IVF, or in-vitro fertilization (इन विट्रो फ़र्टिलाइज़ेशन in Hindi), is the most common artificial reproductive procedure. As the name suggests, IVF is a reproductive technique where the fertilization of the female egg by the male sperm takes place in a glass dish or tube, and not inside a woman’s body. IVF is a series of complex procedures that help couples bear a child who cannot conceive one naturally. Since its introduction, more than 8 million IVF babies have been born all around the world. In non-medical terminology, IVF baby is also known as a test-tube baby – a term that was used decades ago to refer to a fertilization procedure in a tube.
Lupron Down-Regulation, or Long Lupron Protocol
Antagonist Protocol or Short Protocol
The Flare Protocol or Microdose Lupron Co-Flare Protocol
Mini IVF or Micro IVF Protocol
Estrogen Priming Protocol
Before proceeding with IVF treatment, it is important to determine where exactly the problem lies. Both the male and female partners need to undergo certain tests so that the infertility specialist can evaluate and determine the best treatment forward. In males, the IVF doctor would conduct a general physical exam of his overall health and then examine the genitals. Specific tests in the case of men before IVF may include:
Semen analysis – The IVF doctor may ask the men for sperm and semen samples. The semen is generally collected in the lab in a clean container by masturbating. The semen specimen is sent to the lab for analysis.
Hormone testing – A man might also be asked for a blood test through which the doctor may evaluate the level of testosterone and other males hormones in his body.
Imaging tests – In certain cases, the male is suggested to undergo imaging tests such as ultrasound or MRI of his genitals to confirm if there is a presence of any abnormalities.
Vasography – This imaging test is done to check for any damage or blockage in the vas deferens, which is a long tube in males that connects the pelvic cavity to the epididymis. The vas deferens are responsible for transporting mature sperm to the urethra.
Testicular biopsy – A testicular biopsy is recommended to identify any abnormalities in the male reproductive system that might contribute to infertility.
Genetic testing – This test determines whether there’s a genetic defect that might contribute to infertility-related problems in a male.
IVF is an advanced reproductive technique and when done under the guidance and assistance of expert infertility specialists, the chances of any serious complications are very, very rare. However, there is a possibility that a patient might suffer from the following complications during and after IVF treatment.
IVF treatment is a long journey. It includes multiple steps; in most cases, a patient might require to repeat a particular step too.
Step 1: Beginning of your treatment
The IVF treatment journey begins with the doctor determining the best time during your menstrual cycle. IVF treatment requires several eggs to mature.
Step 2: Ovarian stimulation
This step is where the doctor stimulates the ovaries to promote the growth of the follicles that contain the eggs. The common hormones in the medications that are used to stimulate the follicles are Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). Once injected, the IVF doctor along with the team monitors how the ovaries respond to the medications.
Step 3: Trigger Injections
Once the doctor sees that the egg follicles in the ovaries are enough, the ovarian stimulation would be ended. During this phase, the doctor would stop the LH and FSH injections and would recommend the time when you need to administer trigger injections. The trigger injection includes injecting human chorionic gonadotropin (hCG) to mature the eggs and help them get released from the ovarian follicle wall.
Step 4: Egg retrieval
This step is also known as the ‘egg picking stage.’ This is a daycare procedure, done under general anesthesia, and is considered the only painful phase in IVF. During the procedure, the doctor inserts a fine needle with an ultrasound-guided probe through the vaginal canal of the woman to retrieve her mature eggs. The procedure generally does not take more than 30 minutes. On average, 8-15 eggs are collected during this process. Once the eggs are retrieved, the patient is allowed to go home and rest. It is best if the patient is accompanied by her partner or someone else who can help her drive and reach home safely.
Step 5: Sperm collection
After retrieving the eggs, the IVF doctor will need to collect the sperm from the male partner. At this stage, the male partner will be asked to produce his semen specimen. Every IVF lab will have a dedicated room where the male can masturbate and give his sperm/ semen specimen. The male partner can produce his semen specimen at home or at the clinic where the semen specimen would be stored. In case the couple wants to use donor sperm or frozen sperm, the IVF team will get it ready in the lab.
Once the sperm is collected, it will be washed with medicine under a microscope to get rid of all sorts of dirt and debris. This is an important step of IVF as it gives the perfect sperm which will have a fair chance to fertilize the eggs retrieved from the female. A perfect healthy sperm is one that is not very long and not too short either, not too fat or not too thin.
Step 6: Fertilization
Once the sperm is washed and concentrated, it is placed in an incubator along with the eggs for fertilization. The process is very similar to that of natural fertilization where ‘sperm meets eggs’ inside a human body.
Step 7: Embryo development
The eggs that would be fertilized by the egg would then turn into an embryo. The IVF specialist will collect the embryo, place it in a special incubator and monitor its growth for the next 4-6 days. The developed embryo would be mixed with amino acids to its growth. If the growth of the embryo is consistent, it is likely to turn into a 4-8 cell embryo by the 4th day.
Step 8: Embryo transfer
In the simplest description, embryo transfer refers to the process where the developed embryo would be transferred from the incubator and implanted in the uterine wall. This process is quick, does not take more than 20 minutes, and can be done at the clinic of the doctor. During the process, the woman would be asked to lie down on her back and spread her legs. The doctor will collect the embryo with a very soft, flexible, and thin catheter. Using a speculum, the doctor will open the cervix and insert the catheter through the cervix into the uterus.
An abdominal ultrasound is conducted to make sure that the tip of the catheter places the embryo at the best location for the embryo implantation. After the embryo implantation, the woman will be asked to remain in the lithotomy for some time, so that the embryo doesn’t come or fall out. She can head home once the process is over.
Step 9: Pregnancy check
The woman would be called to the clinic after 2 weeks for a blood test that checks the presence of hCG in the blood. If the blood test shows the presence of hCG in it, the pregnancy is successful. If the results are positive, the doctor would suggest the best pregnancy care tips to the woman and encourage her to limit strenuous physical activities.
For many couples who have struggled long enough to become parents, IVF treatment has been a boon. Many celebrities and celebrity couples have stepped into the joys of parenthood with IVF. A few of the popular names are mentioned below:
Former First Lady, Michelle Obama in her memoir, ‘Becoming’ revealed that the couple had their children – Shasha and Malia through IVF treatment. The couple decided to settle for IVF after they realized the change that their biological clocks were not facilitating a natural pregnancy.
Myth 1: IVF is a treatment for all kinds of infertility issues.
Fact: IVF is not a treatment for infertility issues. IVF is just an advanced way to conceive a child in cases where a couple cannot bear one naturally due to any infertility issue. If a woman does not ovulate, or if the male partner fails to produce quality sperm, the couple can choose IVF where the egg can is fertilized in an external environment and then the developed embryo is implanted in the uterus of the woman. IVF is not a direct treatment for ovulation disorder, but it can help couples with such disorders including cases where the man suffers from premature ejaculation. Infertility treatments treat particular infertility conditions, on the other hand, IVF is not a ‘one fits all’ treatment, it is customized according to the problems and needs of the couple or the patient.
Myth 2: IVF treatment is always 100 percent successful.
Fact: No IVF specialist can assure you of 100 percent success for IVF treatment. The outcome of IVF treatment depends upon several factors including the overall health of the woman. But, what plays a significant role in the outcome of IVF is the age of the woman. According to medical reports, the success rates of IVF in case the woman uses her own eggs are as follows:
If the woman is below 35 years of age, the percentage of live births per egg retrieval is 54.4%.
For a woman between 35 to 37 years of age, the percentage of live births per egg retrieval is 42%.
For a woman between 38 to 40 years of age, the rate of live births per egg retrieval is 26.6%.
For a woman aging between 41 to 42 years, the rate of live births per egg retrieval is 13.3%.
If the woman ages 43 or above, her chances of live births per egg retrieval goes to as low as 3.9%.
In many cases, the woman might require to undergo IVF cycle multiple times.
Myth 3: Babies born through IVF are not healthy.
Fact: Many people have a misconception that babies born through IVF are either born with physical deformities or are not as healthy as normal babies. But the fact is, the chances of an IVF baby being born with any physical and mental abnormalities is very rare. IVF is just the fertilization of the egg and the sperm outside the body; once the embryo transplant is done, the rest of the pregnancy takes place just like a natural pregnancy. The 9 months of pregnancy and the health of the baby entirely depend on the health of the mother, her lifestyle, her dietary habits, and how well she follows the necessary tips and suggestions given by her doctor.
Myth 4: IVF can have side effects on the health of the woman.
No, it is not true. IVF is a very safe and medically advanced reproductive technique. According to global reports, only 2 percent of women/couples who undergo IVF face some of the other kinds of complications, the most common being ovarian hyperstimulation. There’s no denying that IVF is a complex process and every step in the treatment needs extreme precision. But, at the same time, it is safe and easy to perform. The only thing that matters is that you undergo the treatment at the hands of an expert IVF specialist who along with his or her team can bring the best possible outcome in your treatment journey.
Myth 5: Only young couples can be benefited through IVF.
This is part fact and part myth. It is true that age plays the most vital role in deciding the success or failure of IVF treatment. But it is not that it works only in the case of young couples. Globally, many couples have become parents during the later stage of their life through IVF. If the couple is not very young, they have an option to choose donor eggs and donor sperm for their treatment.
When a couple decides to undergo IVF, it affects both the partners emotionally and physically. They both need to follow the doctor’s advice to make sure they get the best outcomes of their IVF journey.
Here are a few do’s and don’ts that both the partners need to follow during the course of their IVF cycle and throughout the process.
1. Reduce stress
IVF can be tiring for many people. The process comes along with a lot of emotional, mental, and physical stress. But, stress can have a negative effect on your entire treatment journey. Stress can adversely impact the hormones that are responsible for the reproductives system. Cutting down on your stress level is extremely important for the successful outcome of your IVF treatment.
2. Maintain a healthy weight
Overweight or underweight – both are bad for the outcome of IVF. A healthy weight helps improve the chances of conception. Cut down on our carb intake and replace it with high fiber and high protein diet. In case you are underweight, you can increase your protein and carbohydrate intake. But, you should totally cut down on consuming processed, spicy and oily foods.
3. Stay physically active
If you have stepped into your journey of IVF, it is important that you don’t go sedentary in life. Becoming physically stagnant can reduce the successful outcome of your treatment. Staying physically active is as important as your healthy diet. Include low-intensity exercises such as walking, swimming, etc in your daily regime.
4. Do not smoke or drink alcohol
Drinking alcohol or smoking cigarettes is a total no-no during IVF treatment. If you have the habit of any of these, it is better to end it before embarking on the journey of IVF.
5. Do not indulge in sex without permission from the doctor.
Refrain from indulging in sexual activities for at least 10 days after embryo implantation. Not indulging in intercourse for at least a few days increases the chances of better embryo implantation.
6. Do not compromise on your diet.
Once your IVF treatment begins, you need to be extra careful with what you eat in a day. The couple should eat a balanced diet every day. Water plays an important role in your IVF journey. Staying hydrated is an absolute must. During the process, the couple should completely avoid intake of drugs, alcohol, and smoking cigarettes.
When you and your partner fail to conceive even after trying unprotected sex for one year, you should consider seeing an infertility specialist. You may try on your own for as long as you want, but getting medical help without delay is the best decision. If you have irregular periods, ovulation troubles, or your partner has a problem ejaculating, you should seek guidance from an IVF expert. If you have a heavy thyroid, it can whack your pregnancy outcome. In that case, too, you may need to check with an IVF specialist.
Cost of IVF in major cities of India
The below-mentioned table on the cost of IVF in some of the major Indian cities can help you get an estimate of IVF cost in India. It is to be noted that the average cost of one cycle of IVF treatment (in USD) may range from 1,364.65 – 6,823,23.
|City||Average cost of one cycle of IVF treatment (in INR)|
|Delhi||1,25,000 – 1,50,000|
|Bangalore||1,40,000 – 1,80,000|
|Hyderabad||1,40,000 – 1,80,000|
|Chennai||1,40,000 – 1,80,000|
|Mumbai||1,40,000 – 1,80,000|
|Pune||1,40,000 – 1,80,000|
Cities Where We Treat Ivf
Is IVF painful?
IVF is not painful or discomforting. However, to many, the process might be tiring. Most patients do not feel any pain during any stage of the treatment. Some women, however, feel that the egg retrieval stage is a little painful. On the other hand, there are women who experience cramps and bloating during the ovarian stimulation phase – the beginning of the IVF cycle.
Where will the eggs/ sperm be stored?
There are specialized IVF labs (also known as embryology and andrology labs) where the eggs or the sperm are stored. The eggs and sperm are stored in liquid nitrogen in these labs so that the quality does not degrade. The specialized labs are designed in such a manner that the specimen does not lower the success rate of the process.
Will the treatment outcome be different if I use donor eggs or sperm?
No, using donor eggs or donor sperm will not bring any change in the outcome of the IVF treatment. The IVF specialist and the team along with lab assistant will freeze and thaw the specimen well so that it can be used whenever needed for a successful outcome.
Why do I need to have an ample amount of eggs during IVF treatment?
It is important to have a good amount of eggs while undergoing IVF treatment as there is no assurance to the human reproductive process. Some eggs might be immature, some eggs might not fertilize well normally. Most eggs do not lead to live births. So, in most cases, people require to undergo more than one IVF cycle. Hence, having a good egg reserve is important in the case of IVF.
In 1986, the first test-tube baby in India was born to Mrs. Mani Chawda, a twenty-four-year-old housewife at KEM Hospital Bombay.
According to the report published by Allied Market Research, the India IVF Services Market garnered $478.2 million in 2018 and is expected to reach $1.45 billion by 2026.
According to the Indian Society of Assisted Reproduction, infertility currently affects about 10 to 14 percent of the Indian population.
According to WHO, more than 5 million children are born worldwide from ART interventions such as in vitro fertilization (IVF).
Estimates suggest that between 48 million couples and 186 million individuals live with infertility globally.
IVF is a very critical journey. You cannot step into just any clinic and undergo the treatment. You need to do some groundwork, find out the best doctor, and make sure you are in the right hands. To get started, you can do the following:
Find out the doctor’s education and professional background, his/ her specialization, expertise, the number of IVF treatments they have offered, basically whatever you can to ensure that you are at the right place.