IVF (In - Virto Fertilization) treatment in India

Fertility
If you have been trying to start a family without success you are not alone. The World Health Organization estimates that approximately 8-10% couples experience some for of infertility. But don't panic. There's a lot that can be done to help you. To understand what causes infertility you need to know a bit about fertility, the ability to make babies.

Fertility Facts
It takes one sperm and one egg to create a baby. If you and your partner have been trying to conceive a child for one year and it hasn't happened yet, technically you are experiencing infertility.

In order for pregnancy to occur, an egg has to be released from the ovary and unite with a sperm. Normally this union, called fertilization, occurs within the fallopian tube, which joins the uterus (womb) to the ovary. However, in IVF the union occurs in a laboratory after eggs and sperm have been collected. Embryos are then transferred to the uterus to continue growth.

When it doesn't happen, what are the possible causes?
Conception is a problem of the couple and is definitely not just a woman's problem. Both male and female should be healthy and fertile for a pregnancy to occur. Factors such as smoking, excess exercise, stress, alcohol, poor nutrition, body weight and use of contraceptive can have an impact on the ability to get pregnant. Besides, there are biological factors in males and females that affect fertility.

The most common MALE factors:
+ Complete absence of sperms.
+ Low and very low sperm count.
+ Poor movement of sperms.
+ Defective production of sperms.
+ Infections.

The most common FEMALE factors:
+ Defective or no ovulation.
+ Tubal blocks.
+ Previous infections.
+ Hormonal defects.
+ Uterine abnormalities.

What are the basic tests for MALE and FEMALE infertility?
Semen analysis in males and ovulation study by ultrasound and a uterine tube test (HSG) and other tests in case of females.

What are the methods adopted to help couple achieve pregnancy?
+ Normal sexual activity timed during ovulation. If a woman has regular periods, it is best to have sexual activity on 10th., 12th, 14th, 16th, or 18th. day, with the day the period begins being counted as the 1st. day for this purpose. Please consult your doctor if your periods are irregular.

+ Depending on test results, different treatments can be suggested. Eighty five to ninety percent of infertility cases are treated with drugs and surgery.

+ Assisted Reproduction Technology (ART)
(a) IUI (Intra Uterine Insemination) which involves inserting a processed sperm
sample into the womb to coincide with ovulation to increase the chances fo
conception taking place?
(b) Test Tube baby procedure (IVF - ET)
(C) ICSI - ET is used to treat couples who previously had failure in conceiving
due to the extremely low sperm count of the male partner.

Ideal IVF Candidates
Both fallopian tubes are absent or blocked due to surgery or tubal pregnancy) or infection (STD, or Tuberculosis) Endometriosis
Reduced sperm count or motility (IVF can be normally performed for counts which are more than 5 million per ml. For counts less than 5 million per ml. ICSI is a better option.) Patients where all other treatments such as ovulation induction with intra uterine insemination have proven unsuccessful.

Patients with unexplained infertility where all the investigations performed on the couple are normal, but who still do not conceive with routine treatments. Patients who have failed to become pregnant in- spite of all routine treatments of infertility.

Patients who want to become pregnant by the procedure of embryo and egg donation. In our unit, the success rates of IVF are in the region of 20 to 30%, which are comparable to the leading units in the world.

IVF Procedure
There are five major steps in the IVF and embryo transfer sequence:

1. Monitor the development of ripening egg(s) in the ovaries
2. Collection of eggs
3. Obtaining the sperm
4. Putting the eggs and sperm together in the laboratory, and providing correct
conditions for fertilization and early embryo growth
5. Transferring the embryos into the uterus

To control the timing of egg ripening and to increase the chance of collecting substantial number of eggs, fertility drugs are prescribed according to each individual case. Before determining the egg retrieval schedule, we perform an ultrasound of the ovaries to check the development of eggs and a blood/urine test to measure hormone levels.

The Egg Retrieval Process
The retrieval procedure to obtain the eggs is performed trans-vaginally using a hollow needle guided by the ultrasound image (this is completely comfortable under adequate sedation and local anesthesia). Eggs are gently removed from the ovaries using the needle. This is called "follicular aspiration." Its timing is crucial because the egg will not develop properly if it is collected too early; if too late, the egg also may develop poorly or may have already been released from the ovary and lost.

The eggs are immediately identified by our embryologists in our special IVF laboratory. They are placed with the sperm in incubators to allow fertilization to take place. The eggs are examined carefully at intervals to ensure that fertilization and cell division have taken place; the fertilized eggs are now called embryos.

Embryos are usually placed in the wife's uterus 2 or 3 days after egg retrieval. A speculum is inserted into the vagina to expose the neck of the womb (cervix). The embryos are suspended in a tiny drop of fluid and then very gently introduced through a catheter into the womb, often under ultrasound guidance. The transfer is followed by a resting period, blood tests and possibly ultrasound examinations to verify if pregnancy has been established.

Getting Help !

The Manipal Andrology and reproductive Services (MARS) offers a wide range of treatment programmes for subfertile couples. The pioneering technological improvements make the department one of the most advanced centres for the treatment of infertility.

Treatments and Facilities:
+ Comprehensive Semen Analysis
+ Specialized sperm functional studies for sperm micro structural defects.
+ Advanced studies for sperm egg interaction (only centre in India offering thus
facility)
+ Sperm processing with IUI.
+ Sperm cryopreservation.
+ Surgical sperm retrieval and microsurgery.
+ Evaluation of female factors for like ovulation, tubal assessment, follicular and
pelvic ultrasound.
+ Ovulation induction.
+ Donor semen Bank.
+ Endoscopy - laparoscopy and hysteroscopy.
+ IVF and ICSI.
+ Support services if in-house hormonal lab.
+ Embryocryopreservation.
+ Tissue cryopreservation and sperm retrieval techniques.

To summarize, the IVF procedure consists of:

(A) Controlled Ovarian stimulation with drugs (GNRH Analogues and
Gonadotropins) to produce many eggs.
(B) Monitoring of follicles and egg development with the aid of vaginal
sonography and serial Estradiol hormone estimation.
(C) Administration of HCG injection, (Human Chorionic Gonadotropins) when the
two leading follicles are 18mm in diameter.
(D) Oocyte or egg retrieval under short general anesthesia, 35 to 37 hours after
HCG injection.
(E) Identification and isolation of eggs in the laboratory.
(F) Sperm collection and processing in the lab.
(G) Fertilization of the egg with the sperm.
(H) Embryo formation 2 to 5 days after fertilization.
(I) Embryo transfer of good quality embryos back to the womb, after 2(four cell
embryo), 3 (six-eight cell embryo) or 5 (Blastocyst stage) days after egg
removal.

IVF treatment in India FAQ's

What is Infertility ?
Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children. Conception is a complicated process that depends upon many factors: on the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm's ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman's uterus; and sufficient embryo quality.

Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.

What Causes Infertility ?
No one can be blamed for infertility any more than anyone is to blame for diabetes or leukemia. In rough terms, about one-third of infertility cases can be attributed to male factors, and about one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 20 percent of cases, is unexplained.

The most common male infertility factors include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality.

The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (a sometimes painful condition causing adhesions and cysts). Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages.

How is Infertility Diagnosed ?
Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. The doctor will conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place properly for conception.

If no cause can be determined at this point, more specific tests may be recommended. For women, these include an analysis of body temperature and ovulation, x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis.

How is Infertility Treated ?
Most infertility cases "85 to 90 percent" are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs.
Mediescapes India

What is In Vitro Fertilization ?
In infertile couples where women have blocked or absent fallopian tubes, or where men have low sperm counts, in vitro fertilization (IVF) offers a chance at parenthood to couples who until recently would have had no hope of having a "biologically related" child.

In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a Petri dish ("in vitro" is Latin for "in glass"). After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the women's uterus, thus bypassing the fallopian tubes.

IVF has received a great deal of media attention since it was first introduced in 1978, but it actually accounts for less than five percent of all infertility treatment in the United States.

Is In Vitro Fertilization Expensive ?
The average cost of an IVF cycle in India is US$ 2000 excluding drugs and freezing etc. Like other extremely delicate medical procedures, IVF involves highly trained professionals with sophisticated laboratories and equipment, and the cycle may need to be repeated to be successful. While IVF and other assisted reproductive technologies are not inexpensive, they account for only three hundredths of one percent (0.03%) of your health care costs.

Does In Vitro Fertilization Work ?
Yes. Since early 90's, when IVF was introduced in the country., more than 45,000 babies have been born from IVF and over 70,000 from all assisted reproductive technologies. The average live delivery rate for IVF during early 20th. century was 22.5 percent, about the same as the 20 percent chance in any given month that a reproductively healthy couple has of achieving pregnancy and carrying it to term.

Do Insurance Plans Cover Infertility Treatment ?
The degree of services covered depends on where you live and the type of insurance plan you have. Some countries do have laws that require insurers to either cover or offer to cover some form of infertility diagnosis and treatment.