient is monitored for a couple of hours and asked to return home and is asked to rest for a day to allow for the effects of anesthesia to wear off.
- The eggs are then fertilized in a laboratory with her partner’s sperm. In case the sperms are of a very poor quality, ICSI (Intracytoplasmic Sperm Injection) procedure may be used to aid fertilization. In this procedure a single sperm is injected into each egg as opposed to the traditional method where over a 100,000 sperms are added to each egg.
- After about 2-5 days of retrieval, one or more of the fertilized egg/s are placed in the uterus with the help of a thin, flexible catheter, inserted through the cervix. This is mostly done on day 3 and is done very gently to avoid uterine cramping. Normally, the patient is not under anesthesia for this. The number of embryos transferred depends on the couple’s preference, previous history of pregnancy/miscarriage, the woman’s age and most importantly, the quality of the embryos. While women attempting IVF for the first time are asked to opt for a single or two embryos to increase the chances of pregnancy, those who have undergone multiple attempts of failed IVF may be recommended to go for more than 2. However, this may also increase the chances for multiple gestations (twins/triplets).
- Following the transfer, women are advised to take rest, though there is no definite proof that taking rest increases the chance of pregnancy.
- Embryos not transferred are stored for future use by freezing them. However, chances of pregnancy using frozen embryos is less so couples are often encouraged to donate them for research or to other couples for use.
- Two weeks after the embryo transfer, a blood urine test is done to determine the hCG, a hormone that confirms pregnancy. If the first hCG level is <5 IU/L, the pregnancy is negative; >10 IU/L, the test is repeated every 48 hours to confirm that the levels are doubling. The levels should double every 48 hours in the first 21 days after embryo transfer. If the second hCG levels do not increase, the test is repeated after 48 hours. Even then if it does not increase, then there are chances that the pregnancy is not progressing.
- If the hCG levels are increased, the pelvic ultrasound is done after 3 or 4 weeks to make sure the gestational sac is visible. A heart beat begins after about 6 to 6.5 weeks of pregnancy (approximately 4-4.5 weeks post-transfer)
Involved in IVF That Couples Should Be Aware Of ( Which Doctors Usually Never Tell)
When doctors recommend IVF as an option to conceive, they never usually fully inform the couples of the possible risks that can be encountered during the IVF process. Though, the instances are very less yet as a patient you have all the right to know and be mentally prepared about what you are getting into.
Here are some of the risks associated. Remember, this is meant only to educate and not to overwhelm the patient. And these are only POSSIBLE risks. Sometimes a patient might undergo a procedure without any complication at all. It all differs from person to person.
- Over-stimulation of the ovaries might cause Ovarian Hyper Stimulation syndrome, characterized by nausea, vomiting, low appetite and bloating. Sometimes, it can cause severe bowel pain, shortness of breath, weight gain and decreased frequency of urination.
- Egg retrieval might cause bleeding, infection and damage to bladder or bowel.
- The chances of multiple pregnancies are common.
- The incidence of congenital and chromosomal abnormalities is higher in children born out of IVF, but there is no confirmation on that.
- Preterm birth and ectopic pregnancies cannot be ruled out.
When is IVF Required?
IVF is usually the last resort to couples deciding to start a family when all other options of natural conception have failed. After 1 year of trying naturally and then a few rounds of IUI, the next natural step in this journey is IVF. However, many couples these days are opting IVF procedures early on to avoid wasting time and hassle.
Usually IVF is recommended under the following circumstances:
- Fallopian tubes blocked/absent.
- Low sperm count and motility
- When the woman is over 35. However, there is a new theory these days which says that if you medical case requires IVF then go for it early to increase your chances of conception.
- When problems such as endometriosis, ovulation disorders, unexplained fertility, PCOS have been treated and yet the woman is not able to conceive normally.
- Ovarian failure
- Low or bad quality egg reserve
- Recurrent miscarriages
- Ectopic pregnancy
IVF in India has proved to be successful for many couples that I have met or read about. But there are also cases where many couples have gone through multiple IVF failures, trauma and agony that follow it. It is a highly expensive process and therefore couples have to be really determined to accept success or failure with it.
35% is average national success rate of IVF in India. So, think twice and take an informed decision.
Don’t buckle under pressure from peers and family members. Remember, it’s your body that is going to undergo this and therefore the only person who must have a final say is YOU.
If you are at the verge of taking IVF route and have your questions unanswered, do connect with us without any hesitation (we keep your identity safe and anonymous) and talk to our fertility dost (friend). We can connect you to our volunteer buddy women who have been through the process themselves and are very happy to listen and guide you. Preparation is the key and we help you design your way out of infertility.
Good Luck!Tags: ivf cost ivf guide ivf procedures ivf process step by step guide