IVF Treatment in India

IVF’s full form is “In Vitro Fertilization (IVF)”, IVF’s meaning can be easily described in two parts, In Vitro means in the glass and fertilization which means the fusion of two gametes to form a zygote. [1]

In other words, it is an artificial procedure of giving birth to a baby. It is a technology named ART (Assisted Reproductive Technology), used to treat infertility.

Among other forms of ART such as GIFT (Gamete Intrafallopian Transfer) and ZIFT (Zygote Intrafallopian Transfer), IVF is the most effective and commonly used method of infertility treatment.

IVF (In Vitro Fertilization) is a complex series of procedures beginning by collecting a woman’s egg (egg retrieval) and a man's sperm and later combining them artificially in a laboratory dish. This process is called fertilization.

After fertilization, the fertility expert will identify the best-fertilized eggs (also called as an embryo) to transfer inside the woman’s uterus. The successful implantation of the embryo results in a pregnancy.

The IVF process may involve surrogates or donors (eggs or sperm donors) depending on the individual case. In some cases previously frozen embryos are used during the successive IVF cycle.

IVF is the most effective treatment for infertility available today. Along with being effective, it is also expensive and exhausting for the couple. During the IVF procedure, the doctor and patient need to make many crucial decisions to make the IVF treatment successful. It is important to understand the whole IVF process before undergoing treatment. The procedure of IVF is:

• IVF cycle begins from the first day of your menstruation. According to the fertility plan before the onset of the menstruation cycle, you will be provided medication or injection.
• Medication is provided for 8 to 14 days to stimulate the ovary so that they can produce more eggs.
• After medication, the ovary is kept under watch. Changes in hormonal levels due to medication are tested via a Blood test and ultrasound. If it is affected the doctors can prescribe for change in medication according to the needs of the situation.
• The next step is to process the ovulation of eggs with the help of trigger injection. After this, one day in the IVF treatment cycle you will be sedated and eggs will be transferred from ovary to the tube. This procedure will be carried away within a period of 20 – 30 min.
• This is followed by collecting fresh sperm from a donor or the male partner. If the previously frozen egg or donor sperms have been used for the process then it is being processed in the lab.
• The eggs and the sperm are kept in a petri dish for fertilization in a laboratory.
• For 5 to 6 days the development procedure is being monitored, if eggs get fertilized successfully then it develops into an embryo.
• After the healthy development of the embryo, it is implanted inside the woman’s uterus.

Approximately two weeks after the transfer woman’s hCG level in hormone is measured through a blood test. If the examined levels are high then the whole IVF procedure is successful and pregnancy is safe.

IVF process is considered as an effective solution to those who can’t conceive naturally, like same-sex couples, single mother or single father. This treatment is also offered as a primary treatment for infertility to those women who are in their late 30’s. IVF treatment was initially developed to treat women with the tubal disease. Nowadays, in-vitro fertilization (IVF) can help couples with different types of infertility. For some diseases and conditions, IVF is the first line of treatment, while in other cases, IVF is recommended only when the simple treatments are ineffective.

IVF is commonly recommended for the following factors :

• Fallopian Tube Damage or Blockage

In medical terminology, a damaged or blocked fallopian tube is known as Tubal occlusion which can be one possible reason for female’s infertility.

Fallopian tube plays a vital role in conception as the eggs are fertilized here which results in pregnancy.

If the fallopian tube gets damaged due to any possible reason, such as infection or by surgery, they get blocked due to scar tissue.

This restricts an embryo to travel from the ovary to the uterus or an egg to get fertilized, causing infertility. IVF uses the implantation procedure to overcome this type of problem.

• Ovulatory Disorders

A female succeeds at being a mother when she gets pregnant, which is due to ovulation. But if one fails to conceive after frequent tries, it is considered infertility.

There are no outward signs or symptoms to signify it, this can only be signified by a period of a menstrual cycle which is too short, too long, absent or irregular.

In IVF, medications are given to women having ovulatory disorders to increase the production of eggs or in some cases donor eggs are used for the fertilization process.

• Endometriosis

The uterus is lined with a layer of cells called endometrium, where the embryo grows and develops resulting in pregnancy.

Endometriosis is a disorder in which endometrial tissue grows outside the uterus, this causes infertility. The primary symptom of endometriosis is pelvic pain that’s worse than usual menstrual pain.

• Uterine Fibroids

In medical term fibroids known as uterine myomas or leiomyomas, are abnormal noncancerous growths of the uterus.

These benign growths inside or outside the uterine wall are common for the 30s and 40s woman.

The growth of fibroids varies in sizes from seedling to bulky masses.

Sometimes, fibroids expand so big that it causes severe pain, heavy periods and can interfere with implantation in the IVF process.

• Previous Tubal Sterilization or Removal

Tubal sterilization is a method to control birth permanently. In this method fallopian tubes are cut and tied to avoid pregnancy; it is medically referred to as Tube ligation.

IVF is the best alternative to those women who want to conceive again after this procedure.

• Impaired Sperm Production or Function

The inability to conceive a child is not only due to female infertility, sometimes male infertility can also play a vital role.

Low sperm count, low quality sperm or blockages in the vas deferens are considered to be the cause of male infertility.

Infertility arises due to various factors such as lifestyle, injuries, chronic diseases, illnesses, and other factors.

• Unexplained Infertility

Unexplained infertility as the name suggests remains unexplained.

It is idiopathic infertility which means, its cause remains unknown even after proper evaluation.

• Genetic Disorder

Genetic disorders are serious issues as it passes on hierarchically.

If you want to avoid this to pass on to your child, IVF procedure is the solution in which you have to go through preimplantation genetic testing.

In this procedure, embryos are screened to detect genetic problems and those which do not contain any defects are implanted into the uterus.

• Fertility Preservation for Cancer or Other Health Conditions

If you are diagnosed with cancer and are going to start it’s treatment, fertility preservation is the best option to go with. This is because while going through the treatment procedure, your body is exposed to radiation or chemotherapy which may harm your fertility.

This can be frozen in two states, either by storing eggs and sperm or embryos for future use.

• Surrogacy

Some women face serious complications during pregnancy due to their health conditions. So, with the help of surrogacy, they can feel the joy of being a parent.

About surrogates, they are basically of two types, traditional surrogates are those women who get pregnant using her egg and sperm from the male partner of the couple.

The second one is a gestational carrier. They are just a carrier of the baby.

Before the IVF process begins, both men and women have to undergo various tests and diagnosis. Tests done to diagnose infertility are generally known as Pre-Screening Tests. Which method of IVF is best suitable for you is determined by the results of Pre-screening Tests.

Results of the pre-screening test help doctors answer the following questions:

• Is there a presence of any infections, genetic issues or autoimmune diseases?
• Are you ovulating?
• Are your fallopian tubes normal?
• Is the uterus ready for implantation?
• Are the sperm count and functions normal or not?

Once problems are identified, treatment will be planned as per your current situation. The recommended approach will be based upon your age, diagnosis, the period of infertility, and previous treatments.

While every patient does not require to go through all the diagnostic tests. However, a thorough diagnostic evaluation is an ideal treatment plan to achieve the ultimate goal of pregnancy.

Usually, doctors recommend multiple tests before proceeding with the IVF process. These tests are recommended so that no complications may occur during the procedure and treatment can be done successfully. IVF tests are conducted after a thorough consultation with the doctor. During the consultation, your doctor will let you know your best options and tell you which method of IVF procedure is best suitable for you.

General Screening Test – Infectious and Genetic

• Infectious Screening

If a patient is affected by any infectious viruses or organisms such as Chlamydia Antibody, Gonorrhoea, Hepatitis B, Hepatitis C, Syphilis Serology, HIV then they have to undergo an Infectious Screening test. This test is recommended for both the patient and her partner to avoid diseases from passing on to your baby.

• Pre-Pregnancy Screening

Under Pre-Pregnancy Screening Test complete Blood Count, Blood Type & Rh (Rhesus) Factor, Rubella Titer tests are performed. These tests are performed to protect the fetus from serious complications such as anemia and other possible heritable disorders.

• Pituitary/Thyroid Screening

Mostly women at the stage of childbearing age are commonly diagnosed with Hypothyroidism, which can contribute to infertility or can even cause miscarriage during pregnancy. Therefore, proper diagnosis is required to be done which includes tests like prolactin, TSH, free thyroxine hormone test.

• Genetic Screening

This test is performed to diagnose some genetic diseases such as Tay Sachs, Cystic Fibrosis, Sickle Cell, etc.

According to your medical history if you are diagnosed with Genetic Autoimmune Diseases or Medical Disease, then before initiating the IVF cycle physicians may advise you to take some other tests in order to avoid the heritable disorders to pass on.

• Pap Smear

To diagnose Cervical cancer, other cervix problems or Sexually Transmitted diseases, this test is recommended. If you are diagnosed with any of these diseases then it may cause obstruction or complication in your pregnancy.

Ovarian Function and Ovarian Reserve Screening

About 30- 35% of female-related infertility is due to Ovarian Disorder. So, the basic purpose of the test is to diagnose whether you are ovulating or not.

Following tests are performed under Ovarian Reserve Screening:

• Baseline Ultrasound

Baseline Ultrasound is performed on the second, third or fourth day of the menstrual cycle. With this, you can get information about the size of the ovary, volume and number of follicles.

• Day 3 Blood Work

Under Day 3 Blood Work, FSH, LH, E2 tests are performed. From these tests, the hormone level is diagnosed, such as follicle Stimulating hormones, luteinizing hormones and Oestradiol, at the beginning of the menstrual cycle. This helps the doctors to get to know about a woman’s “Ovarian Reserve”.

Fallopian Tube Evaluation

Usually, 30% of the female infertility cases are related to fallopian tube issues. Some of which are Tubal Blockage, scarring due to prior or undiagnosed Pelvic Infection, stomach infections such as Appendicitis, prior surgical history, previously occurred Ectopic Pregnancy or Endometriosis.

• Hysterosalpingography

Hysterosalpingography is an X-ray examination in which an amount of dye is inserted through the uterus and fallopian tubes. It is done to find out whether the fallopian tubes are blocked or not.

Uterine Evaluation

The lining of the uterus is layered by tissues or cells known as Endometrial cells, where the embryos are implanted which then begin to develop into pregnancy. It is important to evaluate the uterine cavity thoroughly to diagnose the defects or obstacles in the implantation of the embryo.

Tests such as Uterine Scar Tissue (from prior procedures or pregnancies), Polyps, Fibroids and structural defects inside the uterus are examples of the defects.

An evaluation may be performed according to your specific situation, which includes the following test:

• Baseline Pelvic/Vaginal Ultrasound

Pelvic Ultrasound is done on the second, third or fourth day of the menstrual cycle. This procedure gives information about the uterine cavity, such as the length and direction of the cavity.

• HSG (Hysterosalpingogram)

Hysterosalpingogram can provide information about the structural defects of the uterine cavity.

• Sonohysterography/Sonohysterogram (Saline Sonography)

In this treatment, a small amount of sterile fluid is poured inside the uterus for evaluating the uterine wall and inner uterine cavity thoroughly. This procedure provides information about abnormalities of the uterine wall and endometrial cavity.

• Diagnostic Hysteroscopy

A hysteroscopy test is recommended for those women who are undergoing IVF or who have doubts about Sonohysterography.

• Endometrial Biopsy

Under certain circumstances, the test is performed to diagnose problems regarding undeveloped endometrium (known as luteal phase defect), or infection of the endometrial lining.

IVF test rules out any problems with embryo such as abnormalities, infection, or disease, which could reduce the chances of a successful pregnancy and prevents miscarriage.

Infertility does not occur only in women; infertility can also occur in men. Infertility tests are necessary for men who are unable to conceive after several tries. About 40% of cases of infertility are mainly due to male-related infertility. This treatment includes the examination of men’s organs including a general physical examination.

Also, some of the following specific fertility tests are done:

• Semen Analysis

This test includes microscopic evaluation of sperm which is performed by an experienced andrologist. Information from semen analysis such as sperm count and the quality of the sperm helps determine which technique is used to fertilize the egg with the sperm.

These include options such as timed intercourse, Intrauterine Insemination (IUI), traditional IVF or ICSI (Intracytoplasmic Sperm Injection).

• Anti-sperm antibodies

This test detects the abnormal particles in both blood and semen, which are called antibodies. If it is left undetected and undiscovered then it may destroy or harm normal sperm.

• Karyotyping

This is a chromosomal analysis of potentially significant abnormalities hindering fertilization and pregnancy. Subsequent treatment options for this include Preimplantation genetic diagnosis or use of donor sperm.

• Genetic test (Y chromosome deletion testing – Genetic disorder testing)

When the sperm count is very low it can be due to genetics. If there are changes in the Y chromosome it indicates a genetic abnormality that lowers the natural pregnancy rate. It can be detected by simple blood tests.

With IVF, using ICSI’s advanced reproductive technology fertilization can be done. However, this disparity can occur to his child, due to which genetic testing is done to detect diseases found in family history, such as cystic fibrosis.

• Sperm Chromatin Structure Assay (SCSA)

This is a new testing procedure, which is done in case one experiences frequent miscarriage or unexpected, unexplained and repeated unsuccessful IVF cycle. A possible cause of failed fertilization is due to male infertility. This test analyses the defects of DNA fragmentation in sperm.

Studies have shown that there are significant abnormalities in this test which affects the natural conception. However, the good thing is that with ICSI advanced procedures such as IVF can help in achieving pregnancy. This test is usually used for patients suffering from persistent pregnancy loss.

• Testicular biopsy

This test involves removing the sperm specimen from the testicles with a needle. Testicular biopsy result shows that if sperm production is normal, then the sperm transport problem is due to blockage or any other reason.

In some cases, brain MRI and vasography are also performed.

In some rare cases, a semen sample is evaluated to check for DNA abnormalities.

Not all patients require every diagnostic test, although a thorough diagnostic evaluation is important to determine an ideal treatment plan, to achieve the ultimate goal of pregnancy.

IVF (In Vitro Fertilization) is a complex series of procedures that begins by collecting (retrieve) woman’s egg and men’s sperm, combining them in a laboratory dish referred to as a Petri dish for fertilization. After fertilization, the best-fertilized egg(s) [embryo(s)] is determined by the physician, which is then implanted inside the woman’s uterus. If the treatment succeeds, the embryo will start developing and result in a pregnancy.

Steps of IVF Procedure

IVF is a complex technique and so, the procedure needs to be followed carefully. The procedure of IVF is executed in five basic steps:

Step 1: Ovarian stimulation

Step 2: Egg retrieval

Step 3: Sperm retrieval

Step 4: Fertilization

Step 5: Embryo transfer

Generally, a cycle of IVF procedure takes 2 to 3 weeks and there are some cases of failures too. A patient can require more than one cycle to attain the ultimate goal of pregnancy.

If you are healthy enough and choose to use your eggs in the IVF procedure then Ovulation induction is the first step in the IVF cycle in which, through medical procedure, the ovary is stimulated. Which in turn stimulates the release of mature healthy eggs. Because at the time of fertilization some eggs do not get fertilized so more eggs are required to attain the goal of successful fertilization. During this medication, the female partner has to undergo a certain routine check-up such as a blood test to check hormonal imbalance, and a transvaginal ultrasound to examine the ovaries.

In various situation following medications are used for Ovulation induction:

• Medication for Ovarian Stimulation

For ovarian stimulation, injectable drugs such as follicle-stimulating hormone (FSH), Luteinizing hormone (LH) or combination of both can be given.

These drugs stimulate the ovaries to produce more than one egg at a time. In the entire cycle of IVF, 1 – 2 injections can be given every day.

• Medication for Oocyte Maturation

Usually after 8 – 14 days the follicles are ready for egg retrieval. Then you will be given a human chorionic gonadotropin (hCG) hormone, it is helpful in maturing eggs. However, to help the eggs to get mature other medicines may also be given.

• Medication for preventing premature Ovulation

These drugs prevent the developing eggs from releasing soon from your body.

• Medication to build the lining of your uterus

The day your egg is received or at the time of embryo transfer, your doctor may recommend progesterone supplements to make the uterine lining more receptive. After consulting your doctor will determine when to use which medication. You will be required to undergo ovarian stimulation usually for one to two weeks (8 – 14 days) before you are ready to receive eggs. Your doctor will examine to determine whether your eggs are ready for retrieval or not.

To determine the timing of egg retrieval the doctor can make the following examination:

• Vaginal ultrasound - In this, the ovary will be examined to monitor the development of follicles.
• Blood test - A blood test will be done to measure your response to the medication given for ovarian stimulation. Usually estrogen level increases when follicle develops and the progesterone level remains low until after ovulation. Sometimes due to some reason, the IVF cycle needs to be canceled before the egg retrieval.

Following are the reason for canceling IVF cycle:

• An inadequate number of developing follicles.
• Premature ovulation
• High-growth of follicles, which poses a risk of ovarian hyperstimulation syndrome.
• Other medical issues

If your cycles get canceled then your doctor may recommend a change in drugs or their dosage to promote the better response during a future IVF cycle or can advise using a donor egg.

Egg retrieval is a technique in the IVF process, in which eggs are removed from a woman’s ovary to fertilize with the male sperm in a laboratory, outside the body.

Procedure for Egg retrieval:

• Eggs are retrieved through a minor surgical procedure. This process is carried out for 36 hours following an injection used to induce the eggs to mature.
• During this procedure, you will be provided with medicines to keep you relaxed and to reduce potential discomfort.
• With the help of transvaginal ultrasound imaging, which guides a hollow needle connected to a suction device through the pelvic cavity to the follicle, which then gently removes out the eggs from each follicle.
• If the above procedure fails (Ovaries are not accessible) through transvaginal ultrasound then the alternative is done through an abdominal ultrasound that will guide the needle.
• With the help of a suction device, multiple eggs are removed. This procedure takes nearly 20 - 30 minutes.
• After this procedure, you may experience certain discomforts such as feelings of fullness or cramping. It may take 1 – 2 hrs to alleviate this situation, someone must be available to drive you home.
• After the retrieval of mature eggs, they are kept in a culture medium (nutritive liquid) and incubated. In an attempt to create embryos, healthy and mature eggs are mixed with sperm.

In sperm retrieval, if a male partner chooses to use his sperm then he has to produce a semen sample, which is then treated for combining with the eggs. After the semen sample is the sperm is separated from the semen fluid in the lab. In some cases, surgical procedure is used to extract sperm directly from the testicle, this method is known as testicular aspiration. Otherwise, in some cases, donor sperm is used in the IVF procedure.

Sperm retrieval is a simple process and recovery time can range from a few days to a week. Listed below are few points to keep in mind:

• It is advised to avoid strenuous activities.
• You may also be given antibiotics before or after the procedure to lower the chances of infection.
• If you have stitches, it may take some time to heal.
• For returning to heavy work and the normal lifestyle it may take 5-10 days.

Fertilization is a process in which two gametes are fused to form a zygote which later results in pregnancy. In this process eggs and sperm are retrieved from their respective fluids and then they are incubated for fertilization.

Two common methods for fertilization procedure are:

• Conventional Insemination

To encourage fertilization the mixture of sperm and eggs is stored in a laboratory dish, this process is called conventional insemination. Then it is being monitored overnight to confirm that cell division is taking place.

• ICSI (Intracytoplasmic Sperm Injection)

There are some cases of the lower probability of fertilization in that case ICSI (Intracytoplasmic Sperm Injection) is used. In this process, sperm is directly injected into the egg to achieve fertilization. Once cell division occurs, fertilized eggs are considered to be an embryo.

In the IVF process, sperm and eggs are fertilized to develop an embryo. Using a mixture of amino acids, it is placed in a special incubator. The condition inside the incubator is perfect for the growth and development of an embryo.

One day after egg retrieval (the first day of fetal development), the embryologists start the evaluation of fertilization and separate the normally fertilized egg.

On the second day of embryonic development, the normally divided fetus should have 2 – 4 cells and on the third day it should have 6 – 8 cells, this stage is called the cleavage stage.

On the third day of fetal development, embryologists assess embryo and grade them based on several factors.

The factors for grading the fetus are as follows:

• Under the microscope, the outer layer of the embryo should be uniformly smooth.
• Each cell should be approximately the same size
• The outer layer of embryo i.e. zona pellucida should be clear and it should not be very thick.

Embryos in which the are of better quality and also cell division takes place normally, have a greater possibility of implantation.

Therefore, embryos which are of good quality and in which cell division is taking place normally are chosen for implanting.

The embryos which are being transferred depends upon the number of embryos to be transferred, quality of fetus, maternal age and days of transfer (third day vs. the fifth day)

Third day vs Fifth day

After egg retrieval, fertilization and early embryo cell division, on the third day of embryonic development, the fetus is transferred into the uterus.

However, due to availability in scientific progress and advanced cultural media, embryo blastocyst stage (fifth or sixth day of development of embryo with 80 – 100 cells) can be developed in a lab.

The ability to progress to the blastocyst stage of a fetus comes from the development of advanced cells within the embryo.

After five days of growth, the cells of a normal healthy fetus divide several times and adapt to their tasks.

An embryo that survives and grows in this stage of development is called blastocysts. The living embryo in this stage is strong and healthy, which is more likely to be implanted.

In this way, it is better for an embryologist to choose one or two blastocysts rather than selecting many embryos, which reduces the likelihood of more than one pregnancy.

However, not all eggs are able to fertilize and reach the embryo stage. It is because the eggs are unable to mature properly or the sperm is not able to fertilize the egg.

In such a situation, doctors may recommend the following procedures for embryo transfer:

• Assisted hatching

Approximately five to six days after fertilization, an embryo hatches through its outer membrane (zona pellucida) which would allow it to be implanted into the lining of the uterus.

If you are an older woman or if many of your IVF attempts have failed then your doctor will recommend you Assisted hatching. Assisted zona hatching is an artificial In Vitro conception technique.

Under this technique, for embryo hatching and implantation, a hole in the zona pellucida is made just before the embryo transfer is done. Frozen egg and embryo may cause zona pellucida to harden in this state-assisted hatching techniques are effective.

• Preimplantation genetic testing

Until embryos reach a certain stage, it is placed in an incubator for development. A small sample can be extracted after five to six days of development. And then this sample can be tested for the exact number of genetic diseases or chromosomes.

Embryos that do not have affected genes or chromosomes can be transferred to the uterus. Preimplantation genetic testing determines that the parent’s genetic problem will affect the infant or not, its potential can be reduced, while it can not eliminate the risk. In this situation, prenatal testing may be recommended.

Embryo transfer is the last and most important step in the IVF procedure. At this step the fertilized embryo is transplanted into the uterus of a woman. The doctor uses a catheter to place the egg inside the womb.

• This is the final step of the procedure where developing embryo(s) are transferred into the uterus.
• This procedure is usually done after 3 to 5 days after egg retrieval and fertilization.
• In this procedure, you will be given a mild sedative. Usually, this procedure is painless for most of women, but some may experience mild cramps.
• The embryo is placed inside the uterus with the help of a long and thin flexible tube known as a catheter.
• At the end of the catheter, a syringe is attached containing embryo(s) suspended in a small amount of fluid.
• Then doctors place the embryo(s) inside the uterus with the help of the syringe.
• If the whole procedure takes place successfully, then implantation will occur after six to ten days following egg retrieval.

Deciding the number of embryos you need to transfer during an IVF cycle is a difficult decision. Keep the listed points in mind while deciding how many embryos to transfer during an IVF cycle:

• If you have been trying to conceive for a long time, keeping two or more embryos increases your chances of success.
• If you are planning to conceive more than once, you should increase the count.

However, single embryo transfers are safer for the mother and the baby’s health.

The result of the IVF process can be determined by the following procedure:

• About 12 to 14 days after ovulation doctors will prescribe you for hCG (Human Chorionic Gonadotropin) hormone test. For this, they will take a blood sample to check the level of hCG.
• A higher hCG level in your bloodstream usually indicates a positive sign after the embryo transfer.

If you are examined as a pregnant, your doctor will refer you to an obstetrician or a gynecologist for prenatal care.

The IVF process is a complex one and can increase the risk of problems like miscarriage, birth defects, etc. However, the treatment can be adjusted to nearly eliminate these risks. You must make sure to have a detailed discussion with your doctor about the risks involved in the process. The risks and complexities of IVF treatment are as follows:

• Multiple Birth

If more than one fetus is transferred to the uterus then it increases the risk of more than one birth. This also carries the risk of premature delivery and low birth weight of the baby.

• Premature delivery and low birth weight

It is suggested by research that IVF carries the risk of early labor or baby will bear with low birth weight.

• Ovarian hyperstimulation syndrome

For Ovulation injectable fertility drugs such as human chorionic gonadotropin (hCG) are given during IVF. Due to this type of drug, there may be a risk of ovarian hyperstimulation syndrome in which ovaries become swollen and you may experience mild pain.

• Miscarriage

The rate of miscarriage in women undergoing IVF treatment ranges from about 15% to 25%. This rate is similar to those who conceive naturally but it increases with maternal age.

• Egg retrieval procedure complications

Complications may arise in the egg retrieval procedure due to the use of an aspirating needle that collects eggs from the ovary. It could probably affect bladder, bowel or blood vessels by causing infection or bleeding.

• Ectopic pregnancy

In Ectopic pregnancy the fertilized egg implants outside the uterus which leads to the risk of miscarriage. Approximately about 2% to 5% of women will have ectopic pregnancy while undergoing IVF treatment.

• Birth defects

Maternal age is the primary factor which increases the risk of birth defect in the baby. It is similar to those who conceive naturally higher the age of mother more risk of birth defect no matter how the baby is conceived.

• Cancer

The use of certain medications may increase the risk of breast cancer, endometrial cancer or ovarian cancer to those women undergoing IVF.

• Stress

IVF treatment impacts emotionally, financially and physically which results in increased stress. To move through this situation proper support from family and friends is required.

The success rate of the IVF procedure leans on various factors which include the cause of infertility, place of the procedure and also the age factor. According to statistics irrespective of age, a 30% live birth rate due to IVF is considered a good standard worldwide.

The success rate of IVF is as follows:

• For women younger than 35 years, the live birth rate percentage per egg yield is 54.4 %.
• For 35 – 37 years of age, the success rate due to IVF is 42 %.
• For 38 – 40 years of age, the success rate due to IVF is 26.6 %.
• For 41 – 42 years of age, the success rate due to IVF is 13.3 %.
• For a woman aged 43 and above, the success rate of IVF treatment is 3.9 %.
• While using donor sperm the rate of live birth per cycle is 53.5 %.
• While using donor sperm with freezing egg the rate of live birth per cycle is 38.5%.

Intra-Uterine Insemination and Intra Vitro Fertilization are the two techniques that can be used to conceive baby artificially. Intra-Uterine Insemination technique is an artificial way in which healthy sperms are directly injected inside the woman’s womb. Whereas in Intra Vitro Fertilization female eggs are extracted from their ovary and stored in tubes and to be mixed with sperm which later develops in the embryo after that embryo is being transferred back into the uterus.

Intra Uterine Insemination procedure is easier than Intra Vitro fertilization it takes less time and has fewer problems. During In Vitro fertilization women receive several types of health risks, whereas Intra Uterine stimulation does not have any.