In vitro fertilization (IVF)

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What is In vitro fertilization (IVF)

In IVF, mature eggs are removed from ovaries and fertilized in a laboratory using sperm. The fertilized egg (or eggs) is/are then transported to a uterus. IVF cycles are completed in roughly three weeks. When these processes are divided into separate steps, it can sometimes take a little more time.

IVF Steps:

• IVF stands as the most successful type of assisted reproductive technology so far. The process is possible with the use of the couple’s sperm and eggs. A known or unknown donor’s eggs, sperm, or embryos may also be used during IVF.
• Many factors, including your age and the reason for infertility, affect your odds of conceiving a healthy child via IVF. Additionally, IVF can be costly, intrusive, and time-consuming. IVF can result in a pregnancy with multiple fetuses if more than one embryo is put into the uterus.
• Your doctor can explain how IVF functions, the risks associated, and whether this way of treating infertility is appropriate for you.
• Genetic issues or infertility can be treated by In Vitro Fertilization (IVF). Before IVF is used to treat infertility, you and your spouse might be recommended to try less intrusive treatment methods first, such as intrauterine insemination, a process in which sperm are inserted directly in the uterus close to the time of ovulation at Fallopian tube
• For infertility in women over 40, IVF is occasionally recommended as the main treatment.

IVF Indications

IVF may be a choice, for instance, if you or your partner have:

• Damaged or Blocked Fallopian Tubes It is challenging to fertilize an egg or move an embryo when the fallopian tube is damaged or blocked.
• Abnormalities of ovulation There will be fewer eggs accessible for fertilization if ovulation is irregular or non-existent.
• Endometriosis When tissue that resembles the lining of the uterus implants and grows outside of the uterus, endometriosis develops. This condition frequently impairs the ovaries, uterus and fallopian tube’s ability to function.
• Uterine fibroids Fibroids are harmless uterine tumours. Women in their 30s and 40s frequently experience them. The implantation of the fertilized egg can be hampered by fibroids.
• Previous Tubal sterilization or removal To permanently prevent pregnancy, the fallopian tubes are cut or blocked during a procedure known as tubal ligation. IVF may be a better option for you if you want to get pregnant after a tubal ligation than a surgical procedure to undo it.

What Is Sperm Retrieval?

Unlike a diagnostic testicular biopsy, the purpose of sperm harvesting is to locate sperm rather than diagnose anything that might be going on in the testis. Sperm extraction directly from the testis or epididymis is only necessary for men with azoospermia (no sperm in the ejaculate).

Men with blockages may only need a simple aspiration, while men with sperm production issues may need a much more thorough sampling of the testis. The length of time required, the requirement for anaesthesia, and the tools used all differ significantly as a result.

There are very few tests that can accurately predict whether men with testicular issues will have sperm in their testes. Genetic tests are not 100% accurate, but they can provide information about the likelihood of discovering sperm. Although the pattern of the testicular issue discovered during a diagnostic testicular biopsy may be somewhat predictive, there is still no finding that can be used to determine whether sperm will be present or not. Hormonal studies and other blood tests are not prognostic.

Finally, even the discovery of sperm during a previous harvesting session does not ensure that sperm will be discovered during subsequent harvesting attempts. Therefore, when the reason for a patient’s zero sperm count has already been determined by other means, diagnostic testicular biopsy is not generally carried out in individuals who are about to have testicular harvesting of sperm.

When Is The Sperm Retrieved?

It might be challenging to decide when to harvest sperm during the in vitro fertilisation (IVF) cycle. There are benefits and drawbacks to collecting sperm ahead of the IVF cycle or concurrently with the collection of the female partner’s eggs. The IVF program’s preference determines the final decision. Since the likelihood of finding sperm in most cases may be just 60% or less, performing the sperm collection in advance and freezing the sperm until the eggs are extracted allows the couple to make an informed decision about whether to proceed with IVF.

Additionally, it can be challenging for many couples to have surgery on the same day because it necessitates finding outside assistance to get them to and from the hospital and to aid them at home. IVF labs typically prefer to work with fresh rather than frozen sperm, therefore their need for fresh sperm takes precedence over all other factors.

Therefore, straightforward sperm retrievals are frequently carried out on the day of egg retrieval. Simple sperm retrievals are procedures done on men who are known to produce sperm normally but have a blockage. These techniques are listed below in brief, and include testicular sperm extraction, percutaneous sperm aspiration, and TESA (TESE).

The day before to the female partner’s egg retrieval, the far more complicated microdissection TESE (MicroTESE) operation is carried out. On a quarterly basis, MicroTESE is carried out at predetermined intervals after thorough coordination with the reproductive endocrinologist.

When Is Sperm Retrieval Method Suggested?

A male with normal sperm production or a blockage can be harvested in a variety of methods. An aspiration of sperm is the simplest and most economical method. This procedure typically lasts 10 minutes and is done under local anesthesia.

It is far more challenging and frequently takes several hours to collect sperm from a male with a testicular condition. A surgical microscope is used to perform the ideal procedure, microTESE, which increases the likelihood of detecting sperm and reduces the quantity of testicular tissue removed.

It is crucial to realise that the operating room microscope does not have enough magnification to view sperm; rather, it only assists in identifying the testis tubules that are most likely to contain sperm. Throughout the process, tiny bits of tissue are transferred to the IVF lab so that they can check to see whether enough sperm have been retrieved. The IVF laboratory inspects this tissue with a more potent microscope. It takes several testicular biopsies from either one or both testicles to collect enough sperm for that IVF round.

If the current round is unsuccessful or the couple decides they want additional children in the future, extra sperm can be collected and stored for IVF treatments in the future. Depending on how quickly sperm are discovered, this operation could take up to four hours.

Laser Hatching

A scientific IVF procedure called laser-assisted hatching can facilitate the embryo’s “hatching,” or breaking through of its outer layer or “shell,” a membrane also known as the zona pellucida. This layer can occasionally become abnormally thick and/or rigid due to the freezing and thawing process, among other things. The embryo’s chances of adhering to or implanting into the uterine wall are improved by how easily it hatches.

The embryo must hatch and implant for pregnancy to occur, and laser-assisted hatching can play a significant role in attaining these crucial processes.

Treatment Method

Under a microscope, an embryologist applies a procedure in which a brief, powerful light beam is used to crack open the embryo’s shell. This is often done during an IVF or Intracytoplasmic Sperm Injection (ICSI) cycle three days following fertilisation, when the embryo has started to cleave (divide). It merely takes a few seconds and has no negative effects on the embryo. The embryo is then put back into the woman’s uterus where it can connect to the lining and continue to develop.

Who is advised to use assisted hatching?

Any patient may benefit from laser-assisted hatching, however those who are most likely to be the most suitable include those who:

• Have a minimum age of 37
• Produce a significant amount of the hormone follicle stimulating hormone (FSH) early in their cycle.
• IVF treatments that didn’t work
• Have a propensity to develop a zona pellucida that is thicker and/or tougher.

What Is PGT-A?

Preimplantation genetic testing for aneuploidies, or PGT-A, is a genetic test used to examine IVF-created embryos for chromosomal abnormalities. Embryos are examined for additional or missing chromosomes using PGT-A, formerly known as preimplantation genetic screening (PGS). Aneuploid embryos, also known as embryos with extra or missing chromosomes, frequently fail to implant, resulting in miscarriage, or if implantation is successful, a child is born with a genetic disorder. Euploid embryos are those that have been determined to have proper chromosomes, and they have the best chance of becoming pregnant.

Advantages of PGT-A

PGT-A selects for transfer only embryos with no apparent excess or missing chromosomes. PGT-A might:

• Boost the likelihood of implantation and conception
• Lower the possibility of miscarriage
• Less IVF cycles are required to achieve conception
• Increase the chances of having a healthy baby during pregnancy

Who require PGT-A?

The great majority of IVF patients are candidates for PGT-A. It is advised for:

• Ladies that are older than 35
• Females who have lost one or more pregnancies
• Women with chromosomal disorders who have given birth
• IVF patients who have had unsuccessful cycles
• Couples that struggle with the male infertility factor

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