IVF is a procedure that is performed to help the pregnancy process for couples who have fertility disorders. Usually this procedure is done if fertility problems are not resolved or the cause is unknown.
Under normal circumstances, each menstrual cycle, the mature egg cells will be released from the ovary (ovulation process) to be fertilized by sperm in the fallopian tubes (fallopian tubes), then stick to the uterine wall. Or if it is not fertilized, it will still run into the uterus and shed along the uterine wall into menstrual blood. IVF is an assisted pregnancy program that is carried out by combining eggs and sperm outside the body. After merging, the fertilized egg (embryo) will be placed back in the uterus.
IVF Indications
The following conditions can be considered for IVF procedures, including:
- The fallopian tubes (fallopian tubes) are blocked or damaged, making it difficult for the fertilized egg or embryo to reach the uterus.
- Have a history of removal or sterilization of the fallopian tubes.
- Ovulation disorders, resulting in the availability of fewer and fewer fertilized eggs.
- Premature ovarian (ovarian) failure. This condition occurs in women under 40 years old, but the production of the hormone estrogen is low and does not always release eggs during the menstrual cycle.
- Endometriosis. Endometriosis is a condition in which there is tissue of the uterine wall (endometrium) that grows outside the uterus. This can cause interference with the function of the uterus, ovaries and fallopian tubes.
- Miom Myoma is a benign tumor that generally grows in the uterine wall and disrupt the embryo attachment to the uterine wall. This generally occurs in women aged 30-40 years.
- Impaired function, shape, and production of sperm counts, such as low sperm count (oligospermia), weak sperm movement (asthenospermia), or abnormalities in sperm shape and size (teratospermia).
- Genetic disease. IVF is done to prevent the inheritance of genetic disorders from parents to the fetus.
- Unknown reasons for infertility.
- Will undergo treatment that can affect fertility. Treatments for cancer, such as radiotherapy or chemotherapy, can affect fertility. Women can store healthy eggs before treatment for IVF.
IVF Warning
Couples can do IVF procedures if both parties are ready physically and mentally, because it will go through a lot of medical processes and sometimes not successful in one action (cycle). IVF can be said to be successful if the woman is pregnant and gives birth to a baby born normally. On average of all women undergoing IVF, 29.4% succeeded in getting pregnant and 22.4% succeeded in giving birth to a live baby of the entire cycle.
Keep in mind that age is one of the factors that increases the success of IVF programs. As a woman ages, the chances of a successful IVF program also decrease and risk of fetal chromosome abnormalities. Besides age, a woman's body weight is also a factor influencing the success of IVF. Both less and excess weight reduce the success of IVF. Factors such as infertility and lifestyle causes (such as smoking) can affect the quality of the egg, thereby affecting the success of the IVF program.
Success also increases with the number of cycles performed. One study said the success of a woman to have a baby after 3 cycles of IVF was 63.3%.
Before IVF
There are a series of tests that need to be carried out before the IVF procedure, namely:
- Ovarian reserve testing. The doctor will check the quality and quantity of eggs by checking the levels of follicle stimulating hormone (FSH), estrogen, and anti-mullerian hormone (AMH) at the beginning of the menstrual cycle. Pelvic ultrasound (uterus) will also be done as a support.
- Cement analysis. This test is done before the test tube baby is done.
- Examination of infectious diseases. The doctor will examine both partners if there is an infectious disease, such as HIV.
- Examination of the uterine cavity. This test is done in 2 ways, namely by injecting special fluid through the cervix into the uterus, and followed by ultrasound imaging to obtain images (sonohysterography), or by inserting an endoscopic device through the vagina into the uterus (hysteroscopy).
Trial transfer of artificial embryos. This is done to see the thickness of the uterine cavity and find the most appropriate technique when working with IVF later.
IVF Procedure
IVF has 5 steps, namely ovulation induction, egg collection, sperm collection, fertilization and embryo transfer.
Ovulation Induction
For ovulation induction, there are several hormones that will be given, such as:
- Injections of follicle stimulating hormone (FSH), luteinizing hormone (LH), or a combination of both to stimulate the ovaries (ovaries).
- Human chorionic gonadotropin (hCG) to help the process of egg maturation if the egg is ready to be taken, generally after 8-14 days after ovarian stimulant injection. If the egg is released too quickly from the ovary (premature ovulation), ovulation suppressants will be given.
- On the day of the egg retrieval, the doctor will provide progesterone hormone supplements to prepare the uterine wall to become a place to attach the embryo.
The process of ovulation induction generally takes 1-2 weeks before eggs can be taken. Transvaginal ultrasound and blood tests will also be performed to ensure egg cell growth, estrogen levels, and progesterone. The doctor can delay the IVF procedure if problems are found, such as low or even too high egg growth or premature ovulation, and can repeat this process again by changing the dose of the hormone given.
Egg retrieval
This procedure is generally done 34-36 hours after the last hormone injection and before ovulation. Sedative and pain medication injections will be given to ease the pain before the procedure.
Generally, the egg will be taken from the uterus with a transvaginal ultrasound guide inserted through the vagina to find the egg. After that, a small needle will be inserted to take the egg. If this is not possible, the doctor will perform a small operation (laparoscopy) by making an incision the size of a key hole in the abdominal wall, and inserting a small needle with the help of a camera as a pointer. If it reaches the right point, some eggs will be sucked through the needle for about 20 minutes. Mature eggs will be stored in an incubation containing a special fluid to fertilize sperm. However, keep in mind that the fertilization process is not always successful.
Sperm Retrieval
Procedure for sperm and semen sampling will be done through a process of masturbation. If it cannot pass through masturbation, sperm can be taken directly from the testis with a needle.
Conception
Fertilization can be done in 2 ways, namely insemination by mixing healthy sperm and eggs overnight into embryos, or through intracytoplasmic sperm injection (ICSI), where 1 healthy sperm will be injected into each egg cell. ICSI is generally carried out when semen quality is poor or the fertilization process by insemination fails. Keep in mind that not all embryos can survive after fertilization.
Embryo transfer
This last stage is generally carried out in 3-5 days after the process of egg collection until fertilization, where the embryo has begun to develop. But before the embryo is transferred into the uterus, the doctor can do a test by taking samples of the embryo to check for chromosomal abnormalities or if there are certain infectious diseases.
When the embryo is ready to be transferred, a mild sedative injection will be given to the expectant mother. The doctor will then insert a catheter containing several embryos protected by a special fluid through the vagina into the uterus. When it reaches the uterus, the embryo will be injected. This process is considered successful if the embryo is embedded in the uterine wall within 6-10 days after embryo transfer.
After Test Tube Baby
In general, women who have just undergone the IVF procedure will be asked to take a vacation at least one day before returning to their activities. After that, avoid strenuous activity because it can trigger discomfort in the uterus.
After undergoing the embryo transfer process, expectant mothers may experience clear discharge or blood from the vagina, feel their breasts softer due to high levels of the hormone estrogen, constipation, flatulence, abdominal pain, dizziness, skin rashes, and mood swings. See a doctor immediately if the condition or pain worsens, or if you experience other effects, such as heavy bleeding and fever.
A pregnancy test through a blood test will be done within 12-14 days after the embryo transfer procedure. If declared pregnant, the doctor will recommend routine control during pregnancy. If negative, the doctor will ask to stop taking progesterone supplements and menstruation will appear within 1 week.
IVF Risk
The following are some risks of IVF procedures, namely:
- Twin Pregnant. This condition can occur if there is more than one embryo implanted in the uterus. Twin pregnancy can trigger premature birth and low birth weight.
- Ovarian hyperstimulation syndrome. Ovulation induction injections, such as human chorionic gonadotropin (hCG), can trigger swelling and pain in the ovaium. Symptoms that appear are abdominal pain, flatulence, nausea, vomiting, and diarrhea for a week. If the woman is pregnant, the symptoms can last longer. Sometimes, drastic weight gain and shortness of breath can occur.
- Ectopic pregnancy. 2-5% of women can experience the risk of an ectopic pregnancy, which is a pregnancy outside the uterus, such as in the fallopian tubes. This pregnancy cannot be continued.
- Miscarriage. Similar to natural pregnancy, IVF can also have a risk of miscarriage. This risk increases with maternal age.
- Birth defects. As we get older, women who undergo IVF have the potential to give birth to a defective baby. But this is still in further research.
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