In the last few decades there has been an enormous upsurge in the number of couples facing infertility. This has been attributed to changes in lifestyle, environment and very pertinently the economic and academic aspirations of women, leading to a delay in childbearing. The one constant in the reproductive ability of a woman is her age. Thus, the success of any infertility treatment is majorly dependent on a woman’s age.
Of the many treatments available for infertility, IVF gives the maximum chance of success (30-50%). Be that as it may, simpler treatments like intrauterine insemination (IUI) and ovulation induction are worth trying if the woman is below 35 years and/or the number of years for which the couple have been trying to conceive is less than three. Whilst these are less intensive the chances of success are around 10-15% per cycle.
Though the number of couples using IVF has increased exponentially in recent years, many couples are still reluctant to use it for fear of having an abnormal child, believing that the process of conception is ‘unnatural’. These fears are unfounded and precious years are lost by the time they seek IVF. Concerns of physical, financial and emotional stress associated with IVF also prove to be a deterrent. Dealing with infertility can be emotionally taxing so prepare yourself physically and mentally through exercise and counselling and schedule your work so that you are not stressed in any way during IVF treatment.
When should a couple opt for IVF and what should they expect during the process?
IVF is the only treatment when infertility is due to blocked fallopian tubes or severe male factor infertility. For other cases, a woman’s age and years of infertility become the deciding factor. In Indian women, ovarian aging occurs earlier than in Caucasian women hence they should get proactive about their treatment once they touch thirty.
What should one expect during the process of IVF?
Preliminary blood tests are done to assess general health and check ovarian reserve (number of eggs in the ovary). For the male partner a sample of semen is stored as a back-up in case of inability to provide a sample on the day of egg retrieval. Hormonal injections started from the 2nd day of the period are given for approximately 9 days. These injections stimulate the ovaries to produce eggs, which are then retrieved under a short anesthesia (15-20 minutes approximately) using transvaginal ultrasound guidance – no cuts or stitches required! The eggs are fertilized with sperm, the resulting embryo is either implanted into the uterus right away or frozen for use later. The injections are not painful though a daily injection may not be very appealing. Egg growth is monitored by ultrasound and a blood test done prior to the final egg maturation injection (HCG). Approximately 4-5 short visits to the clinic would be required – plan your time accordingly. Embryo transfer is a simple, painless procedure, done under ultrasound guidance without an aesthesia. After embryo transfer progesterone is given to sustain the pregnancy. If you don’t like injections you can opt for oral or vaginal progesterone. Progesterone supplementation may be increased if your progesterone levels are low. A pregnancy test would be advised after 14 days. These 14 days are the most difficult emotionally as you are agonizing over the outcome. Sharing your fears with a counsellor or a close friend/family member helps reduce anxiety and stress.
A few do’s and don’ts:
Bedrest is not required; routine activity improves blood circulation and promotes implantation. Keeping your mind and body active is the key to decreasing stress and improving outcome. Heavy exercise is not recommended.
Travel is not contraindicated however plan it a couple of days after the procedure if you are feeling normal. People respond differently to physical stress, some deal with it more easily than others – so listen to your body!
An often-asked question is regarding the ‘right’ diet or a diet that promotes success and the ideal weight. Unfortunately, a change in diet a week or two before the process is not going to change much in your body. Adopting healthy eating habits and regular exercise should be incorporated into your lifestyle. Excessive intake of vitamin supplements does not help. Get your vitamins from natural products like fresh fruit and nuts. Vitamin D deficiency- common in India- impacts fertility so get it checked.
Avoid smoking and drinking at least 3 preferably 6months prior to planning conception. Reduce intake of coffee as it may impact your chances of success. BMI is related to IVF outcome and problems during pregnancy, so get those extra kilos off.
Men must bear in mind that body building supplements, smoking, alcohol and drugs affect sperm count. Interestingly, it has been observed that chances of miscarriage are higher if the man drinks at least two or more caffeinated beverages per day. Exercise should be in moderation, biking should be avoided. Taking antioxidants may reduce oxidative stress on sperms.
Most importantly choose your IVF centre and doctor carefully as your success is dependent on the knowledge and expertise of the doctor and the quality of the embryology laboratory.