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In vitro fertilization tips – Taseer Dawakhana
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IVF – In Vitro Fertilization Tips

How In Vitro Fertilization is Done

When a woman, or couple, and the Fertility Specialist determine that in vitro fertilization is the treatment of choice, there are several steps that must be taken to promote the greatest chance of success.

The primary steps in in vitro fertilization include:

  1. Counseling – you will discuss the IVF process, risks and benefits, and outcome goals. Treatment consents will be signed, which may include consents for IVF and embryo transfer, micro-insemination, cryopreservation of resultant embryos and psychological treatment/evaluation.
  2. Semen analysis – semen samples will be analyzed for: volume and consistently, sperm count, motility, structure and survivability
  3. Testing – including ultrasound and hormone levels to establish baseline uterine and hormonal status, for the syncing of your IVF cycle
  4. Fertility drugs – hormones will be provided to the woman, to stimulate egg production, including superovulation, where the ovaries produce more than one egg during a cycle. A greater number of eggs increases the chances for a successful IVF. Drugs will be added at different times during the IVF cycle, to prepare the uterus for implantation, promote egg and follicle development, and aid in egg retrieval or harvesting.
  5. Egg Retrieval – eat or drink nothing 8 hours prior to your retrieval. Ultrasound is used to guide the needle as it enters the ovary for harvest, through the vaginal wall.
  6. Fertilization – concentrated sperm is introduced to your eggs, in a petri dish or test tube
  7. Transfer – with the use of a speculum, the procedure is similar to a Pap smear. An ultrasound guides placement of the embryos inside the uteris.

The steps related to IVF are fairly consistent, regardless of the Fertility Clinic that you use, due to the sequential nature of the human body in terms of fertility. Following the guidelines and instructions of your Fertility Specialist, will help to promote positive outcomes following IVF.

Ethical and Moral Issues Related to In Vitro Fertilization

The use of assistive reproductive technologies is more than just a question of medical treatment and conception. There are also ethical and moral dilemmas that can be a part of this process, which can include, but are not limited to:

  1. Fate of any stored embryos should a couple divorce – is the embryo property or a person. Who can claim the embryo or determine if it is to be destroyed or kept in frozen stasis?
  2. Rights of the sperm or egg donor – some States laws include that donors have no parental rights, however this is not as clearly delineated in other States.
  3. Destruction of residual embryos – are we, in fact, murdering children? Some religious beliefs feel that we are taking the life of a child, rather than a potential being.
  4. Selective reduction in the event of multiple successful implants – selective abortion of a fetus or more than one fetus, to promote a more successful outcome for the remaining fetuses, is viewed the same as the destruction of residual embryos. Some believe that a child begins at conception rather than at birth.
  5. Religious morality regarding the use of assistive reproductive technologies (ART)- the Catholic tenets specifically restrict the use of ART such as IVF. The Donum Vitae states that intrusion of someone other than a man and his spouse in the making of a child is immoral, which rules out donor sperm and eggs, and fertility treatments to promote conception.
  6. Beyond the physical aspects of the in vitro fertilization, there are also the social and moral aspects that some feel must be considered when making the determination to create a child using a test tube.

Role of In Vitro Fertilization in Fertility Treatment

There are many causes of infertility, including hormonal problems, structural or mechanical issues and medical conditions. There are also many different treatments available, to address the specific causes of infertility, such as hormone treatments or surgical correction of structural anomalies.

In vitro fertilization – IVF – is one type of infertility treatment, however it is not a first line treatment. Your Fertility Specialist will try other less invasive and less expensive options before choosing IVF, since many causes of infertility can be overcome with other treatment options.

IVF is best used for those situations in which a woman is trying to conceive and intrauterine insemination is not possible or effective, or in which donation of eggs or sperm is necessary to complete the process due to either male or female fertility problems within a couple.

Risks and Complications of In Vitro Fertilization

As with any medical treatment or procedure, there are potential risks and complications. This is true for in vitro fertilization, which has its own special risks that can include:

  1. Fertility Drug Side Effects – injectable medications may cause soreness, injection site infection, swelling or localized allergic reaction. Oral medication can contribute to weight gain, nausea, bloating, mood swings, breast tenderness and headache.
  2. Ovarian Hyper-stimulation Syndrome – a reaction related to excessive elevation of estrogen levels and the hormone given to ripen the eggs for harvest, resulting in: fluid in the abdominal cavity, blood clots in the large blood vessels, swelling of the ovaries, which have a risk of rupturing or twisting.
  3. Egg Retrieval Risks – since anesthesia, general IV sedation and a needle are used for retrieval, anesthetic reaction, infection at the needle insertion site, bleeding, damage to adjacent internal organs and scarring are risks of the procedure.
  4. Sperm Collection and Preparation Effects – this is a stressful time for the man, who may have erectile difficulties or even changes in sperm count in response to stress.
  5. Embryo Transfer Side Effects – after embryo implantation, the woman may experience vaginal dryness, PMS symptoms such as bloating and tender breasts, depression or mood changes, which can be a result of the hormones administered to prepare the ovaries and uterus for the fertilization process.
  6. Psychological Symptoms – infertility is stressful in itself. Add to this, the stresses related to chemicals, physical evaluations and treatments, and anxiety or depression may result, in addition to sleep abnormalities, tensions within the relationship and stress-related illness.
  7. Recognizing the potential risks and complications involved with IVF will help you better prepare for the process and the potential side effects.

Defining In Vitro Fertilization

The process of In Vitro Fertilization was initially brought to fame by the creation of the world’s first “test tube baby” – a breakthrough in assistive reproductive technology, also called ART, that has helped many people achieve pregnancy and childbirth, when other fertility treatment options proved ineffective.

The IVF was first pioneered by Embryologist, Dr. Edwards, and Gynecologist, Dr. Steptoe, in England in 1978, to help couples who were unable to have children, by natural conception, due to fertility problems that could not be overcome with traditional treatments.

The term “in vitro” means, “outside the living body,” and was initially referred to as in vitro fertilization – pre-embryonic transfer, or IVF-ET, to refer to the stage of cell development at the time of the implantation into the woman’s uterus.

Alternatives to In Vitro Fertilization

Since IVF is not the first line treatment for infertility, there are other available options. Some of these options include:

  • Hormonal therapy – sometimes it is a hormonal imbalance that is preventing conception, and correction of this imbalance can result in successful pregnancy
  • Surgical intervention – if structural problems, such as blocked fallopian tubes or blockage of sperm ducts, are contributing to infertility, repair of these reproductive parts can successfully promote conception
  • Treatment of external causes – if acquired infection, radiation treatment for cancer or other externally generated cause of infertility is present, correction of these causes can aid in correcting infertility
  • Alleviation of medical conditions – cysts on the ovaries or testes, diabetes, pituitary tumor or other medical conditions can contribute to infertility and, when corrected, the result is a successful pregnancy and delivery
  • Counselling or therapy – if emotional factors are contributing to infertility, such as fear of failure, depression or anxiety resulting in erectile dysfunction or painful intercourse, counselling or other psychotherapy can help to relieve these symptoms, and promote sexual function and fertility
  • Other assistive reproductive technologies – intrauterine or intrafallopian insemination involve placement of sperm directly into the uterus or fallopian tubes during ovulation.
  • There are a multitude of causes of infertility and a corresponding number of treatment options, many of which are readily available, inexpensive and effective.

Fertility Drugs and IVF

In order for in vitro fertilization to be successful, assistance must be provided in the form of fertility drugs. These drugs are designed to stimulate and emulate hormones which normally regulate reproductive activities, to control the reproductive cycle and promote success with IVF. The primary drugs used in IVF include

  • Gonadotropin go-nad-oh-trow-pin) Releasing Hormone (GnRH) Agonists Antagonists Gonadotropinsh CGSolu – Medrol Doxy cycline Progesterone
  • Progesterone is taken daily beginning two days after egg retrieval to support the embryo in the uterus until the placenta is able to make enough progesterone. This takes about 2 months.
  • Doxycycline is given to the male partner during the woman’s stimulation cycle to reduce bacteria that may be present in the sperm.
  • Medrol is a steroid hormone given daily, for up to four days, to assist pre-embryo implantation in the uterine wall, following embryo transfer.
  • Pregnyl, Profasi or Novarel is taken to help maturate the eggs and prepare them for retrieval. Gonal F, Bravelle, Follistim, Pergonal and Repronex are the most commonly used gonadotropins and they stimulate the egg follicle to ripen during inadequate follicular development.

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