Indications for IVF are:-
- Blocked fallopian tubes.
- Pelvic Adhesions.
- Genital tuberculosis.
- Unexplained infertility.
- Advanced maternal age.
- Male factor infertility.
- Hormonal/Immunological disorders.
How is IVF conducted at JFMCH?After the initial work up of the couple, the patients who are selected for IVF routinely undergo the following procedure:-
- Counseling - A detailed explanation is provided to every couple whereby they are made to understand the reason and outcome of doing IVF for them. Every patient is individualized and a protocol is decided for stimulation. Most of the patients are selected for a long protocol unless otherwise indicated. Any queries of the patients are answered at all times and they are made to feel comfortable and at ease with the entire staff of the hospital.
- Ovulation-Induction - Usually the couple is requested to present itself for all visits, but in certain cases where it is not possible, the wife maybe present alone for OI. Down regulation using GnRH analog is started on day 21 of the cycle (Day 1 is the start of the menstrual period). For this the patient needs to take a daily injection at a fixed time during the day. She then comes back on the second day of the menstrual cycle and induction is then started with gonadotropins for a period of minimum five days after which the follicular monitoring is done on a daily basis till at least two follicles are 18mm in size and have a good perifollicular flow. hCG is given on the same day and ovum retrieval is done thirty six hours later. In some patients daily injections of GnRH agonists may not be possible for a long period. In these patients and others who are chosen for an antagonist protocol, stimulation starts on day 2/3 of the cycle. Here an antagonist is added on a daily basis along with gonadotrophins which have already been started on day 2/3 once the follicle size reaches 14 mm. This protocol decreases the duration of injections and does not allow the LH surge to happen which is detrimental to the quality of eggs.
- Ovum pick up - This is done under general anesthesia using trans-vaginal sonography. It is only a needle prick and the patient need not worry about any pain after the procedure. Hospital stay is only for 3-4 hours and is because of general anesthesia. Patient can go home the same day. This procedure does not involve any kind of risk except in a very few patients with dense adhesions or other pelvic diseases. Any bleed into the pelvis may cause little discomfort or cramps in the lower abdomen for a few days. Usually no treatment is required for the same. Only mild analgesic drugs are usually sufficient to take care of the symptoms.
- Insemination - The husband is asked to give a semen sample on the day of egg retrieval. A fresh sample is always preferred though a backup of husband’s frozen semen sample is always kept in our hospital. Semen sample is processed usually using a swim up technique. Wherever required, PESA or TESA is done on the same day and processed. Regular insemination/ICSI is carried out as the case maybe. The eggs are examined for fertilization after 16-18 hours and any abnormal forms are discarded at this stage (eg- eggs with 3pn or 1pn).
- Embryo Transfer - This does not require any anesthesia. A maximum of 2 embryos are transferred using a fine embryo transfer catheter. All additional embryos are frozen for future use with the consent of the couple. The patient can go back on the same day within a few hours; but it has been observed that they usually prefer to stay overnight. In cases of hyperstimulation (OHSS), embryo transfer may not be done in the same cycle depending on the severity of OHSS. In this case all embryos are frozen and transferred in another cycle. This is necessary to avoid worsening of hyperstimulation which may be then life threatening.
- Day of transfer - This is discussed individually with all couples. It may be done on day 2, day 3 or day 5 depending upon the number of embryos, age of the patient, results of the previous IVF cycles, and the quality of the embryos.
- Post ET Treatment - Progesterone support is given to all patients in the form of vaginal pessaries/gels or intra muscular injections. A blood test is done 14 days after the embryo transfer to see if it positive for pregnancy.