Everything you need to know about IVF - By Dr Aindri Sanyal, Fertility Consultant, Nova IVF Fertility, Kolkata

1.What is In-Vitro Fertilization?

It’s been almost four decades since IVF (in vitro fertilization) was first used. It is a complex series of procedures that helps with fertility or prevent genetic problems and assist with the conception of a child. It is a kind of assisted reproductive technology that aids couples to have baby, who are unable to conceive naturally. A woman's egg and sperm are normally fertilized inside her body. A baby is born roughly 9 months after the fertilized egg attaches to the uterine lining and continues to grow. Natural or unassisted conception is the name given to this process. Many factors, like your age and the cause of infertility, influence your possibilities of having a healthy baby with IVF. Also, IVF can be time-consuming, and intrusive. The chances of having a healthy baby with the IVF process depend on several factors like the age of both male and female and their cause of infertility.

2.How long should one wait before consulting a fertility doctor?

If you are under 35 years of age and have been trying to conceive naturally for more than 12 months, then it is time to see a fertility specialist. In Indian women, the ovarian reserve usually declines rapidly after the age of 35. As we age, an otherwise healthy woman's egg stores begin to deplete and are completely depleted by the age of 40 to 45, leading to perimenopause & finally menopause. If you are over 35 years old and have tried to conceive naturally but have failed for 6 months or more, see a fertility specialist immediately. Even with assisted reproductive technology, women over 35 are less likely to get pregnant, because, at older ages, the quality of the eggs may not be the best. As we age, other complications can also occur, leading to the depletion of the ovarian reserve.

3.What factors determine if a patient is suitable for IVF treatment?

Maternal age: The younger you are, the more likely you are to use your own eggs to conceive and deliver a healthy baby during IVF. Embryo scores have been established indicating that embryo morphology is an important factor in IVF and embryo transfer because the increase in pregnancy rate is directly proportional to the number and quality of embryos transferred. On the other hand, fragmented embryos can conceive normally, but this occurs less frequently than non-fragmented embryos.

Ovulation disorders: For women who conceive naturally, normal, and regular ovulation is required, or the release of mature eggs. Keeping a monthly calendar or using an ovulation prediction kit can help you identify ovulation. Tubal occlusion (blockage): If both tubes are blocked, in vitro fertilization (IVF) is required.

4.What are the different tests one must go through if they haven't conceived after a year of trying naturally?

• Blood tests and semen analysis. Blood test to check the levels of female hormones, thyroid hormones, prolactin, and male hormones, as well as HIV and hepatitis. A physical exam may include a pelvic exam to look for chlamydia, gonorrhoea, or other genital infections that can cause fertility problems. The male partner may also need to be evaluated for genital infection. Doctors recommend your male partner perform a complete semen analysis to check the number, shape, and motility of sperm.
• AMH test-This is a kind of test that will measure the level of anti-müllerian hormone (AMH) in the blood and AMH is made in the reproductive tissues of both males and females which is important as it plays an important role in the development of sex organs in an unborn baby.
• Thyroid test -It is a method for testing the viability of sperm and interaction with cervical mucus.
• Transvaginal ultrasonic exam (pelvic). Check the state of ultrasound, uterus, and ovaries.
• Hysterosalpingogram. HSG helps diagnose occlusion of oval tubes and uterine defects. The uterine verification doctor allows you to see and shoot that area to find the problem.
• Laparoscopy. Among these, laparoscopes are inserted into the abdomen through small incisions to find endometriosis, healing, and other conditions.
• Endometrial biopsy. The doctor may want to apply for the coating of your Uterus lining to see if it is normal, so the embryo could implement it.

5.What restrictions should one follow while going through the treatment?

• Keep an eye out for substance abuse: It's critical to avoid smoking, drinking, and taking drugs that aren't prescribed during therapy to maximize your chances of success hence one must avoid it at all costs.
• When infertility is due to blocked fallopian tubes or severe male factor infertility, IVF is the only treatment. In other cases, the age of the woman and the number of years of infertility becomes the decisive factor. The ovaries of Indian women age earlier than white women, so once they reach their thirties, they must be actively treated.
• Developing healthy eating habits and regular exercise should be incorporated into your lifestyle. Excess intake of vitamin supplements will not help. Get vitamins from natural products like fresh fruits and nuts. Common vitamin D deficiency in India can affect fertility, so check.

6.How long does the process of IVF take?

Each cycle can be slightly different, but the fertilization in vitro or the FIV process generally lasts from 2 to 6 weeks. Patients with IVF use the first three weeks of cycles to take care of their hormones and synchronize the menstrual period. This ensures that the drug is taken by it is taking. The medical professional of your fertility clinic will give you a comprehensive timeline calendar from IVF and a sheet of medications that your fertility clinic professional needs.

7.What kind of diet should one follow before and during the treatment?

An anti-inflammatory diet contributes to the success of IVF. To do this, try to reduce your intake of processed foods, fast food, and sugar. Healthy fats, whole grains, fruits and vegetables, and clean proteins like fish, beans, and low-fat poultry are all part of an anti-inflammatory diet. Whole grains, fish, and nuts rich in omega 3 contribute significantly to a healthy endometrium. Soy products are good for women undergoing IVF and are even considered beneficial.

8.If an IVF is unsuccessful, how long should one wait before trying again?

Statistically, there is no significant difference between the success rate of successive repetition cycles and the success rate obtained after a few months. Studies have shown that in terms of success rate, the time gap between failure and subsequent IVF cycles is negligible. Therefore, it is entirely up to the patient to decide how long they should wait and try again after the initial failure of IVF, although they should wait long enough to recover from the trauma. Therefore, they are advised to wait a while before the subsequent attempt, although they can answer the call at any time. At the same time, they must adopt a healthy, stress-free lifestyle and prepare for the joyous journey that awaits them.

9. What is the age limit for opting for IVF?

The age of women plays an important role in IVF. For any couple, this is a key factor in the success of IVF. If a woman is under 35 and receives IVF, the chance of pregnancy is very high, while for women over 40, the chance of pregnancy is lower and choosing between fallopian tube reversal or test tube baby is a difficult choice.

The decision must be based on the costs involved, success rate, and fertility-related issues. For example, if a couple wants several children and the woman is still young, then tubal inversion is a better choice. If only one child is needed and the woman is over 35 years old, IVF is the best option. Over the age of 42 or 43, the success rate of IVF and fallopian tube reversal is the same and extremely low. However, if all age groups are considered, the success rate of IVF is higher than that of fallopian tube reversal. From a cost standpoint, fallopian tube reversal is more cost-effective than IVF.

10. Are there any side effects associated?

Some side effects of injected fertility drugs include mild bruising and pain at the injection site, nausea, or occasional vomiting. Temporary allergic reactions like skin redness and/or itching at the injection site, breast tenderness, increased vaginal discharge, mood swings, and fatigue Ovarian hyperstimulation syndrome (OHSS) can also be seen. Most of the symptoms of OHSS (nausea, bloating, ovarian discomfort) are mild. They usually disappear without treatment within a few days after egg collection. In severe cases, OHSS can cause large amounts of fluid to collect in the abdomen (abdomen) and lungs. This can cause greatly enlarged ovaries, dehydration, shortness of breath, and severe abdominal pain. In very rare cases (less than 1% of women collect eggs for IVF), OHSS can cause blood clots and kidney failure.

11. What other tests can be combined with IVF?

Prolactin Test: Prolactin is a key hormone that is essential to produce breast milk. The results of this test allow doctors to decide the best combination of drugs for each woman.

Infectious Disease Screening - Doctors can screen patients for HIV, Hepatitis B, Chlamydia, Rubella, and Chickenpox. All these diseases can pose risks to the growing foetus and can lead to serious complications. Other options include high digital magnification, in which only the healthiest and best sperm are selected for insertion.

Fallopian tube patency test: HyCoSy, also known as hysterosalpingography ultrasound, this procedure is unique. Normal ultrasound or X-rays cannot correctly view and evaluate the condition of the uterus and whether the fallopian tubes are blocked or operated on. Semen evaluation: If a sperm sample is provided, the sample will be provided and sent to the laboratory for analysis.