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In Vitro Fertilization (IVF)

In Vitro Fertilization (IVF)

Simply... What is In Vitro Fertilization (IVF)?
IVF is an artificial intracytoplasmic sperm fertilization process and one of the effective means of inducing pregnancy in cases of delayed pregnancy.
It is done by collecting eggs from the wife and sperms from the husband and then each egg is injected with one sperm using a thin needle.
The success rates of IVF processes vary from one woman to another, depending on the case, and according to many factors that affect the success rates that we will be displayed shortly. The most important is the woman's age where the success rates of IVF are high with the young lady.

When do we need IVF process?
1-In cases of delayed pregnancy and wife aging without normal pregnancy.
2-In case of blockage or swelling of the fallopian tube.
3-In the case Endometriosis.
4-Cases that prevent the egg fertilization.
5-Problems in the husband, such as the sperms small number or the motion weakness.

What are the investigations and procedures required before IVF procedure?

* Wife investigations:
1-Blood Test. Where it is required:
a-FSH percentage: and is done on the second, third or fourth day of the menstrual cycle.
It has to be less than 12... If the ratio appears above 12, it means a weak uterine stock of the lady.
Also the FSH percentage should be higher than LH percentage.

b-Percentage of the milk hormone: it must be less than 20.

c-TSH thyroid investigation where it is done at any time and must be less than 2.5.

d-Investigation of ovarian stock or AMH: To be done at any time.
If the percentage is 1 or higher, it means there is a good ovarian stock.
If the percentage is less than 1, it means there is a weak ovarian stock.

The doctor gives a look at the uterus and ovaries to ensure their good state.

It is a very important procedure and must be done before IVF to avoid the failure of injection in case of a uterine problem. The hysteroscope illustrates everything inside the uterine cavity through a thin camera that enters through the cervix of the uterine cavity and reveals the presence of any adhesions, diseases or uterine septum.
It is known that these problems may prevent the adhesion of the fetus and thus prevent the occurrence of pregnancy.
Hysteroscopy is not only an exploratory but therapeutic procedure at the same time as the problem is removed (if present) before the IVF is started to raise its success rates.

* Spouse Investigations:
1-Semen Test:
Dr Ahmed Hussein stresses the importance of conducting this test in a specialized fertility laboratory to take into account the latest international standards and accurate specifications necessary for the test. There is sometimes a difference in these results between normal and fertility-specific laboratories.

2-Sperm DNA Fragmentation Test:
It is not a routine investigation, but it is done only in cases of:
-Repeated failure of IVF for no apparent reason.
-Cases of delayed pregnancy of unknown cause.
-The weak husband results.

Are there certain treatments required for the wife before IVF?
Dr Ahmed Hussein prefers for the wife going for IVF procedure, to take some of the medications needed to raise the success rates of injections, namely:
1-Antioxidants such as omega-3 medications.
2-Aspocid tablets: This is to help blood thinning and thus avoiding clots and abortion.
3-Folic acid: to hep foetus division.
The doctor can prescribe other treatments for the wife depending on her condition.

Now, It is the turn of the most common question: what are the steps of IVF procedure?
Here is a detailed explanation of the step-by-step IVF procedure steps provided by Dr Ahmed Hussein, Lecturer of Obstetrics and Gynaecology and consultant of infertility and IVF procedures:

1-Determination of the ovulation stimulants dose:
Which is determined by the age of the wife, her weight, her ovarian stock and the ovarian response in previous cases (if found).
The wife starts it during the first 3 days of the menstrual cycle.

2-Ovulation Follow-up:
-At this stage, the Doctor is visited several times in succession to follow the ovulation and the size of the egg after the wife's intake of ovarian stimulants:
-Ovulation stimulants may be injected intramuscularly or subcutaneously.
-Ovulation medications include stimulant injections and other inhibitory injections that are very important as they prevent the egg exit from the uterus after its maturity.
-Then comes the step of HCG shot which is injected to the wife when the egg arrives to the appropriate size.
-After the HCG shot by 34 to 36 hours, the ova are retrieved... The timing of the retrieval of eggs is very important to avoid the egg exit.

3-Egg retrieval:
-Performed under general anesthesia.
-This step is carried out in a specialized centre for fertility and IVF processes.
-It takes 20-30 minutes for Egg retrieval.
-This step is extremely simple.
-The pain is simple and tolerable.
-The motion is allowed after it and no fear from it.
-Intercourse is not allowed after this step.

Egg retrieval day... Don't forget:
-The wife attends fasting for at least 6 hours for eating and drinking.
-Identity card and marriage document.
-Investigations of the operation and anesthesia.

4-After the retrieval of the eggs:
Eggs are injected with sperms and each egg is carried by one sperm under a microscope.
Leave in the incubator for 24 hours for fertilization.
Fertilization and follow-up of embryos are observed after 3 days of fertilization to make sure that a healthy embryo develops.

5-Embryo Transfer:
-The most healthy ones are chosen.
-After 3-5 days of fertilization.
-Done without Anesthesia.
-It is necessary to provide a calm atmosphere for the wife and help her to relax her muscles especially the pelvic muscles, where it is easy to remove the embryo transfer and thus increase the rates of success of the injections.
-In this day, the wife must ensure that her bladder is full due to its effect on the shape of the uterus and thus helps to transfer the embryos easily.

6-After Embryo transfer:
-Rest in the centre is required from one to two hours.
-Emptying of the bladder.
-Comfort at home for 3 days.
-Light movement afterwards.
-Drink water frequently.
-There are no prohibited meals.
-Intercourse is prohibited after embryo transfer.

7-Pregnancy test:
-Done after 14 days of embryo transfer.
-Dr. Ahmed Hussein prefers the blood and digital pregnancy test to check on the quality of the pregnancy.
-If the test is positive, it is repeated after 48 hours.
-The good rate of testing is higher than 100 which means a non-weak pregnancy.
-No specific symptoms of pregnancy.

Factors affecting the success of the IVF process:
1-The wife Age: the higher the age of the wife, the lower the rates of success of the injection, according to scientific studies and practical experience.
2-Wife's weight: The wife may not expect her excess weight to be the main cause of delayed pregnancy but unfortunately, it can be.
But it is a scientific fact, as the success rates of IVF decrease with the wife's weight gain. Therefore, Dr Ahmed Hussein advises obese wives to postpone the procedure of IVF until they lose weight in order to avoid its failure.
3-The existence of previous experience of birth or successful IVF process, which increases its rates of success.
4-Ovarian stock or AMH ratio (the ratio must be higher than 1 microgram/ml).
5-The good uterine state, free from congenital defects and problems such as adenoids, adhesions and uterine septum, significantly increases the rates of injection success.
6-Fallopian Tubes: An essential factor in the success of IVF as the blockage of the tubes or their swelling leads to the failure of injection. Therefore, the tubes must be separated before the IVF is performed if there is a problem.
7-Quality of semen: significantly affect the success of the IVF process. Scientific studies have shown that sperm abnormalities do not necessarily cause injection to fail. However, in the case of repeated IVF failures, it is advised that the semen sample is taken by a testicle sample, where the success rates of the process have been increased by this procedure.
8-Endometriosis: Scientific studies have shown that the removal of blood cysts as a result of endometriosis, does not increase the rates of success of IVF and is not a preferred procedure.

Special tips for Follow up of IVF pregnancy:
1-Do not hurry for sonar as soon as the positive pregnancy test appears. We appreciate your concern and your passion to be aware of your pregnancy, but Dr Ahmed Hussein explains that urgency does not help as early sonar shows nothing.
The right timing for sonar is two to three weeks after the pregnancy test to ensure the pulse appearance.
2-Vaginal sonar is very important in following up of the pregnancy and is completely safe and does not cause any harm to the fetus or abortion and does not enter into the uterus as said by some rumours.
3-Complete rest for the duration of the nine months of pregnancy is extremely dangerous as it may cause clots in the leg and foot. Motion is necessary for a pregnant woman without carrying heavy objects or pulling them.
4-It is preferable to follow up every two weeks in the first period of pregnancy and then every month in case of stable pregnancy until the ninth month, becomes every week.
This arrangement may vary from one woman to another depending on her condition, fetal state and pregnancy case.
5-Dr. Ahmed Hussein describes some treatments throughout the pregnancy period which we will display later.
6-Dr. Ahmed Hussein recommends the four-dimensional sonar in the fifth month for an accurate check on the fetus.
7-It is also advisable to give the pregnant, the lung injection in the seventh month (and not the ninth) to improve the fetus respiration in case of premature delivery and thus reduce the chances of the child entry to the incubator.
8-Caesarean delivery is chosen and not natural for the birth of a pregnant woman from IVF process to maintain it and to avoid the problems of natural childbirth, As the mother makes a lot of effort and fatigue to get this child...it is a so precious one.

If you are pregnant by IVF process, you should commit to these treatments:
Dr Ahmed Hussein describes some of the treatments that you must commit to during your pregnancy:
1-Folic acid: necessary for fetal growth.
2-Aspocid: to help with the liquidity of the blood, avoid clots and abortion.
3-Vitamins D: As most of the women suffer from its shortage.
4-Pregnancy stabilizers.
5-Blood thinning injection: To help with blood liquidity and avoid abortion.
Note: These injections work differently than the Aspocid tablets, so you must be committed to taking them together.

What are the causes of repeated IVF process failures?
These causes are divided into the causes related to the mother, Father or fetus.

A. Causes related to Mother:
It is divided into causes related to the uterus, ovaries, fallopian tubes, blood or immunity.

1-Uterus: The presence of uterine problems causes repeated failure of the IVF process.
Therefore, Dr Ahmed Hussein advises that hysteroscopy should be done before the initiation of the injection, especially in cases of its repeated failure. This is to exclude the presence of uterine problems such as fibroids, adenoids, congenital defects such as uterine septum or adhesions.

2-Fallopian tubes: It is a major and important factor as it may cause the failure of the injection in case of its blockage or swelling.
It is swollen with fluid that pours on the uterus and causes the fetus not to implant in the uterus after embryo transfer.

3-Ovaries: The problem may be due to the poor ovarian stock, which produces a few eggs and sometimes low quality.

4-Blood: As in the case of blood clots formation which affects the flow and liquidity of the baby's nourishing blood after implantation in the uterus. Therefore, Dr Ahmed Hussein advises that you should commit to the blood thinning tablets and injections before embryos transfer.

5-Immunity: The wife may suffer from an imbalance in her immune system, which produces antibodies that attack the fetus itself at the time of implantation in the uterus. Therefore, Dr Ahmed Hussein describes a small dose of cortisone during pregnancy to avoid abortion.

B. Causes related to father:
1-In case of the very weak semen results which may mean, zero movements and 100% distortions percentage.
2-Semen DNA fragmentation rate percentage: in the case of a fragmentation percentage above 30, it means a high percentage, i.e. the inability of the sperm to fertilize. Thus, the failure of the process.

The problems caused by the weak sperm can be avoided by using a specific developed microscope to enlarge the sperm. To find out more precise details about the sperm and its quality, this enables the medical team to choose the best sperm to fertilize the egg which therefore produces a strong embryo (God willing).

C. Causes related to the fetus:
The problems that cause IVF failure related to the fetus can be avoided by:

1-Examination of the genetic material of the fetus by sampling a fetal cell on the fifth day to exclude any defect in the genetic material of the fetus.
This action is done in case of:
-Repeated failure of IVF.
-Aging of the wife.
-History of hereditary diseases.
-Repeat abortion.

2-Perforating the fetus to help it get out of the crust and get implanted in the uterus, whether chemical perforation or laser.
This step is done in case of:
-Poor ovarian stock.
-Aging of the wife.
-The embryo with a thick crust.
-Repeated failure of the IVF process.