When entering into marriage, most couples hope to obtain a child of love. However, there are some couples who are always unable to conceive a child. Failure to conceive after a year of regular sexual intercourse without contraception is called infertility. IVF technology is one of the trump cards in the treatment of infertility. After more than three decades of development, this pregnancy assistance technology has helped many people and is increasingly becoming available to the general public. However, for many people, it is still shrouded in mystery.
1. When should I have IVF?
Female indications: pelvic tubal lesions, ovulation disorders, endometriosis, immune factors, etc.
Pelvic tubal pathology is the most common cause of female infertility, accounting for about 60% of all female infertility. The main cause is pelvic (fallopian tube) inflammation, which causes pelvic (fallopian tube) adhesions and mechanically blocks the “magpie meeting” of sperm and eggs. The specific manifestations may be chronic pelvic inflammatory disease, pelvic adhesions, tubo-ovarian inflammation, tubal obstruction, tubal umbilical adhesions, tubal effusion, etc. In the past, surgery has been the first choice of treatment, but after evidence-based medical testing, IVF has now been confirmed as the most effective method to assist pregnancy.
Ovulation disorders account for about 30% of female infertility, the most common being polycystic ovary syndrome. These patients usually have delayed menstruation or amenorrhea with polycystic ovaries, and in some cases, masculine manifestations such as acne and hirsutism caused by high androgens. The treatment of choice for ovulation disorders is ovulation induction, followed by intercourse or IUI treatment during the time period directed by the doctor. Those who remain infertile after 3-6 cycles of such treatment may consider IVF to help conceive.
The mechanism of infertility caused by endometriosis (endometriosis) is not clear. The incidence of this condition is increasing with the delay in childbearing age and the increase in abortions. It is causally linked to infertility, creating a vicious circle. The best treatment for patients with endometrial infertility is an October pregnancy. Therefore, patients with endometriosis who have fertility requirements should seek the fastest way to conceive, for which IVF may be needed to assist in pregnancy.
Immune factors are unlikely to cause infertility in women. The currently identified immune factor for female infertility is antiphospholipid antibody syndrome, which can cause embryonic death or arrested development. Other immune factors, including female anti-sperm antibodies, anti-endometrial antibodies, and closed antibodies, have not been recognized to the extent that they affect all corresponding aspects of reproduction. In addition to immunotherapy, IVF is a proven alternative method.
Male indications: male oligospermia, weak and malformed spermatozoa, immune infertility, etc.
Normal conception requires a certain number of sperm with good insemination ability. When a man’s semen does not contain enough sperm with good density and/or motility, or when the malformation rate is too high for natural conception, he will have to resort to IVF treatment. Depending on the sperm condition, the doctor will choose between conventional in vitro fertilization or intracytoplasmic single sperm microinjection.
Immunologically, anti-sperm antibodies in men at high titers can cause severe sperm agglutination and braking, impairing the male’s ability to conceive. This is one of the male infertility factors that necessitate the choice of IVF for pregnancy assistance.
In addition to the above mentioned infertility factors, sometimes infertile couples are unable to find any factor sufficient to cause infertility after exhaustive medical examination of both partners, which is called unexplained infertility. This condition accounts for about 30% of all infertility cases. The treatment of choice for such patients is intrauterine insemination between the couple. If IUI has failed 3 or more times, IVF is recommended to help conceive.
When one of the couple is unable to provide sperm or eggs for some reason, IVF assisted conception with donor sperm (eggs) can also be performed through donor sperm or eggs from another person. There are clear national regulations regarding the source of sperm and eggs, the rights and obligations of the donor and recipient parties, and the rules and procedures that must be followed.
It is important to note that the above medical indications are not dogma and cannot be applied mechanically. In addition to medical indications, the wishes of both patients, age, social, family and economic factors should also be taken into consideration when deciding on the method of assisted conception. It is recommended to listen to the analysis of the condition by professional assisted reproduction doctors and adopt their professional opinions.
2. Do you need to ask for the consent of your significant other?
Of course.
Before deciding to undergo IVF treatment, both partners should sign an IVF informed consent form in writing, indicating that both parties are informed, agree and approve of the treatment and have some understanding of the general process, expected results and complications of the treatment.
When the male partner suffers from azoospermia and the couple requests IVF with donor sperm, in addition to signing the above-mentioned informed consent form, they should also sign the relevant documents provided by the artificial sperm bank, indicating that both parties agree to use third-party sperm for conception, comply with and accept the guidelines and procedures for sperm donation, understand the rights and obligations of the donor and recipient, and be willing to bear the possible sociological implications.
3. Is an IVF baby grown in a test tube? How is it done?
No.
Rather, IVF babies are simply grown in a laboratory petri dish during the first few days of life (a few days after the egg is fertilized).
The IVF process, simply put, involves removing the mother-to-be’s eggs from the ovaries and combining the father-to-be’s sperm with the eggs in a laboratory after processing to form a fertilized egg. The fertilized egg is then artificially cultured into an embryo, which is transferred back to the mother-to-be’s uterus at the right time. Of course, there are many steps before and after, such as
Ovarian function assessment: The ovarian reserve capacity and hormonal status are checked at specific times of the menstrual cycle to determine the feasibility of performing IVF and to develop an egg preparation protocol. Ovulation preparation: The most common method is ovulation promotion, during which injections and medications may be administered, ultrasound may be performed to check follicle development, and sometimes blood may be collected to check hormone levels for adjustment of ovulation medication usage. As ovulation techniques mature and concepts are updated, ovarian microstimulation is increasingly becoming a widely used method of egg preparation. Egg retrieval, in vitro fertilization, embryo culture: When the eggs have grown to maturity, they are removed from the follicle by puncturing the ovary with a fine needle, called egg retrieval. After egg retrieval embryologists in the laboratory get busy with semen processing, in vitro fertilization and fertilization observation, and embryo culture. In vitro fertilization methods include single sperm microinjection into the oocyte plasma, in addition to the conventional in vitro fertilization method of mixing sperm and eggs. Usually, the day after egg retrieval, embryo formation is informed and a decision is made on when to proceed with embryo transfer. Embryo transfer: A special catheter is used to carefully place the embryo into the most appropriate part of the endometrium. After the transfer, you may also need to take injections or medication for post-embryo transfer luteal support. Wait for about two weeks and the mother-to-be will have a chance to upgrade!
4. What are the preparations for IVF?
”Three certificates” and medical examination.
Before actually entering the IVF cycle, the doctor will ask the patient and the couple a detailed medical history to determine the necessity and feasibility of IVF, ask the patient and the couple to present proof of marriage and identity, proof of family planning (commonly known as the “three certificates”), and conduct the necessary physical examination and laboratory tests.
5.How much does it cost to do it once?
Tens of thousands of dollars.
Although IVF technology has long since been removed from its “aristocratic” status and has come to the common people, it is still relatively expensive due to its technical precision and complexity, which requires the use of expensive ovulation drugs, surgical equipment, laboratory instruments and reagents. Most domestic fertility centers charge around RMB 15,000 – 40,000.
6.What are the chances of success?
40%.
What is the success rate of IVF? First of all, the “success rate” of IVF is differentiated between “fresh cycles” (i.e. embryo transfer in ovulation cycles) and frozen-thawed embryo transfer cycles. These are divided into “transfer cycle clinical pregnancy rate” and “transfer cycle live birth rate”, as well as many other success rate measures. The clinical pregnancy rate for a transfer cycle is the probability of at least one gestational sac being observed in the uterus after transfer for each treatment cycle in which an embryo is transferred, and the live birth rate for a transfer cycle is the probability of a live birth for each treatment cycle in which an embryo is transferred. Since clinical pregnancy is a prerequisite for live birth, and not all clinical pregnancies result in live birth, these two indicators of success are in the range of 40% and 25%, respectively, in fresh cycles; frozen-thawed embryo transfer cycles are correspondingly lower, at around 30% and 20%. At first glance, it seems that the overall success rate of IVF is very low, but considering that the probability of natural human conception is only 15% per month, this is an acceptable result. Of the many factors that affect success rates, the most critical one is the age of the patient. Regardless of the infertility factor undergoing IVF treatment and regardless of the egg preparation method, the success rate is significantly higher in the <36 years old group of patients. Very few successful patients (non-egg donor IVF) were >44 years of age.
7. Is IVF the same as any other normal child?
The same.
After following up hundreds of thousands of IVF babies in several European fertility centers, it was determined that there were no significant differences between these babies and natural babies in terms of physical, health, intellectual, emotional, and social adaptation. There was no significant increase in the incidence of congenital defects in IVF babies compared to natural births. Of course, since the world’s first IVF baby is still only 30 years old, there are no problems with the IVF babies themselves, but what about their offspring? This is subject to further follow-up and observational studies.
8. Can I have multiple babies with IVF?
Yes.
In fact, in order to increase the conception rate, multiple embryos are transferred (2-3 embryos), resulting in a significantly higher rate of multiple pregnancies in IVF than in natural pregnancies. Multiple pregnancies are inconsistent with human reproductive physiology and pose a higher risk of pregnancy complications and perinatal disorders, such as premature rupture of membranes, preterm delivery, intrauterine growth retardation, and gestational hypertensive syndrome. IVF for the purpose of obtaining multiple births is not advisable. How to minimize multiple pregnancies, especially three or more pregnancies, while maintaining the pregnancy rate is one of the research directions in the development of IVF technology.
9. Is IVF painful for women?
It can be tolerated.
There are two surgical procedures involved in the whole IVF treatment cycle. Normally, these two procedures are not very painful for women and there is no need to be anxious about them.
One of the procedures is egg retrieval. When IVF was first introduced, egg retrieval was done by cesarean section or laparoscopy, which can be described as “killing the chicken to get the eggs” and was painful. Nowadays, ultrasound-guided fine needle puncture of the ovaries is commonly used for egg retrieval. Although there is still some discomfort, most patients can tolerate this discomfort and usually do not require additional anesthesia or analgesia. Another surgical procedure is embryo transfer. This operation causes little to no sensation to the patient.
If there are any questions in the above explanation, you can also request a one-on-one consultation with me by applying for the telephone consultation service, and I can give you specific instructions by way of telephone communication.