IVF (In-Vitro Fertilization) in Iran
IVF is a method for assisted reproductive technique in which the egg and sperm would be fertilized in the laboratory.
IVF (In-Vitro Fertilization) in Iran :
- Duration : 4 to 6 weeks
• Fertilization in a lab when the egg can not be fertilized in the womb
• Overcoming infertility problems mostly related to egg not descending to uterus
IVF IN IRAN: ALL YOU NEED TO KNOW
IVF is the most effective method of assisted reproductive technology (ART). In this approach, the eggs are retrieved and fertilized with the sperm in a laboratory. Then, the embryos are implanted in the woman’s uterus. Each attempt is called a cycle. Every cycle takes about 3 weeks.
The cause of infertility and the age along with other factors, determine your chance of having a healthy baby. IVF is a time consuming, costly and invasive procedure, therefore it is better to try non-invasive ways like infertility drugs before IVF.
The cause of IVF
IVF is aimed to treat infertility. Infertility has two types: secondary and primary.
• Primary infertility: the couple has been having unprotected sexual intercourse for at least one year without a result.
• Secondary infertility: the couple has experienced a successful pregnancy before but after some years they get infertile.
IVF may be suggested to couples as an ART choice. However, in women older than 40 it may be recommended as the first approach of infertility treatment.
IVF can be beneficial in the following items:
• Absent, damaged or blocked fallopian tube that doesn’t respond to surgery and hinders the embryo from reaching to uterus or egg to be fertilized.
• Loss of appropriate eggs for fertilization due to ovulation disorders such as infrequency or absence of ovulation.
• Endometriosis or the abnormal growth of uterine tissue inside or outside the uterine cavity that is unresponsive to drugs and surgery, which impairs the function of ovaries and fallopian tubes.
• Leiomyoma or uterine fibroid is a type of benign smooth muscle tumors in the uterine wall interfering with the implantation of fertilized eggs. This condition is almost common in women in their 30s and 40s. If you have previously removed your fallopian tubes or operated sterilization (your fallopian tubes are cut or blocked), you may have recommended tubal ligation reversal surgery or IVF to get pregnant.
• Sperm production is below the average or their function is impaired with poor mobility which leads to obtaining the sperms with surgery. In some cases, the abnormal shape and size of the sperm make it difficult for it to fertilize the egg. A specialist should examine your partner to see if this condition is correctable.
• Despite different examinations and evaluations, no apparent reason has been found to explain infertility.
• Genetic disorders leading to miscarriages and passing genetic disorders to the child. With testing the embryos, you can select the healthy ones.
• If you are about to start cancer treatment courses, you can preserve your egg and freeze them in related fertility centers until the appropriate time for pregnancy.
Preparations for IVF procedure
Prior to stepping in the IVF cycle, several tests are performed including:
• Imaging techniques may be recommended such as sonohysterography, transvaginal ultrasound of ovaries and uterus and in some cases hysteroscopy to see the interior of the reproductive system.
• Blood tests to determine the quantity and quality of your eggs by assessing the concentration of follicle-stimulating hormone (FSH), estradiol (estrogen) and anti-mullerian hormone in your blood during the first few days of your menstrual cycle.
• Your doctor may prescribe some medications before the IVF cycle such as contraceptive pills and leuprolide (Lupron).
• If you have not done semen analysis, your doctor will order the test prior to starting the IVF.
• You and your partner will be screened for infectious diseases such as HIV.
• You may have a practice embryo transfer to determine your uterus cavity depth and the best method for implantation of embryos.
Risks of IVF
IVF may contain risks including:
• Premature delivery: the studies show that the risk of early birth or low birth weight is higher in IVF.
• Multiple births: since several embryos are transferred to the uterus, there is a chance of multiple fetuses that have a higher risk of early and low weight birth compared to pregnancy with a single fetus.
• Ovarian hyperstimulation syndrome: injection of chorionic gonadotropin (HCG) for inducing ovulation, may cause hyperactivity of the ovaries. Swollen and painful ovaries, abdominal pain, nausea, vomiting, bloating and diarrhea are the symptoms of these conditions that last for about one week. However, if you get pregnant they may last for several weeks. In rare cases, the syndrome may cause rapid weight gain and shortness of breath.
• Miscarriage: The probability of miscarriage is similar in IVF and natural pregnancy which is 15% to 25%. However, the mother’s age increases this risk.
• Complications in egg retrieval: for egg retrieval, your doctor uses an aspirating needle. This may cause bleeding, infection, and damage to the blood vessels, bowel, and bladder.
• Ectopic pregnancy: in this condition, the embryo is out of the uterus, usually in the fallopian tube, and there is no way that it can survive and the pregnancy in futile. An ectopic pregnancy happens in about 2% to 5% of IVF cases.
• Stress: Using IVF may put pressure on your financial, physical and psychological status. A support network including your partner, family members, friends, and infertility counselors can help you during this time.
Recent studies suggest that ovarian stimulatory medications may increase ovarian tumors. However, the relevant studies also show that the risk of breast, endometrial, cervical and ovarian cancer does not increase significantly through IVF. Some couples are concerned about birth defects. There has been no evidence for risks of birth defects in IVF pregnancies in comparison with a natural pregnancy. most of the time peri-implantation diagnosis is done before the IVF procedure.
What to expect from an IVF?
IVF includes 5 steps:
1. Stimulating ovary or ovulation induction: this step takes about 1 to 2 weeks and it may bring some complications such as overstimulation syndrome or premature ovulation. In these cases, your doctor changes your medication.
2. Egg retrieval: 34 to 36 hours after your final medications for ovulation induction prior to ovulation, the retrieval procedure is performed in your doctor’s office or clinic. This procedure is operated under local anesthesia then the eggs will be removed using the transvaginal ultrasound aspiration method by a needle. It takes about 20 minutes to remove multiple eggs from the follicles. Then the eggs are placed in the culture medium for the next step.
3. Sperm retrieval: concurrently with the egg retrieval, your partner will provide his semen sample either through masturbation or testicular aspiration (use of needle). Then the sperms are separated from the semen fluid in the laboratory.
There are two methods for fertilization:
- Conventional insemination: Healthy sperms and mature eggs are mixed in a culture dish and incubated overnight.
- Intracytoplasmic sperm injection (ICSI): This method is commonly used when recent IVF was unsuccessful or the quality and quantity of sperms are inappropriate. In ICSI, the doctor directly injects a single functional sperm into the egg.
5. Embryo transfer: 2 to 5 days after egg retrieval, the implantation takes place. The surgeon inserts a catheter (long, hollow tube) into your vagina. Then, the embryos are placed into the uterus using a syringe attached to the end of the catheter. Then the embryos are implanted into the uterus lining 6 to 10 days after egg retrieval.
4 types of medications will be administered in different stages of IVF procedure including:
1. Ovarian stimulatory drugs: FSH or LH for developing more than one egg at a time.
2. Oocyte maturation: HCG after 8 to 14 days to mature the eggs
3. Preventing premature ovulation: medications to prevent releasing of eggs ahead of the desired time.
4. Preparing the uterus lining: before transferring the embryos to the uterus, taking progesterone helps to make the uterus more receptive
12 to 14 days after egg retrieval, your doctor tests your blood to detect the pregnancy.
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