Nearly one in six couples will encounter fertility problems, defined as failure to achieve a clinical pregnancy for a 12-month delay. Steadily increasing numbers of couples are turning to IVF-ICSI treatment, conceiving and ultimately giving birth to a healthy live baby of their own.
Since the first ‘IVF baby’, Louise Brown, was born using natural IVF in 1978, the technology has advanced, and techniques refined to create a safer and successful treatment. IVF success rates have been increasing with the advances in technology.
IVF can help many people achieve a successful pregnancy and a healthy baby who otherwise would never be able to conceive. It is important to know all the pros and cons for the couples and decide whether this is a good option. While some couples might choose to remain childless or adopt instead of undergoing IVF, others choose IVF treatment accepting the risks and costs are worth the potential outcome.
A woman’s fallopian tubes may become blocked due to previous pelvic infections such as appendicitis, chlamydia, or endometriosis, previous pelvic surgeries.
When fallopian tubes are blocked or damaged women can not be able to have a successful pregnancy using their eggs. IVF is the only possible treatment when attempting to conceive. With IVF, eggs can be harvested from the ovaries and the embryo will be implanted directly into the uterus, so the issue of non-functioning tubes is bypassed.
As the women age ovarian reserve drops. Some women do not have a naturally high egg count. IVF helps by concentrating on quality as opposed to quantity, with healthy eggs being fertilized and implanted.
If the quality of the man’s sperm or the sperm count is an issue, IVF is a good option because it injects the sperm directly into the egg by ICSI (Intracytoplasmic Injection of the sperm into the egg),which facilitates successful fertilization of an egg. Couples with a male infertility problem will have a much higher chance of conceiving with IVF than conceiving naturally.
Where no obvious reason for infertility is found after fertility tests and a variety of interventions, IVF may prove a good option to help couples conceive. In some cases of unexplained infertility, there could be a problem with fertilization. Cases such as these may not be diagnosed until fertilization is attempted in the laboratory.
Women with early menopause or premature ovarian failure can no longer conceive naturally with their eggs. They can have IVF treatment using donor eggs, which typically has high success rates.
PCOS causes irregular menstrual cycles due to a hormone imbalance, which can make conception difficult. IVF can help women with PCOS fall pregnant. IVF has been proved very successful for PCOS women, who do not conceive with ovulation induction treatments.
Endometriosis is a condition where parts of the lining of the womb grow outside of the womb. Endometriosis might negatively impact fertility. Surgery, ovulation induction with intrauterine insemination (IUI),and IVF are treatment options that help women with endometriosis to conceive. In women whose ovarian reserve is compromised and/or who are over 35 years of age IVF is chosen as the primary option for treatment.
Preimplantation genetic diagnosis (PGD) gives information about embryos’ genetic health to help us to select the best embryo for transfer and improve the chance of achieving a successful pregnancy. For couples who are known carriers of genetic disorders such as cystic fibrosis, Huntington’s disease, Sickle cell anemia, Tay-Sachs disease, or Duchenne muscular dystrophy, IVF with PGD is one of the most reliable ways to ensure that a child conceived will not suffer from the disorder.
Pre-implantation genetic screening (PGS) can improve the chances of a successful outcome, as it screens embryos for chromosomal disorders such as Down’s syndrome.
IVF treatments are costly procedures than other fertility treatments such as ovulation stimulation and intrauterine insemination cycles (IUI). These include also medications, blood tests, and other costs besides the procedure itself.
When no follicle develops or none of the few number of small follicles grow to reach adequate size for egg collection during the stimulation phase of IVF treatment, the egg retrieval procedure is canceled. During treatment, women whose ovaries do not produce enough eggs (or follicles) are called “poor responders”. The rate of the poor responder women is between 5% and 35% varying to the age of the women.
During the ovarian stimulation as a part of the IVF treatment stages, injectable fertility medications are used to retrieve multiple eggs. A very few women might have some reaction to the medications such as nausea, soreness or bruising from Injections, breast tenderness, allergic reactions, hot flushes, and fatigue.
When the follicles are enough in size to retrieve mature eggs, human chorionic gonadotropin (hCG) is injected to trigger ovulation, and the egg collection procedure is done 35-36 hours later under anesthesia. It is a minor surgery and most women have no bad effects. Very rarely, some women might have vaginal bleeding, intra-abdominal bleeding, intestinal injuries, as a risk of the needle injuring structures such as the bladder, bowel, or a blood vessel during the procedure.
The egg retrieval rate per egg collection procedure ıs around 80% of the follicles. In some cases, there are very few follicles available and on rare occasions, no egg is retrieved.
The fertilization rate of the mature eggs collected is approximately 60-85%. Immature eggs cannot be fertilized in standard IVF, even also if sperm is directly injected into the egg by ICSI. The fertilization rate may be lower than the average if the eggs are of poorer quality and/or the sperm used is very poor. Very rarely, no eggs are fertilized due to poor sperm or egg quality, yielding no embryos for implantation.
Patients of advanced age with low ovarian reserves are at the greatest risk of having suboptimal embryo/blastocyst development and embryo transfer cancellation. In general, there is an 11% increased likelihood of cycle cancellation for every additional year of age. Maternal age and ovarian reserve markers are the most important predictors of poor embryo development.
Ovarian stimulation for IVF is associated with up to a 5% risk of severe OHSS. Risk factors include the presence of more than 15 follicles greater than 12 mm in diameter, AMH greater than 3.5 ng/mL, PCOS-anovulatory infertility, BMI less than 25 kg/m 2, and the establishment of a successful pregnancy.
OHSS may be categorized as early-onset (<10 days from egg collection, and related to ovarian stimulation protocols and hCG trigger shot) or late-onset (≥10 days from egg collection, and related to endogenous hCG production from the pregnancy).
Fortunately, with the prevention strategies, in particular with the increased utilization of GnRH-antagonist cycles, GnRH-agonist-only or dual hCG/GnRH-agonists triggers, and elective freeze-all cycles, severe OHSS has become increasingly rare in most IVF clinics.
Implantation is the attachment of the embryo to the endometrium (uterine lining). Even though the treatment and everything up to the point of pregnancy test goes well embryos might not attach to the womb.
Recurrent implantation failure is diagnosed when it has not been possible to achieve a baby after at least three cycles of IVF, or the transfer of more than ten good quality embryos.
The success of an IVF cycle can not be guaranteed, and some patients have to undergo more than one cycle of treatment. This varies from woman to woman, and after an evaluation and consultation by the fertility specialist, the personalized likelihood of success can able to be estimated more accurately.
Early miscarriage refers to pregnancy loss before 12 weeks of gestational age, while late miscarriage occurs between 12 weeks and 24 weeks. Most miscarriages take place before 12 weeks of pregnancy.
As women get older the incidence of chromosomally abnormal eggs increases dramatically. This results in lower chances of getting pregnant at all, as well as increasing the risk of miscarriage. For women over 40, the rate is a 35-40 % risk of miscarriage, women over age 45 can have up to a 60% risk of miscarriage.
An ectopic pregnancy occurs when a fertilized egg implants in a site other than the endometrial lining of the uterus, usually in the fallopian tubes. Even though the embryo is placed into the uterus during the embryo transfer procedure, an ectopic pregnancy can still occur.
The fallopian tube can not hold a growing embryo and can not stretch like a uterus. Symptoms of a ruptured ectopic pregnancy include the following: Low back pain, sudden, severe abdominal or pelvic pain, pain in the shoulders, fainting, or dizziness. The bleeding in the mother is a life-threatening condition that requires emergency treatment.
An ectopic pregnancy rate of 0.6% of fresh IVF cycles was initiated, which was remarkably similar to the baseline risk from natural conception. The risk is slightly higher in IVF patients with damaged fallopian tubes. The high prevalence of tubal disease and endometriosis in women undergoing IVF is associated with ectopic risk.
Around 20-30% of IVF pregnancies can result in multiple pregnancies. With the improvements in embryo selection and increased acceptance of elective single embryo transfer, the multiple gestation rate has decreased.
Pregnancies complicated by multiple gestations are associated with increased prematurity, low birth weight, gestational hypertension, gestational diabetes, a higher incidence of birth defects, and an increased perinatal mortality rate.
IVF pregnancies may be at an increased risk of pregnancy-induced hypertension, gestational diabetes, placental abnormalities, preterm delivery, low birth weight, and congenital defects. Although these risks are much higher in multiple pregnancies even singletons achieved with IVF treatment may be at a higher risk than singletons from naturally occurring pregnancies. Further studies are needed whether these risks are associated with ART per se or rather the diagnosis of infertility.
Any association between IVF treatment and an excess risk of birth defects is complex and is not fully understood and most analyses to date have been limited by several factors. Infertility is a risk factor for congenital anomalies given the equal rate of anomalies recorded in infertile patients conceiving spontaneously.
Some studies focusing on birth defects among children after IVF report that infants conceived with IVF were associated with an increased risk for birth defects compared to those conceived naturally while on the other hand most of the studies published until now show no statistically significant differences in the rates of anomalies between babies born after IVF/ICSI transfer and infertile patients conceiving spontaneously without any treatment.