ICSI steps


What is IVF ? 

In vitro (Latin: In glass) fertilization (IVF)  is a form of assisted reproductive technology (ART) during which the process of fertilizing eggs with sperm is done outside of the human body. Once the eggs are fertilized, the resulting embryos are placed in the woman’s uterus hoping for a successful pregnancy.

Is Test Tube Baby same as IVF ?

Decades back, females who had blocked tubes, did not stand any chance of pregnancy until scientists and doctors devised a way to fertilize eggs outside human body. Since the process of fertilization of eggs was done in lab instead of fallopian tube, the term test tube baby was used by laymen who did not understand the complexities of IVF. Essentially “Test Tube Baby” is same as IVF and is used interchangeably. Many IVF Center’s in India still use the term Test Tube Baby Centre for the benefit of common man.

When is IVF recommended ?

IVF is done to help a woman become pregnant. It is used to treat many causes of infertility, including:

  • Damaged or blocked fallopian tubes (can be caused by Pelvic Inflamatory Disease or prior reproductive surgery)
  • Severe Endometriosis or mild to moderate endometriosis not responding to IUI
  • Advanced reproductive age, as time to conception is critical and pregnancy rates with other therapies are low
  • Severe male factor infertility (sperm counts or sperm motility is low)-ICSI is recommended
  • Unexplained fertility problem in which other modalities have not been successful

How is IVF Procedure done?

IVF is not just one simple procedure, but a series of steps interlaced with each other and done over several weeks (usually 6 weeks). The steps involved in this procedure are:

  • Stimulating the ovaries – Super Ovulation
  • Collecting the eggs – Egg Retrieval
  • Fertilization of eggs – Insemination and Fertilization
  • Embryo Culture
  • Embryo Transfer
Step 1: Stimulating the ovaries

Hormones (Fertility Drugs) are usually given to stimulate the ovaries to produce more than the usual one egg per cycle. This is done to enable the collection of several eggs.
The development of the eggs is monitored by blood tests and Trans Vaginal Ultrasounds that ensure eggs are collected at precisely the right time.

Step 2: Egg Retrieval

At the time of ovulation the eggs are collected. An ultrasound probe is placed within the vagina while the woman is under light sedation. The ultrasound monitor shows where the follicles are within the ovaries.  The needle is connected to a suction device, which pulls the eggs and fluid out of each follicle, one at a time. The procedure is repeated for the other ovary. The woman may have some cramping after the procedure, but it usually goes away within a day.

The egg retrieval process is normally done as an outpatient procedure in the Operation Theater under General Anesthesia

If a woman does not or cannot produce any eggs, donated eggs may be used.

Step 3: Insemination and Fertilization

On the day of egg collection, the male partner provides a sample of semen. As a precautionary measure a semen sample of the husband is taken at the onset of stimulation and Cryopreserved. In a standard IVF treatment, the semen and best quality eggs are placed together in an environmentally controlled chamber. This process of mixing the egg and sperm is called insemination.  The sperm usually enters (fertilizes) an egg a few hours after insemination.

If the Embryologist feels that the chances of Fertilization using IVF is low, he/she may directly inject the sperm into the egg. This is called IntraCytoplasmic Sperm Injection (ICSI).
Step 4: Embryo culture

When the fertilized egg divides, it becomes an embryo. An embryologist will regularly check the embryo to make sure it is growing properly. Within about 3-5 days, a normal embryo has several cells that are actively dividing.

Couples who have a high risk of passing a genetic (hereditary) disorder to a child may consider Pre-Implantation Genetic Diagnosis (PGD). The procedure is done about 3 -4 days after fertilization. Laboratory scientists remove a single cell from each embryo and screen the material for specific genetic disorders. PGD can help doctors decide which embryos to implant, which decreases the chance of passing a disorder onto a child.

Step 5: Embryo Transfer

Once the embryos have grown to a predetermined size, one to a maximum of three embryo’s will be transferred back to the woman’s  womb 3 – 5 days after egg retrieval and fertilization. This procedure involves passing a very fine plastic tube (catheter) through the cervix and into the uterine cavity under ultrasound guidance. Pregnancy results if an embryo implants in the lining of the womb and is able to grow successfully.

Embryo transfer is very similar to a Trans Vaginal Ultrasound, is generally painless and usually involves no anesthetic. More than one embryo may be placed into the womb at the same time, which can lead to twins, triplets, or more. The exact number of embryos transferred is a complex decision that depends on many factors, especially the woman’s age. Unused embryos may be frozen and implanted or donated at the will of both partners at a later date.

Two weeks after the transfer, blood is taken and tested to determine if the woman is pregnant.

In recent times a newer protocol of IVF is being popularly used, it’s called a Freeze All IVF Protocol. In this protocol the Embryo’s are NOT transferred in the same cycle. Instead the Emrbyo’s are frozen and Embryo Transfer happens in the subsequent natural cycle of the patient.

What to expect during IVF Treatment ?

IVF requires a significant physical, emotional, financial, and time commitment. Stress and depression are common among couples dealing with infertility. Studies have shown that reducing stress levels can drastically improve the results of IVF. Hence it is very important to keep a positive attitude during the treatment.

From start to end a typical IVF cycle lasts upto 6 weeks. During these six weeks, based on the Steps indicated above, a woman should expect the following:

  • Multiple visits to the Clinic
  • Injecting or Ingesting Fertility Drugs at pre decided dates by the Doctor
  • Multiple Trans vaginal Ultrasounds to monitor the follicles
  • An outpatient procedure for Egg Retrieval which usually is done under General Anesthesia
  • An outpatient procedure for Embryo Transfer
  • Daily Progesterone dose either orally or as an injectable  or as a vaginal gel to help the embryo implant
  • A two week time period to patiently wait before you can perform a pregnancy test
  • Lots of Positive thoughts and a heart to deal with a Cycle failure since not all IVF Cycles are successful

What are the Risks or Side Effects of IVF ?

There is no clear evidence that infertility medicines, if used properly, increase the risk of birth defects or cancer. The increase in the hormone estrogen can cause breast tenderness, slight nausea, dizziness and slight abdominal swelling.

Occasionally, during Ovarian Stimulation too many follicles develop and the levels of the hormone estrogen rise too high, causing a condition called Ovarian Hyperstimulation Syndrome (OHSS). This is an unpleasant experience, which may include marked abdominal swelling, nausea, vomiting and diarrhoea, lower abdominal pain and shortness of breath. OHSS is rarely severe enough to require hospitalisation.

There is also a theoretical risk (very rare) of damaging other organs, or causing infection or bleeding, with the collection needle.

What is the success rate of IVF?

According to the Society of Assisted Reproductive Technologies (SART), the approximate chance of giving birth to a live baby after IVF is as follows:

  • 41-43% for women under age 35
  • 33-36% for women age 35 – 37
  • 23-27% for women ages 38 – 40
  • 13-18% for women over age 41

The main potential factors that influence pregnancy and live birth rates in IVF have been suggested to be maternal age, duration of infertility or subfertility and ovarian function.Optimal woman’s age is 23–37 years at time of treatment.In women of age more than 38 years, if suffucient number of their own oocytes are not available, IVF with oocyte donation is a good option.

When IVF Cycle Fails!

In Vitro Fertilization has a reasonable rate of success. Overall, approximately 35 percent of IVF cycles will end in a live birth after single attempt, and the cumulative chances of success are higher when more than one cycle of IVF is done.

However, an individual’s chance of success depends on several factors, including the woman’s age, cause of infertility, and treatment approach. Also with newer protocols like Freeze All IVF Cycle, the chances of conception are as high as 70%.

It can be difficult to deal with the emotional highs and lows of  Infertility Treatment. This is especially true if the woman (and her partner) have been trying to conceive for a long time or if there are any underlying problems in the couple’s life (eg, medical, family or partner, job, financial).

Counseling services are at times needed to counsel a couple especially after a failed IVF Cycle. Since results of IVF are best when more than one cycle is tried, it is important that a couple stays focused and positive during the entire treatment rather than being stuck upon a single failed result.
Video showing the entire IVF Process that happens in IVF Lab
Animated View of IVF Process
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