ART – IVF / ICSI

Infertility means you cannot get pregnant (conceive). Primary Infertility refers to couple who have not become pregnant after at least 1 year having sex without using birth control methods.

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What is IVF?

What is TESA/TESE/PESA?

Success Rate of IVF/ICSI

Procedure of IVF

More about IVF

What is Natural Cycle IVF?

What is IVF?

IVF stands for In-vitro fertilization. It refers to the process by which a woman’s eggs are collected and then fertilized with sperms outside her womb in the laboratory.

Washed sperms are added in the petridish where eggs are collected so that one of the sperm fertilizes the egg.

The fertilized eggs (embryos) are then cultured in the laboratory and after appropriate growth; they are transferred back to the uterine cavity.

It thus bypasses the fallopian tubes completely.

What is ICSI?

ICSI stands for Intra Cytoplasmic Sperm Injection in which the sperm is injected into the oocyte instead of placing them together and allowing them to fertilize naturally. ICSI is thus a very effective method to get fertilization of eggs.

It is done by trained embryologist using specialized micro-manipulation tools and equipment and inverted microscopes which help them to select the most morphologically normal and active sperm to be injected into the oocyte cytoplasm.

This usually results in normal fertilization in approximately 70-85% of eggs injected with viable sperm.

What are Indications of IVF?

Women with tubal diseases like blocked tubes, hydrosalpinx, and previous tubectomy done.

Patent tubes but non-functional like in previous pelvic inflammatory disease or tubal tuberculosis.

Infertility due to endometriosis.

Unexplained infertility.

Infertility due to male factors like oligospermia (low count), asthenozoospermia (less motility), teratozoospermia (abnormal sperms) or a combination of abnormalities like oligoasthenoteratozoospermia.

What are Indications of ICSI?

Previously failed IVF cycle due to failed fertilization.

Severe male factor Infertility- Oligoasthenoteratozoopermia- that is very low count, low motility or high percentage of abnormal sperms.

Sperms obtained through TESA (Trans Epididymal Sperm Aspiration), PESA (Percutaneous Epididymal Sperm Aspiration), TESE (Trans Epididymal Sperm Aspiration) or Testicular Biopsy-sperms are obtained microsurgically from testis or epididymis.

What is the purpose of IVF/ICSI treatment?

By pass the fallopian tube where fertilization normally occurs, so that tubal factor is overcomed.

By removing the oocyte, the quality of egg can be assessed.

Subtle hormonal defects get corrected and endometrial receptivity improves.

ICSI bypasses inherent weakness of fertilization of normal looking sperm like acrosome defect etc. It also overcomes failed fertilization due to thick zona pellucid.

What is TESA / TESE / PESA?

In men with obstructive azoospermia (because of duct blockage or absence of the vas deferens), sperm are usually recovered from the epididymis by puncturing it with a fine needle. This procedure is called PESA (percutaneous epididymal sperm aspiration).

In TESA or testicular sperm aspiration (also known as TESE, or testicular sperm extraction), testicular tissue is sucked out through a fine needle, under local anesthesia. The sperm are then liberated from tissue and used for ICSI.

What is the success rate of IVF / ICSI?

Average success rate is around 30-35% but varies from case to case. Women with good ovarian reserve and PCOS have better cumulative success rates (60-70%) whereas women with poor ovarian reserve, damaged endometrium have poor success rate (20-30%).

Success rate depends on :

Age of couple.
Pre IVF-evaluation- use of OC pills, use of estradiol valerate, use of leuprolide.
Stimulation protocol used.
Quality of gametes (eggs and sperms) & embryos.
Number of embryos transferred.
Laboratory practises.

What is the Procedure of IVF?

It starts on Day2 of menses. Baseline ultrasonography is done to rule of ovarian cysts. If required, baseline hormones like Serum E2, LH and P4 may be done to confirm that the ovaries are suppressed.

On basis of Age, BMI, Previous stimulation result, AFC and AMH, Injections are started

Growth of follicle and endometrium is monitored by serial ultrasonography. Blood tests if required are done.

Dose of injections is increased, decreased or maintained, injections are added as and when required.

After 9 to 10 days of Injections, when 2 or more follicles are more than 18mm in diameter, trigger injection is planned.

35 hours post trigger, oocyte pick up is done. Oocyte retrieval is a surgical procedure which is done under anesthesia where the follicles are aspirated.

Aspirated follicles will be searched for oocytes, or eggs. Not every follicle will contain an oocyte.

All the oocytes which are retrieved are carefully identified and kept in the CO2 incubator.

Semen sample is obtained and semen processing done which isolates the healthiest sperms.

IVF/ICSI is performed in laboratory.

Formation of embryos and growth of embryos are monitored in the laboratory.

3 to 5 days post fertilization, embryo transfer is done. Embryo transfer is a simple procedure just like an IUI procedure done under sonography guidance. When the embryos are transferred on day 3, the embryo is said to be 8 cell stage. When the embryos are transferred on day 5, it is at the blastocyst stage. This is the highest form of human life that can be sustained in the laboratory.

If there are surplus good embryos, one can freeze them.

Luteal support is given.

Patient is asked to follow up after 15 days for result.

More about IVF

Treatment cycle can be cancelled if enough follicles don’t grow. It usually happens in older women and poor responders. It happens in around 5-6% of IVF treatment cycles.In such cases, different medications or protocols can be used in the next cycle.

Sometimes, inspite of follicles being formed, egg may not be there. That is empty follicle. It occurs due to improper trigger, ineffective trigger. It may require change in protocol and treatment regimen.

Embryo transfer may be postponed and all embryos frozen if there are excessive follicles that form like in PCOS.

There is an increased chance of multiple pregnancies and ectopic pregnancies due to the transfer of multiple embryos. However, the risks for pregnancy i.e. complications per se during pregnancy due to IVF treatment/ICSI & during delivery are unchanged.

Risk of birth defects after ICSI is the same as for babies conceived through IVF treatment without ICSI, and for those conceived naturally. However, in severe male factor infertility associated with balanced translocations and Y chromosome micro-deletion, transmission may occur to the male offspring.

It does not require bed rest or prolonged leave. It doesn’t require overnight admission.

Associated Endometriosis may affect the egg quality and implantation.

Associated Fibroids, depending on size and location may need treatment.

Associated Hydrosalphix should be treated, as the fluid affects implantation and is embryotoxic.

Exercise and healthy diet help to fight oxidant stress and improve result.

Life cycle of sperm is approximately 3 months, hence the sperms that are expelled are produced 3 months prior.Hence use of alcohol, cigarette, tobacco should be avoided. Frequent ejaculation (every 2 to 3 days) should be recommend.

In some cases, pre-cycle Hysteroscopy may be recommended.

What is Natural cycle IVF?

In women with poor ovarian reserve, giving excessive injections doesn’t improve the outcome in terms of quantity and quality of eggs. It instead adds to cost and trauma to the patient.

Natural cycle IVF uses minimal or no drugs to recruit naturally selected follicle. It is extremely cost effective and provides a chance of conception to women with poor ovarian reserve.

Here rather than focusing on the quantity of the eggs the focus is on the quality of the eggs collected.

The uterine lining is more receptive as there is minimal use of medication leading to better implantation.

Eggs can also be pooled using multiple cycles and then transferred back to the uterus.

The success rate of Natural Cycle IVF is reliant on a multiple factor that are beyond the control of the doctors. Therefore, the success rates of Natural Cycle IVF are comparatively low as compared to Stimulated Cycle IVF fertility treatment.

What is TESA/TESE/PESA?

Success Rate of IVF/ICSI

Procedure of IVF

More about IVF

What is Natural Cycle IVF?

ART – IVF / ICSI

Infertility means you cannot get pregnant (conceive). Primary Infertility refers to couple who have not become pregnant after at least 1 year having sex without using birth control methods.

What is IVF?

IVF stands for In-vitro fertilization. It refers to the process by which a woman’s eggs are collected and then fertilized with sperms outside her womb in the laboratory.

Washed sperms are added in the petridish where eggs are collected so that one of the sperm fertilizes the egg.

The fertilized eggs (embryos) are then cultured in the laboratory and after appropriate growth; they are transferred back to the uterine cavity.

It thus bypasses the fallopian tubes completely.

What is ICSI?

ICSI stands for Intra Cytoplasmic Sperm Injection in which the sperm is injected into the oocyte instead of placing them together and allowing them to fertilize naturally. ICSI is thus a very effective method to get fertilization of eggs.

It is done by trained embryologist using specialized micro-manipulation tools and equipment and inverted microscopes which help them to select the most morphologically normal and active sperm to be injected into the oocyte cytoplasm.

This usually results in normal fertilization in approximately 70-85% of eggs injected with viable sperm.

What are Indications of IVF?

Women with tubal diseases like blocked tubes, hydrosalpinx, and previous tubectomy done.

Patent tubes but non-functional like in previous pelvic inflammatory disease or tubal tuberculosis.

Infertility due to endometriosis.

Unexplained infertility.

Infertility due to male factors like oligospermia (low count), asthenozoospermia (less motility), teratozoospermia (abnormal sperms) or a combination of abnormalities like oligoasthenoteratozoospermia.

What are Indications of ICSI?

Previously failed IVF cycle due to failed fertilization.

Severe male factor Infertility- Oligoasthenoteratozoopermia- that is very low count, low motility or high percentage of abnormal sperms.

Sperms obtained through TESA (Trans Epididymal Sperm Aspiration), PESA (Percutaneous Epididymal Sperm Aspiration), TESE (Trans Epididymal Sperm Aspiration) or Testicular Biopsy-sperms are obtained microsurgically from testis or epididymis.

What is the purpose of IVF/ICSI treatment?

By pass the fallopian tube where fertilization normally occurs, so that tubal factor is overcomed.

By removing the oocyte, the quality of egg can be assessed.

Subtle hormonal defects get corrected and endometrial receptivity improves.

ICSI bypasses inherent weakness of fertilization of normal looking sperm like acrosome defect etc. It also overcomes failed fertilization due to thick zona pellucid.

What is TESA / TESE / PESA?

In men with obstructive azoospermia (because of duct blockage or absence of the vas deferens), sperm are usually recovered from the epididymis by puncturing it with a fine needle. This procedure is called PESA (percutaneous epididymal sperm aspiration).

In TESA or testicular sperm aspiration (also known as TESE, or testicular sperm extraction), testicular tissue is sucked out through a fine needle, under local anesthesia. The sperm are then liberated from tissue and used for ICSI.

What is the success rate of IVF / ICSI?

Average success rate is around 30-35% but varies from case to case. Women with good ovarian reserve and PCOS have better cumulative success rates (60-70%) whereas women with poor ovarian reserve, damaged endometrium have poor success rate (20-30%).

Success rate depends on :

What is the Procedure of IVF?

It starts on Day2 of menses. Baseline ultrasonography is done to rule of ovarian cysts. If required, baseline hormones like Serum E2, LH and P4 may be done to confirm that the ovaries are suppressed.

On basis of Age, BMI, Previous stimulation result, AFC and AMH, Injections are started

Growth of follicle and endometrium is monitored by serial ultrasonography. Blood tests if required are done.

Dose of injections is increased, decreased or maintained, injections are added as and when required.

After 9 to 10 days of Injections, when 2 or more follicles are more than 18mm in diameter, trigger injection is planned.

35 hours post trigger, oocyte pick up is done. Oocyte retrieval is a surgical procedure which is done under anesthesia where the follicles are aspirated.

Aspirated follicles will be searched for oocytes, or eggs. Not every follicle will contain an oocyte.

All the oocytes which are retrieved are carefully identified and kept in the CO2 incubator.

Semen sample is obtained and semen processing done which isolates the healthiest sperms.

IVF/ICSI is performed in laboratory.

Formation of embryos and growth of embryos are monitored in the laboratory.

If there are surplus good embryos, one can freeze them.

Luteal support is given.

Patient is asked to follow up after 15 days for result.

More about IVF

Treatment cycle can be cancelled if enough follicles don’t grow. It usually happens in older women and poor responders. It happens in around 5-6% of IVF treatment cycles.In such cases, different medications or protocols can be used in the next cycle.

Sometimes, inspite of follicles being formed, egg may not be there. That is empty follicle. It occurs due to improper trigger, ineffective trigger. It may require change in protocol and treatment regimen.

Embryo transfer may be postponed and all embryos frozen if there are excessive follicles that form like in PCOS.

There is an increased chance of multiple pregnancies and ectopic pregnancies due to the transfer of multiple embryos. However, the risks for pregnancy i.e. complications per se during pregnancy due to IVF treatment/ICSI & during delivery are unchanged.

It does not require bed rest or prolonged leave. It doesn’t require overnight admission.

Associated Endometriosis may affect the egg quality and implantation.

Associated Fibroids, depending on size and location may need treatment.

Associated Hydrosalphix should be treated, as the fluid affects implantation and is embryotoxic.

Exercise and healthy diet help to fight oxidant stress and improve result.

Life cycle of sperm is approximately 3 months, hence the sperms that are expelled are produced 3 months prior.Hence use of alcohol, cigarette, tobacco should be avoided. Frequent ejaculation (every 2 to 3 days) should be recommend.

In some cases, pre-cycle Hysteroscopy may be recommended.

What is Natural cycle IVF?

In women with poor ovarian reserve, giving excessive injections doesn’t improve the outcome in terms of quantity and quality of eggs. It instead adds to cost and trauma to the patient.

Natural cycle IVF uses minimal or no drugs to recruit naturally selected follicle. It is extremely cost effective and provides a chance of conception to women with poor ovarian reserve.

Here rather than focusing on the quantity of the eggs the focus is on the quality of the eggs collected.

The uterine lining is more receptive as there is minimal use of medication leading to better implantation.

Eggs can also be pooled using multiple cycles and then transferred back to the uterus.

The success rate of Natural Cycle IVF is reliant on a multiple factor that are beyond the control of the doctors. Therefore, the success rates of Natural Cycle IVF are comparatively low as compared to Stimulated Cycle IVF fertility treatment.

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