Understanding IVF

Dr Parul Katiyar, MS Consultant Infertility & Reproductive Medicine, Fortis Bloom IVF Center, New Delhi drparulk@gmail.com

First test tube baby

July, 25, 1978 Louise Brown

Louise Brown with Drs Patrick Steptoe (R) & Robert Edwards (L)
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Louise Brown (Middle) with her parents, Grown up

Assisted Reproductive Technology( ART)

ART refers to all techniques involving direct retrieval of oocytes (eggs) from the ovary ART procedures include
IVF GIFT ZIFT ICSI IMI

The simplest ART procedure, IVF has been around for over 20 years and is perhaps the most commonly recognized ART of all procedures
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Stages of IVF Process

Premedication Ovulation Induction Follicular Monitoring Blood Tests for Hormonal Assessment Egg Retrieval Fertilization Of Egg and Sperm (Embryology) Embryo Transfer

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IVF Preparation
Investigations:
Ensure that all the reports are done and assessed Validity of all test is 6 months

Premedications:
To ensure that the body is well prepared to achieve the best possible chance of pregnancy

Semen Freezing:
Mandatory part of standard IVF procedure to ensure back up sample Very useful in cases with low sperm count
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Methodology of Ovulation Induction

OI refers to the use of medications to stimulate ovaries to produce one or more eggs Involves taking injections known as gonadotropins; common brands are: Gonal F/ Reacagon/ Menogon etc. Injections have to be taken for 11-14 days continuously, to stimulate the growth of eggs Dose of hormones has to be individualized depending upon diagnosis, age, ovarian reserve, drug being used and numerous other factors The success of ovulation induction in achieving a pregnancy is highly variable
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Follicular Monitoring
Follicular monitoring generally starts after taking the injections for 4-5 days and is usually done on alternate days Involves regular transvaginal ultrasounds, done in the morning hours starting at 9 am You are needed to come to the ultrasound department straight, at right time There are 5-6 such serial ultrasounds done over period of 11-14 days
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Hormonal assessment
Blood Estradiol (E2): Typically done before beginning the hormone injections; thereafter on 5th day of stimulation and then as and when required Helps in correlating and estimating bodys response to hormone injections
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Egg Retrieval
Is a day care procedure Is done under short general anesthesia Using a special needle, through vagina Done under ultrasound guidance No cut on body Takes almost half an hour Patient is discharged on the same day within 6-8 hrs
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Embryo Transfer
Involves putting the embryo inside the uterus under ultrasound guidance Done after 48-72 hrs of egg retrieval No admission / Fasting required Again no cut on body
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Success Rates
Success varies with many factors, including the number of embryos that are transferred

With one embryo transferred, there is ~10% chance of successful implantation; with two embryos, this rate increases to 25-30%, with the success rate peaking with 3-4 embryos
At Fortis Bloom IVF centre, overall IVF pregnancy rate is 35-50%

Whatever the success rates, there will be some failures and each patient may statistically require up to 3 attempts at 5/31/2012 IVF 11

Embryo freezing
Technology where the embryos formed in 1 cycle can be frozen for future usage Saves the need for repeated stimulation and stringent monitoring Success rates are comparable to fresh embryo transfer cycle Helps in improving success rates in cycles where endometrial lining is not good Also useful in hyperstimulated cycles
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Team At Bloom IVF

Senior consultants
Dr HD Pai Dr Nandita Palshetkar

Embryologists
Dr Sudesh Kamath Dr Sandeep Joshi Ms Rekha

Consultants
Dr Parul Katiyar Dr Jyoti Bali

Radiologists
Dr S Khandwala Dr S Mahimkar

Support Staff
Ms Anchal Ms Navneet
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