Understanding the Basics of IVF

Written by

Arva Health Team

31-Jan-2024

In vitro fertilization: a pipette injecting a sperm into an egg.
In vitro fertilization: a pipette injecting a sperm into an egg.
In vitro fertilization: a pipette injecting a sperm into an egg.

In this comprehensive guide to fertility treatments, we've curated essential information to assist you on your fertility journey. From assembling the right medical team to addressing health concerns, creating a personalized treatment plan, diving into IVF intricacies, dealing with pregnancy loss, and exploring diverse family-building options, we cover it all in easily digestible sections.

Getting started with IVF

Here are the pros you might want on board, before starting your IVF journey:

1. Fertility Experts

Here’s the thing about IVF: It’s more like teamwork, rather than a single specialist guiding you the way. Gynaecologists, reproductive endocrinologists, and embryologists work together during different stages of your IVF cycle. Here’s a small breakdown of how they’re involved:

Obstetrician-Gynaecologist (OBGYN): While most start with a regular visit to their gynaecologist, consulting an RE early is smart. You may also be redirected to one, post your chat with your gynaecologist. Your gynaecologist, on the other hand, is responsible for obtaining your reproductive history, ensuring that the screening tests such as AMH and AFC (and/or others, if needed!) are done, for you and your partner.

Reproductive Endocrinologist (RE) / Infertility Specialist: We advise you to go for an Reproductive Endrocrinologist who's trained in obstetrics, and gynecology, and has specialized fertility training. They’re responsible for running tests related to your hormone levels, running semen tests, ultrasounds, or any other required tests based on your medical history

You would primarily find them at IVF centers or through our list here. Personal recommendations from your regular gynaecologist may also help.

Embryologist / In Vitro Fertilization (IVF) Lab: Embryologists participate in a major chunk of the entire IVF process. You get to this stage once your gynaecologist recommends an IVF/IUI cycle. For IUI, the embryologists are involved in a smaller proportion, but for IVF/ICSI cycles, you may have to regularly connect with them, to obtain details on the day-to-day progress of your IVF cycle.

Did you know? 🧐

The quality of the lab matters for successful fertility treatments. It’s because IVF involves handling delicate human specimens, and having a lab that follows all the guidelines, is certified, and has a good reputation is a better choice. Look into the best labs nearby, or even have a chat with your gynecologist to decide on one!

Other Healthcare Providers: If you have health conditions that might affect fertility, it's good to chat with a specialist who knows how those conditions impact pregnancy. Finding someone you trust can be a big relief. Arva can help with this too- with our curated list of gynaecologists.

🤒 Recognizing and Managing Health Issues Impacting Fertility

Be it for an IVF cycle or not, it’s essential to identify and address potential health issues that might affect conception. Consider these key factors and ensure you and/or your partner undergo screenings for common causes of infertility:

Polycystic Ovary Syndrome (PCOS)

PCOS, affecting [1 in 10 women] of childbearing age, can significantly impact fertility and overall health. It often leads to [ovulation issues], such as irregular menstrual cycles, and even has other effects such as increased facial hair growth (due to overproduction of androgens), etc. Lifestyle adjustments may help, but it's essential to seek professional evaluation.

Here are some questions to ponder:

📝How is your current hormonal balance being monitored?

📝Are your periods regular, indicating ovulation?

Managing PCOS involves various approaches. In the case of anovulation or irregular menstruation, you may be suggested ovulation-inducing medications like Clomid and Letrozole, alongside treatments like Metformin to enhance insulin sensitivity. You may also be asked to make dietary and lifestyle changes that aid the process of managing your PCOS symptoms.

Endometriosis

Endometriosis is the condition where the inner lining of your uterus, grows beyond the body of the uterus and affects the fallopian tube and ovaries. It affects about 10% of reproductive-age women, and a significant percentage of those facing fertility issues.

Here are some questions that can help guide your journey to managing endometriosis, if you’re trying to conceive:

📝Have you received prior treatment for endometriosis?

📝Do you know the severity level (e.g., assigned stages or ReceptivaDX test results)?

📝Is there a treatment plan recommended by your doctor? This could involve surgeries, Depot Lupron, Orlissa injections, or letrozole medication.

It’s best to discuss with your healthcare provider, how how these align with your proposed fertility treatments.

Severe endometriosis may impact egg reserves and quality. Studies have also found that fertility preservation options or IVF/ICSI may be a beneficial path for people with endometriosis.

For those undergoing IVF, discussing the timing of endometriosis treatment in relation to egg retrieval and embryo transfer is crucial. Treating endometriosis before egg retrieval, and/or embryo transfers may boost implantation and pregnancy rates, as it removes scar tissues and/or large endometriotic cysts.

Diabetes and Thyroid

It’s important to review your medications with your fertility specialist and make any changes if required, especially when you’re trying to conceive.

🌡️Explore the use of devices like continuous glucose monitors to maintain stable blood sugar levels.

👨🏼‍⚕️Seek guidance from professionals for personalized exercise and diet plans, as they can help manage diabetes.

🧪Assess for PCOS, as it often correlates with insulin resistance, affecting menstrual regularity and ovulation.

While most screening tests include thyroid, you can also request for one separately, and ensure you are aware of your thyroid levels prior to conceiving. Both cases- hypothyroidism (low thyroid levels) and hyperthyroidism (high thyroid levels) can lead to sub-fertility or infertility.

For diabetes management during pregnancy, consult with a specialist experienced in supervising diabetic patients through pregnancy. Consider speaking to a high-risk obstetrician or a maternal-fetal medicine specialist to ensure optimal control for fertility and pregnancy.

Male Factor Fertility Treatment

It’s important to discuss with your doctor various supplements, medications, or surgical options to address male infertility, depending on the diagnosis. You may be asked to avoid smoking, reduce or abstain from alcohol consumption when you’re trying to conceive.

Even if opting for IVF, enhancing sperm quality and quantity can increase success rates and potentially reduce the number of cycles needed. Supplements such as Co enzyme Q10 may be advised to improve semen quality during IUI cycles.

Varicocele repair surgery may be beneficial for certain varicoceles, improving success rates in intrauterine insemination (IUI), IVF, and testicular sperm extraction (TESE).

Surgical sperm retrieval methods such as TESE might be necessary for obstructive azoospermia.

Unexplained Infertility

Sometimes, despite testing, the cause of infertility remains unknown. Additional diagnostics could shed light on potential underlying issues.

By addressing these endocrine concerns and exploring tailored treatments, you pave the way for a more informed approach to fertility and increase the chances of a successful conception.

Develop Your Fertility Treatment Blueprint

Crafting a well-thought-out plan for fertility treatment is pivotal to navigating this journey effectively. Here's a structured approach to creating and refining your strategy:

Initiating Your First Round of Treatment:

a. Seek a provider and seek clarification on:

Their diagnosis, hypothesis and rationale.

  • The recommended diagnostic and treatment plan.

  • Expected success rates, timeline, and financial considerations.

  • Essential tests to validate the diagnosis before treatment initiation.

  • The rationale behind the chosen treatment, its invasiveness, and alternatives.

  • Contingency plans if the initial strategy fails and the timeline for reassessment.

b. You can obtain a second opinion as well, based on the situation and outcome. Comparing plans can fortify your confidence or offer diverse perspectives.

c. Evaluate the opinions received and, and review the proposed treatment plan.

d. Verify treatment costs and insurance coverage diligently.

e. Finalize your plan and commit to its execution. Best wishes for success! 🍀

Subsequent Treatment Rounds

Revisiting your strategy after unsuccessful attempts is crucial. Discuss the following with your doctor:

  • Review the reasons for previous treatment failure.

  • Explore the insights gained and potential need for further testing.

  • Inquire about adjustments or a different approach for the next cycle.

  • Consider seeking a second opinion before investing more resources or time.

💡 IVF Cycle Optimization

Discuss these procedures with your doctor to enhance your chances of success during an IVF cycle.

🥚 Preparing for Egg Retrieval and IVF

Preparing for your IVF cycle can be a long process, as it involves testing, deciding the duration for each procedure and especially when there are multiple egg retrieval cycles. Here are some adjustments that may be made based on insights:

Quality Enhancement before egg retrieval and protocols:

  • Optimize egg and sperm quality pre-retrieval. Different supplements may suit different individuals, so consult your doctor for personalized recommendations.

  • Address conditions like PCOS, endometriosis, or varicocele that could affect egg or sperm quality.

  • Discuss IVF drug protocols tailored to your situation and inquire about the rationale behind the selected protocol.

Inquire About the IVF Protocol:

  • Question your doctor about the chosen protocol, expected egg yield, and protocol specifics.

  • Clarify aspects like the use of birth control pills in the protocol and its purpose.

  • Communicate expectations, and speak to your gynaecologist, and even embryologists, even though outcomes might differ from expectations. They may help provide a detailed perspective into the situation to help you understand the process better.

Supplementary Techniques

Consider Human Growth Hormone (HGH) flush for improved ovarian response and embryo development. Some clinics may do this prior to your embryo transfer.

Trigger shots (HCG or Lupron) are a crucial part of your IVF cycle as they help mature the egg before retrieval. The type of shot you receive, the dosage, and the duration at which, can vary, so ensure that the shots are provided at the given timing.

Acupuncture, though its effect is debatable, may aid relaxation and holistic wellness. Consult with your gynaecologist prior to proceeding with such supplementary techniques.

Considerations for Males

For males, it’s essential to adopt a healthy lifestyle and avoid smoking, abstain from alcohol, and avoid excessive screentime and travel time daily, to minimize issues linked to oxidative stress.

In some cases, you may be advised to go for advanced sperm selection methods like Zymot chips and PICSI-selection dishes for enhanced sperm quality. These can help choose motile, viable sperm as per the procedure recommended.

If needed, freezing sperm beforehand might be beneficial.

Other Techniques

Varicocele repair surgery may boost success rates in various fertility treatments.

Surgical sperm retrieval (TESE) can retrieve limited sperm for IVF.

Genetic Testing of Embryos

Preimplantation genetic testing (PGT-A) assists in identifying embryos with the correct number of chromosomes, aiding in selecting viable embryos for transfer.

Your healthcare provider might consider single-embryo transfer of PGT-A normal embryos to increase pregnancy chances without the risk of multiple pregnancies.

Navigating IVF procedures involves a multifaceted approach, and it requires personalized strategies and considerations for both partners. This can help optimize chances of success.

FAQs

1. What are the basic steps of IVF?

The basic steps of IVF include:

  1. Ultrasound monitoring

  2. Hormonal medication to grow eggs

  3. Egg retrieval

  4. Collection of semen sample

  5. In vitro fertilization of egg and sperm

  6. Embryo growth and development

  7. Embryo transfer

2. How long do stages of IVF take?

The stages of IVF take about 4-6 weeks. This includes hormonal medication, egg retrieval, fertilisation and embryo transfer. This timeline is in the case of a fresh embryo transfer. In some cases, the embryo can be frozen until further use, and transferred at a later date.

3. What treatment options are available for male factor fertility issues?

Treatment options for male factor infertility may include supplements, medications, or surgical interventions based on specific diagnoses such as azoospermia. Enhancing sperm quality through lifestyle changes, varicocele repair surgery, and procedures like surgical sperm retrieval (TESE) can improve success rates in various fertility treatments.

4. Is IVF costly?

In India, an IVF cycle can range anywhere from 1.5 lakh upto 4 lakh if it involves processes such as genetic testing of embryos. The success rates of IVF also depend on the clinic chosen, the lab as well as your medical history.

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Fertility care, reimagined for India—on your timeline.

This site is for informational purposes only and not a substitute for medical advice, diagnosis, or treatment. If you're looking for medical advice, we suggest talking with a qualified physician.

55, 4th A Main, 5th Block, Koramangala, Bangalore, 560095

© 2023 Arva Health

Fertility care, reimagined for India—on your timeline.

This site is for informational purposes only and not a substitute for medical advice, diagnosis, or treatment. If you're looking for medical advice, we suggest talking with a qualified physician.

55, 4th A Main, 5th Block, Koramangala, Bangalore, 560095

© 2023 Arva Health

Fertility care, reimagined for India—on your timeline.

This site is for informational purposes only and not a substitute for medical advice, diagnosis, or treatment. If you're looking for medical advice, we suggest talking with a qualified physician.

55, 4th A Main, 5th Block, Koramangala, Bangalore, 560095

© 2023 Arva Health