20.000 babies were conceived in 2017 in Germany by in vitro fertilisation. Six and a half million children have been born so far owing to that procedure. Still, when people hear about it, many couples feel fear and discomfort.
It is said that in vitro fertilisation is a measure of last resort of the assisted reproduction and that terminology sounds even scarier. IVF procedure is preceeded by many other, simpler techniques which often reverse the course toward the desired direction already during preparations for the procedure itself.
The precondition is finding the real cause of the problem, and that is a well-founded diagnosis, which is certainly the most important lead to follow.
Is it time for me to have in vitro fertlisation?
“When a couple with conceiving problems addresses our team, we try to gain an accurate insight, through conversation with them about the previously performed analyses, radiographic imaging, former interventions or surgeries.
Thereafter, we perform a quality diagnostic assessment. It includes ultrasound examinations of fallopian tube function, diagnostics of uterine anatomy, checking the spermogram and sperm culture.
On the basis of all these information we determine a precise diagnosis, ie. try to identify the real cause of conceiving problems of that couple“, says doctor Bozana Stepanov, a gynecology and obstetrics specialist, Head of the Specialist consultative department of the Specialized Gyneacolgy Hospital “Genesis“.
Depending on the results, we recommend additional diagnostic methods like hysteroscopy, ERA testing and other most up-to-date genetic analyses that we perform, and which can provide many valuable answers, Dr Stepanov adds and points out that some method of assisted reproduction is always recommended to a couple, while in vitro fertilisation is an ultimate method in situations when conditions for a simpler one are not met.
Age of both partners, hormonal status, spermogram values, condition of fallopian tubes and possibly, some comorbidities are the most important factors which affect the decision about the further treatment.
What can be done before in vitro fertilisation
Sometimes, counselling is enough for a couple who wants to achieve pregnancy, regarding healthier life style, eating habits and loosing weight, as well as introducing or correcting the dosage of some vitamin supplements, thyroid hormone therapy, insuline resistency. Very often, only psychological counselling is enough, Dr Stepanov says.
Another possibility is folliculometry, that is ultrasound surveillance of the follicule growth and prediction of ovulation, with recommendation to have timed intercourse. Conditions that must be satisfied for folliculometry are normal hormonal status and a partner’s spermogram.
Afterwards, intrauterine insemination is usually recommended. This procedure actually includes, besides folliculometry, ultrasound surveillance of the follicle growth and prediction of ovulation, whereby a processed sperm sample is inserted during timed ovulation.
In order for the procedure to be successful, a woman must have normal vaginal and cervical smears, as well as passability of uterine tubes. Her partner should have a normal spermogram and spermoculture. It can be carried out in a spontaneous cycle or with addition of hormones, in a so-called stimulated menstrual cycle.
If these steps do not make patients’ dreams come true, a couple is recommended in vitro fertilisation.
In vitro fertilisation – step by step
In vitro fertilisation is used after thoroughly conducted diagnostics and adequate therapy administration. That can mean managing thyroid gland disorders, insulin resistance, and obesity and so on, along with timing a menstrual cycle from which a procedure will start. That is a preparatory phase for the patient.
Then comes ovulation induction phase. It includes starting administration of hormonal balance supplements which entice follicular growth in the ovaries. These supplements can be in pill form or through injection, they can be administered within long or short protocols, that is, they can be prescribed for a longer or shorter time period.
The effect of hormonal balance supplements, as follicles grow, is evaluated by ultrasound, several times during the stimulation procedure, depending on the ovary response to stimulation. When follicles reach an adequate size, the level of certain hormones is checked and patients are prescribed a so-called “ovulation trigger“ – “stop shot“ which denotes the end of stimulation and planning for aspiration, retrieving the eggs from developed follicles.
The very aspiration is preceeded by certain preparation which includes taking antibiotics, bowel emptying and is performed under general intravenous anaesthesia. On the day of aspiration, a partner gives a semen sample and afterwards fertilisation of retrieved egg cells is performed in an embryo laboratory, where embryologists can further monitor the growth and development of embryos.
The Genesis Hospital enables couples to observe development from the very beginning, owing to continuous embryo monitoring by means of our PRIMO VISION system.
By observing the speed and manner of cell division, it is easier for embryologists to precisely select quality embryos which have the greatest potential for insemination into the interior of the uterus, Dr Bozana points out and adds that embryologists from Genesis increase the pregnancy rate also owing to assisted hatching as well as an embryo glue medium, which facilitate embryo implantation into the uterine mucosa.
After embryo development with a little “help“ of supreme embryologists, there follows an embryotransfer, that is returning the embryo into the uterus. It is performed on the third, that is the fifth day (if embryos are in the blastocyst stage) after aspiration.
Thus the very procedure of in vitro fertilisation is finished. The duration of this procedure is aproximately two weeks within short protocols, and three to four weeks within long protocols where a preparatory phase lasts longer. The patient continues with prescribed therapy and performs a pregnancy test after 8-12 days since embryotransfer, Dr Bozana says.
She points out that IVF method is not painful. Some patients may feel discomfort at the site of injection. Only aspiration is performed under short-term anaesthesia to prevent it from being painful.
Time is the most precious ally
Anyone can ask whether a young couple really needs in vitro fertilisation treatment. Older gynecologists used to advise: wait, you still have time, it will happen.
This way of thinking has changed today. It is considered that a young couple facing conceiving problems after having unprotected intercourse for one year’s time should consult a gynecologist and be referred to the basic infertility diagnostics, and subsequently to possible additional diagnostic investigations.
Making timely decision is important in order to begin therapy on time and avoid reducing an array of possibilities. The younger a couple is, the more methods of assisted reproduction are in front of them. More attempts. The younger a couple is, the faster and easier will they achieve a desired pregnancy with our help, says Dr Stepanov.
Can hormonal therapy be harmful
– One of the most frequently asked questions during instruction about the process itself and a final decision is whether such stimulation may also have negative consequences. However, hormonal balance therapy within in vitro fertilisation is short-term (only about ten days within short protocols) and usually has no harmful effect on one’s health.
Hormonal balance therapy can be used in healthy women, but also in patients who suffer from some diseases (for ex. liver and kidney insuficiency, cancer) when it must be undertaken with caution and appropriate monitoring. These are exactly the reasons for which a patient is thoroughly examined before IVF, including a mandatory breast examination.
There might be possible some side-effects during hormone administration, like for example, ovarian cyst formation. In patients who underwent several IVF procedures with hormonal stimulation, it is inevitable for a decrease of so-called “ovarian reserve“ to happen, which results in a weaker ovarian response in the future IVF treatments, along with getting a smaller number of egg cells, Dr Stepanov points out.
Couples who have fertility problems and ask for help often get surprised to hear that the only option for them is in vitro fertilisation, Dr Stepanov notices.
–Infertility is not a disease, they feel healthy, therefore it is hard for them to accept IVF as a treatment.
Unfortunately, in vitro fertilisation treatment is often indicated only because of the age. There are numerous couples who are over 40 and the other methods of assited reproduction are unacceptable for them.
We always try to explain to them what in vitro fertilisation treatment is about, what it looks like, and to support them and earn their trust. Trust between patients and the team is highly important, and statistics shows that they are not alone with this problem.
Over 186 milion of couples in the world and over 400.000 in Serbia are faced with the infertility problem, and in vitro fertilisation is an increasingly used solution, the doctor points out.
Bringing a decision about which way to go further and with whom, is not easy at all. Good knowledge of the results an institution achieves in that field and especially in your age group, the relation it has with a patient and the technology it uses, can be extremely helpful in choosing a team you will trust.
All information reagrding consultations for infertility treatment, one-day diagnostics for infertility, available dates and a complete procedure of in vitro fertilisation can be obtained by calling +381 21 549 444, +381 21 549 777, by sending an E-mail firstname.lastname@example.org or personally at the addres 4 Urosa Predica street in Novi Sad.