The desire for children is given to man by nature, but it can not always be fulfilled. About every seventh couple faces the challenge of unwanted childlessness. The causes of infertility are varied - as well as the ways to treat them. Since the mid-80s, there is medical aid for it - regardless of whether the reasons lie with the woman or the man. In the process, the success rates through the ongoing development of diagnostics and treatment in the field of artificial insemination are getting better and better, although there is never a one hundred percent guarantee for conceiving a child. Among the best known methods in reproductive medicine is in vitro fertilization.
What is In-vitro-Fertilisation?
During in vitro fertilization (IVF, fertilization in glass), egg cells are harvested from the ovary and mixed with the partner's sperm after a hormonal stimulation treatment. In contrast to intrauterine insemination (IUI), fertilization takes place outside the woman in a culture dish in the laboratory. After fertilization, the resulting embryos are reintroduced into the woman's uterus, where they can nest. However, IVF is a complex and expensive process of reproductive medicine that can put a heavy strain on the patient both physically and mentally.
Should I undergo IVF?
The so-called test tube fertilization is mainly used in women whose fallopian tubes are defective,obstructed or irreversibly damaged. Other reasons for an IVF therapy may be severe cycle disorders with a deficiency of the hormones FSH (follicle stimulating hormone) or LH (luteinizing hormone) or a markedly limited fertility of the male partner.
What does IVF procedure include?
On the day of the planned egg retrieval the couple comes together to the fertility center. While the man gives his semen sample for reprocessing, the eggs are taken from the woman who had underwent hormonal stimulation for maturation of several eggs. The oocytes are usually removed in an appropriate operation or treatment room. With a fine hollow needle under vaginal ultrasound control, the individual oocytes, which are located in the fluid-filled follicles, are carefully sucked through the vagina into a test tube. This process is called follicle puncture. The procedure normally lasts no longer than 15 minutes and can be done with a short-term anesthetic or a painkiller.
In the meantime, the extracted eggs are examined and counted under microscope in the IVF laboratory, in order to then place them into an already prepared culture dish. The sperm concentrate already prepared for IVF treatment is added to the oocytes in the culture dish.
After two to five days, the embryos can be transferred. With a soft catheter, one to two embryos are gently transferred to the uterine cavity. The whole process takes a few minutes and is perceived by most women as painless. In the following days the embryos should aline themselves and attach to the uterine lining. Women should avoid physical efforts as far as possible during this period.
Overview of the stages of a In-Vitro procedure:
Ovarian stimulation: The aim is the growth of multiple follicles in the ovaries of the woman. For this purpose, the ovaries are usually made artificially quiet for some time through treatment with the anti-baby pill, and then by the administration of hormones (usually in the form of injections under the skin, which the woman usually can administer itself) to stimulate the maturation of multiple oocytes - several eggs are required for IVF treatment to maximize the chances of fertilization. If the ovarian follicles reach a sufficient size when stimulated - usually after eight to twelve days - ovulation is induced with a special drug (hCG), and then the oocytes are punctured;
OCR (egg retrieval): The ovulation is artificially induced by subcutaneous (under the skin) injection of a hormone (human chorionic gonadotropin, HCG). The injection triggers the last phase of egg cell maturation and causes the eggs to float freely in the fluid in the ovarian follicles. The oocytes are harvested 36 hours after administration of the injection using an ultrasound-targeted puncture. This can only happen if the last phase of egg maturation has already been completed but no ovulation has yet occurred - for this reason, it is extremely important to administer the injection at the exact time indicated;
Fertilization: After the eggs are extracted from the ovaries, they are brought together with the sperm cells in the IVF laboratory, allowing fertilization to take place;
Embryo transfer (Transferring the fertilized eggs to the uterus): When the fertilization has taken place, which happens in most cases two to five days after the puncture, one or maximum two embryos are inserted into the uterus. Transmission into the uterus is done through a thin, soft and flexible transfer catheter. It is introduced through the vagina into the uterine cavity. The procedure is not painful. With the number of transferred embryos the probability of a pregnancy increases, but of course also the risk or the probability of a multiple pregnancy.
Whether a pregnancy has ocurred, is determined by a reliable blood test and the level of the pregnancy hormone HCG (human chorionic gonadotropin) after about two weeks.
What are the success chances in IVF treatments?
The embryo does not nest in the womb in every attempt - statistically, the chance of getting pregnant with IVF treatment is around 30 percent, but the pregnancy rate can be affected by factors such as the couple's age, existing chronic illness, and lifestyle habits vary significantly. The success of IVF procedures is very much dependent on the age of the woman - in some couples, it works the first time, but in older women, some IVF attempts are necessary so that the desire to have children can become true. The average success rates up until 35 years of age is close to 30% but this drops significantly each year after that to 10% after the age of 40.
On average, the probability of pregnancy after IVF treatment is around 25-30 percent. After three IVF attempts, you have a 50 percent chance of having a child. Since the chances of a successful pregnancy are renewed with every new treatment cycle, half of the couples on average leave the clinic with one or more children after three attempts.
What are the risks in IVF?
The stimulation of the ovaries is always under strict control of the body response to the hormones, yet hormone therapy can sometimes lead to the so-called. Overstimulation syndrome (Ovarian Hyperstimulation Syndrome, OHSS), in which the ovaries produce many and very large follicles. Factors that promote the development of overstimulation syndrome include, but are not limited to: an existing polycystic ovarian syndrome, increased androgen levels, underweight, younger age etc.
Artificial fertilization often also carries the risk of a multiple pregnancy, which in turn can lead to premature birth or to developmental disabilities of the baby.
Egg retrieval can sometimes lead to injury of the vessels, the intestines and the bladder are potentially at risk. However, such complications are very rare since the puncture takes place under ultrasound control. Of course, medical specialists are obliged to explain the health risks of IVF treatment and the various treatment steps.
How much does In vitro fertilization cost?
Since regulation is different around the world so is the healthcare coverage of the overall cost of the treatments. Prices vary around the world from few thousand US dollars per cycle to over 11 000 US in the USA. These only cover the procedure and the medications are an additional cost for the couples who undergo IVF treatment. Hormonal drugs can cost between 20% and 80% of the basic cost. You should be prepared to additionally pay other fees and medical tests not covered by the basic costs.
The average cost of IVF in India is between 2,50, 000 and Rs. 4,50,000 (between 3 000 and 8 000 USD) per cycle. The private clinics in big cities are the most expensive. These prices along with well-developed technology and English-speaking staff make India a favorite place for medical tourism including for in vitro fertilization procedures.