IVF ناباروری

In Vitro Fertilization (IVF)

In vitro fertilization (IVF) is a procedure used to treat fertility problems and assist with the conception of a child. During in vitro fertilization, mature eggs are retrieved from your ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs are implanted in your uterus. One cycle of in vitro fertilization takes about two weeks. In vitro fertilization is the most effective form of assisted reproductive technology (ART).
Your chances of having a healthy baby using in vitro fertilization depend on many factors, such as your age and the cause of infertility. In addition, in vitro fertilization can be time-consuming, expensive and invasive. If more than one embryo is implanted in your uterus, in vitro fertilization can result in a multiple pregnancy.

Why IVF is done?

IVF In vitro fertilization is a possible treatment option for infertility. Depending on the cause of infertility, you and your partner might try less invasive treatment options before attempting in vitro fertilization, including fertility drugs to increase your production of eggs (superovulation) or intrauterine insemination — a procedure in which sperm are placed directly in your uterus. Occasionally, in vitro fertilization is offered as a primary treatment for infertility in women older than age 40. In vitro fertilization can also be done if you have certain health conditions.

Causes of Infertility

  • Fallopian tube damage or blockage. Fallopian tube damage or blockage makes it difficult for an egg to be fertilized or for an embryo to travel to the uterus.
  • Ovulation disorders. If ovulation is infrequent or absent, fewer eggs are available for fertilization.
  • Premature ovarian failure. Premature ovarian failure is the loss of normal ovarian function before age 40. If your ovaries fail, they don’t produce normal amounts of the hormone estrogen or release eggs regularly.
  • Endometriosis. Endometriosis occurs when the uterine tissue implants and grows outside of the uterus – often affecting the function of the ovaries, uterus and fallopian tubes.
  • Uterine fibroids. Fibroids are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. Fibroids can interfere with implantation of the fertilized egg.
  • Previous tubal sterilization. If you’ve had tubal ligation – a type of sterilization in which your fallopian tubes are cut or blocked to permanently prevent pregnancy – and want to conceive, in vitro fertilization may be an alternative to tubal ligation reversal.
  • Impaired sperm production or function. Below-average sperm concentration, weak movement of sperm, or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg.
  • Unexplained infertility. Unexplained infertility means no cause of infertility has been found.
  • A genetic disorder. If you and your partner are at risk of passing on a genetic disorder to your child, you may be candidates for preimplantation genetic diagnosis.

During IVF

In vitro fertilization has multiple steps: ovulation induction, egg retrieval, sperm retrieval, fertilization and embryo transfer.

Ovulation induction

At the start of a cycle you’ll begin treatment with synthetic hormones to stimulate your ovaries to produce multiple eggs rather than the single egg that normally develops each month. Multiple eggs are needed because some eggs won’t fertilize or develop normally after fertilization.

Egg retrieval

During egg retrieval you’ll be sedated and given pain medication. Eggs are generally retrieved 34 to 36 hours after the HCG injection and before ovulation. Typically, transvaginal ultrasound aspiration is used to retrieve the eggs. Then eggs are removed from the follicles through a needle connected to a suction device. Multiple eggs can be removed in about 30 minutes. After egg retrieval, you may experience cramping and feelings of fullness or pressure. If your ovaries aren’t accessible through transvaginal ultrasound, laparoscopy may be used to guide the needle. After retrieval, mature eggs are placed in a nutritive liquid (culture medium) and incubated.
On the day of egg retrieval or at the time of embryo transfer, your doctor might recommend that you begin taking progesterone supplements (in the form of oral tablets, injections or vaginal suppositories) to make the lining of your uterus more receptive to implantation.

Sperm retrieval

Your partner will provide a semen sample at your doctor’s office or a clinic through a special method, then sperm are separated from the semen in the lab.
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Fertilization

Fertilization can be done using:

  • Insemination. During insemination, healthy sperm and mature eggs are mixed and incubated overnight.
  • Intracytoplasmic sperm injection (ICSI). In ICSI, a single healthy sperm is injected directly into each mature egg. ICSI is often used when semen quality is a problem or if fertilization attempts during prior in vitro fertilization cycles failed.

Embryo transfer

Embryo transfer usually takes place one to six days after egg retrieval. You might be given a mild sedative. Then the doctor will insert a long, thin, flexible tube called a catheter into your vagina, through your cervix and into your uterus. A syringe containing one or more embryos suspended in fluid is attached to the end of the catheter, and the fluid is pushed through the tube into your uterus. The procedure is usually painless, although you might experience mild cramping. If successful, the embryo will implant in the lining of your uterus about six to 10 days after egg retrieval.

After IVF

After the embryo transfer, you can resume your normal daily activities. Consider avoiding vigorous activity, which could cause discomfort.
Typical side effects include:

  • Passing a small amount of clear or bloody fluid shortly after the procedure
  • Breast tenderness and engorgement
  • Mild bloating
  • Constipation
  • Mild cramping

Results

Your doctor will take a blood sample to detect pregnancy hormones about two weeks after egg retrieval. If you’re pregnant, your doctor will refer you for prenatal care. If you’re not pregnant, you’ll stop taking progesterone and likely get your period in one to three days. If you don’t get your period or have unusual irregular bleeding, contact your doctor.
He or she may examine you to rule out an ectopic pregnancy. If you’re interested in attempting another cycle of in vitro fertilization, your doctor might suggest steps you can take to improve your chances of getting pregnant through in vitro fertilization.
The chances of giving birth to a healthy baby after using in vitro fertilization depend on various factors, including:

  • Maternal age. The younger you are, the more likely you are to get pregnant and give birth to a healthy baby using your own eggs during in vitro fertilization. Birth rates resulting from a cycle of in vitro fertilization are:
    • about 41 percent for women age 34 and younger
    • 31 percent for women ages 35 to 37
    • 22 percent for women ages 38 to 40
    • 12 percent for women ages 41 to 42
    • 5 percent for women older than ages 43 to 44
    • 1 percent for women age 45 and older
  • Embryo status. The live birth rate is lower when frozen embryos are used instead of fresh embryos. The use of fresh or frozen sperm, however, hasn’t been shown to affect success rates.
  • Reproductive history. Women who’ve previously given birth are more likely to be able to get pregnant using in vitro fertilization than are women who’ve never given birth. Success rates are lower for women who’ve previously used in vitro fertilization multiple times, but didn’t get pregnant.
  • Cause of infertility. Having a normal supply of eggs increases your chances of being able to get pregnant using in vitro fertilization. Women who have endometriosis are less likely to be able to get pregnant using in vitro fertilization than are women who have tubal damage or blockage.
  • Lifestyle factors. Women who smoke typically have fewer eggs retrieved during in vitro fertilization. Smoking can lower a woman’s chance of success using in vitro fertilization by 50 percent.