There are many times couples face frustration, confusion and heartache as they embark upon the process of parenthood, yet there are miracles stories around the world when a family get blessed with a child after years of trying to conceive, thanks to In-Vitro Fertilization treatment. With numerous advancements in science, specialists believe not being able to conceive is now a thing of the past and with IVF treatment at a place, pregnancy is a matter of personal choice.

Here, Senior Gynaecologist and IVF specialist at Cocoon Fertility Dr Rajalaxmi answers the frequently asked questions around IVF method. Edited excerpts:

What Is In Vitro Fertilisation (IVF)?

IVF is a process that involves fertilisation of an egg with the sperm outside the body. The process involves stimulating the ovary to grow follicles (fluid-filled sacs in the ovary that contain eggs), monitoring this growth, when mature collecting these eggs via a small procedure, allowing sperm to fertilise the eggs in a laboratory, growing the fertilised egg in the lab and transferring it back to the womb after 3 to 5 days. It is called in vitro as the fertilisation occurs outside the body.

What are the other procedures combined with IVF?

When the sperm is of poor quality or the cover of the egg is thick and hard, ICSI comes to the rescue and helps fertilisation. ICSI is where sperm is directly injected inside an egg to achieve fertilisation. Women whose eggs have thicker covering shell (zona) also have trouble with implantation (sticking of the embryo to the lining of the womb) even after the embryo is formed. Thinning of this thick shell with a laser is called laser hatching. In cases of severe male factor infertility, PICSI or physiological ICSI allows us to select a physiologically normal sperm thus allowing a chance at a better-quality embryo.

Blastocyst culture is growing the egg in the lab until the 5th day after fertilisation. Such an embryo has a better chance of implantation. Similarly, a sequential transfer where double transfers are attempted in a single cycle e.g day 3 and day 5 one embryo each is another procedure used to increase the chance of success.

How successful is IVF?

The success ratio rate for IVF depends on the age of the woman, cause of infertility, years of infertility, type of embryo transfer, quality of the sperm and whether self-eggs or donor eggs were used. The success rate is higher when frozen embryos are used as opposed to fresh embryos. Success is higher in younger women, so even when a woman has an embryo transfer, say in her 40s with embryos that were created when she was in her 30s, her chance of success is that of a woman in her 30s. Frozen cycles tend to have a higher success rate as the embryos that survive the thawing process will be more robust, resulting in higher chances of achieving a pregnancy. Donor eggs likewise come from a younger donor who is medically fit and hence tends to give better success rates. Better the sperm quality better the success rate.

Success in IVF is measured in various parameters for audit purposes. The fertilisation rate, implantation rate, clinical pregnancy rate, take home baby rate etc. Of significance is the live birth rate as this is the chance that any couple having treatment will take a baby home. Irrespective of the age of the patient, a live birth rate of around 30% is considered as gold standard around the world.

How long does IVF take? Are there any restrictions while undergoing IVF?

The procedure typically takes up to 17-20 days from the start of the period followed by 15 days of waiting to do a pregnancy test to find out if a pregnancy has occurred. Sometimes the procedure is done in 2 steps. Step 1 involves creating the embryos and freezing and then step 2 is preparing the womb at a later date for an embryo transfer.

It is highly recommended to avoid smoking and drinking alcohol when planning a pregnancy. Exposure to pesticides, any kind of chemicals and radiation should be avoided as much as you can. Medicines should not be taken without prior consultation from a medical expert. Always emphasise that you eat freshly cooked homemade food.

If not pregnant, when can be tried again?

The first IVF cycle will often be successful at a high-quality IVF programme. One of the most frustrating situations for patients and clinicians is the failure of a well-progressing cycle. It is important to understand that IVF is not a miracle solution; instead, it is the most successful treatment when all other fertility treatments have failed.

The success rate of IVF/ICSI is in the range of 30-35% per embryo transfer. Hence, unfortunately, many couples may not conceive at their first cycle of IVF and will need to consider a second cycle. If it's been a perfect cycle with good quality of embryos and a good lining of the womb, then often all one needs to do is to repeat it until it works. This requires a lot of patience, fortitude and support from the treating team. When faced with such a situation do consider taking a break, understanding why your treatment didn’t work and planning your next step. Usually, a break of 2 to 3 months is recommended.

Does IVF increase the chances of having twins or triplets?

It is not necessary that while one opts for IVF, the couple will always have twins or triplets. World data suggests that when 2 good quality embryos are transferred on a day 3 after fertilisation the chance of twins is around 25%, interestingly when 2 good quality blastocysts of day 5 are transferred the twin rate is 50%. The success rate of IVF is not just measured on transferring of the number of embryos. However, the fertility experts successfully freeze the extra embryos and store them for future vitrification thus reducing the risk of multiple births.

What is the cost of IVF treatment?

IVF is not always expensive. The cost of the treatment depends upon the cause of infertility, the type of intervention needed and the protocol used. Depending upon the patient, the fertility treatment and medicines required would differ and the cost would vary accordingly. There are many other factors such as age, type and duration of infertility and the type of procedure done. Certain insurance agencies have started offering fertility insurance as well.