IVF(In vitro fertilization )

IVF(In vitro fertilization )

   What Is IVF?

In vitro fertilization (IVF) is a process by which an egg is fertilized by sperm outside the body: in vitro ("in glass"). The process involves monitoring and stimulating a woman's ovulatory process, removing ovum or ova (egg or eggs) from the woman's ovaries and letting sperm fertilise them in a liquid in a laboratory. The fertilized egg (zygote) is cultured for 2–6 days in a growth medium and is then implanted in the same or another woman's uterus, with the intention of establishing a successful pregnancy.

   How Is IVF Done?

Fertilization is performed outside the body by extracting out the eggs from the ovaries and incubating them in a special lab plate with the husband's sperm under suitable conditions. Collecting the eggs is done by inserting a syringe to aspirate eggs through the vaginal wall. The position of the syringe is observed using a vaginal ultrasound probe until it reaches the follicle (eggs' casing) then the follicle is emptied in the hope that an egg is obtained. This process is done under light anaesthesia and usually does not exceed 30 minutes.

It is common knowledge that the probability of success increases with the increase in the number of eggs obtained. In order to get a sufficient number of eggs, the ovaries are stimulated by hormonal injections. Monitoring the egg's maturation is done by an ultrasound device which enables measuring of the follicle's diameter.

Hormonal levels correlating to ovulation are also measured by obtaining regular blood samples. When the follicle's diameter reaches 16-18 mm, an HCG hormone muscular injection is given to help in final egg maturity. This hormone is usually given at night and eggs are extracted within 33 to 36 hours after the injection.

The number of follicles seen during ultrasound monitoring reflect the number of potential eggs produced. But in some cases the number of extracted eggs is less than expected due to many reasons one of which is when the follicle does not contain an egg. The number of obtained eggs may also exceed the expected due to growth of some follicles after the HCG injection.

   How Does Fertilization Occur?

At The Deccan Hospital, we used to follow the traditional method of fertilizing the eggs by placing them in a specific nurturing medium containing a suitable number of selected sperms. If the eggs did not get fertilized, we resorted to microscopic injection of the egg to increase the probability of fertilization. This is referred to as intra cytoplasmic sperm injection (ICSI).

Due to the fact that most of our patients are from abroad, and that the microscopic injection of the egg results in better success rates of fertilization; we use this process with all patients at The Deccan Hospital to provide them with better chances of fertilization and thus potential pregnancies.

This fertilization process takes between 18 to 20 hours and is confirmed by observing changes on the egg under the microscope

   What Is ICSI?

The In Vitro Fertilization (IVF) program provided solutions for many problems for many families who suffer from lack of conception due to a number of potential reasons. But the success rate remains negligible or nonexistent when the reason is a severe weakness of the husband's sperms. We have been forced to reject couples due to this reason. Today, Hope is restored for such couples by utilizing an extremely developed method which injects sperm directly within the egg's liquid (cytoplasm): Intra Cytoplasmic Sperm Injection (ICSI).

Injection of the sperm within the egg near the nucleus is a modern approach which requires accurate sensitive technology and skillful laboratory work. At our Assisted Reproductive Unit we provide the best with our team who has extensive knowledge and experience in implementing this procedure, placing us among the leading countries in this field.

Hormonal levels correlating to ovulation are also measured by obtaining regular blood samples. When the follicle's diameter reaches 16-18 mm, an HCG hormone muscular injection is given to help in final egg maturity. This hormone is usually given at night and eggs are extracted within 33 to 36 hours after the injection.

The number of follicles seen during ultrasound monitoring reflect the number of potential eggs produced. But in some cases the number of extracted eggs is less than expected due to many reasons one of which is when the follicle does not contain an egg. The number of obtained eggs may also exceed the expected due to growth of some follicles after the HCG injection.

   Sperm Freezing

The Assisted Reproductive team at The Deccan Hospital takes pride in being the first to introduce the Sperm Freezing Program in Jordan. This idea became a reality for

various important reasons:
First: Some young men are subject to testiclular diseases that require chemical treatment and/or radiation treatment which may result in dryness of testicle tissues and their seizing to function. In some cases orchidectomy (removal of testicles) may be required and in such cases sperms can be collected and stored prior to such procedures or treatments in order to later use if the couple wish to conceive.

Second: Some husbands cannot remain with their wives for extended periods of time due to hard work conditions and they may need to travel abroad. In such cases sperm are stored and used when needed.

Third: Some husbands are unable to give the sample when needed to fertilize the egg. In these cases, sperm can be collected and stored beforehand to be used if the husband is unable to provide new samples when needed.

Fourth: If there is an occlusion in the spermatic cord which prevents sperm from flowing outside and causes retention in the epididymis. In this case we resort to obtaining sufficient sperm liquid using a syringe, where the required amount is used and the extra amount is frozen to be used when needed for another pregnancy. This freezing process helps save the husband a lot of hassle as he may need other operations, in addition to saving on financial costs.

   Quality of Embryos

Embryos are categorized into four major categories as follows:

  • Failure to get pregnant. Success is never guaranteed.
  • Type 1: The cells of the embryo split evenly and the broken cell ratio does not exceed 10%.
  • Type 2: The cells of the embryo do not split evenly and the broken cell ratio does not exceed 25%.
  • Type 3: The cells of the embryo do not split evenly and the broken cell ratio exceeds 25%.
  • Type 4: The cells of the embryo do not split evenly and many cells are broken.
Potentially life-threatening abdominal emergency can be caused by acute gastrointestinal (GI) bleeding.

In regards to conception potential and those of a natural delivery, all are able to form normal fetuses but the chances of pregnancy with embryos of the first and second categories are greater. Chances of pregnancy with the first and second categories can be equal but the third and fourth categories have less of a chance, although not entirely impossible. Regarding congenital malformations, there is no proof that embryos of the third and fourth categories have a higher ratio of occurrence.

   Embryo Transfer

Embryo transfer plays a critical role in making or breaking the treatment. Thus, no matter how good the status of embryos is and regardless of their quantity, if embryos are not transferred smoothly and accurately, all the financial, physical, and scientific efforts will be in vain. The Deccan Hospital adopts special techniques for embryo transfer into the mother's uterus, it has also developed an exclusive tool, which is being used by centres worldwide. This tool increases percentages of success as a result of overcoming the difficulty of embryo transfer. We faced various cases in which embryo transfer was very difficult or near impossible, and was nonetheless achieved easily in our centre thanks to this tool.

It is worth mentioning that the embryo transfer stage is a great prognostic indicator to the overall state of the case. The actual process of embryo transfer lasts on average ten minutes and is similar to a speculum exam in the clinic. Usually no sedation is required. Afterwards, the wife can safely leave the hospital.

   How Many Embryos To Transfer?

The decision regarding the number of transferred embryos lies with the couple, with the approval of the supervising team. For instance, the couple may request to transfer five or six embryos, or even more, to the mother's uterus. The unit does not advise or agree to such requests in fear that the mother will become pregnant with triplets or more, which would have negative repercussions. The number of embryos advised for transfer depends on the following factors:

  • Failure to get pregnant. Success is never guaranteed.
  • The mother's age.
  • Previous trials the mother has undergone.
  • Was the mother pregnant previously? And did she reach her term?
  • Has the mother miscarried previously? At which stage of pregnancy did the miscarriage happen?
  • The mother and father's desire concerning the number of transferred embryos.
  • The couple's approval to decrease the number of embryos if multiple twin pregnancies occur.
  • Number of available embryos and their quality. The uterus's shape.
  • The mother's health; Does she suffer from any complications such as blood pressure, diabetes, etc...?

The Deccan Hospital prefers single child pregnancies, as they possess many advantages for both mother and child. Pregnancy of three or more babies is not advised as it may affect both mother and fetuses negatively. Before proceeding with the transfer, embryos are checked closely to determine quantity and quality, and parents are advised accordingly on the number of embryos preferred to be transferred to the mother's uterus. The previous mentioned factors are taken into consideration.

In conclusion, we warn the couple from insisting on transferring many embryos, for this has many negative effects. If it results in multiple pregnancies, The Deccan Hospital's team is delighted to discuss this with concerned parents at their discretion.

   The Fate Of Transferred Embryos

Some mistakenly think that if the embryos are transferred to the mother's uterus then conception had occurred or is about to occur. This of course is the wish of both the couple and the team, but unfortunately, pregnancy does not always happen. Success ratios depend on many factors some of which are the quality of embryos, the type of uterus and the nature of its endometrium (inner lining of uterus where embryos implant), and of course how facilitated the transfer process to the uterus was, and whether the mother had conceived previously.

The greatest moments for the team are when good news are brought to the couple of positive lab tests and the gift of conception, we often hear 'Zaghareed' and sounds of joy over the phone or feel the tears of joy when the wife receives the joyful news. Other times, we are forced to give bad news, where some people thank God for everything and make another appointment to study what happened and what can be done in the future. But a few are frustrated to receive the news and condemn the failure which emotionally affects all parties concerned. Thus we kindly ask the couple to have patience if the attempt was not successful. In fact, embryo transfer is a great prognostic indicator and the success rate increase upon repetition to about 90%, consequently, we ask the unfortunate couple to be optimistic and patient and book another appointment to discuss what can be done in the future. Failing a trial does not mean the loss of information retained, but to the contrary, can be invaluable information to be used for future attempts.

   Surplus Embryos

The Deccan Hospital seeks to offer medical services of the highest international standards for its patients. We are often faced with the issue of surplus embryos, at which point The Deccan Hospital's team is ready to advise the couple: What should we do with these surplus embryos? Would you prefer freezing them? The advice depends on the number of embryos, their category, and location of the couple's residence. If surplus embryos were from first or second category cells, we advise the couple to resort to freezing. But, if surplus embryos are of the third or fourth category, we don't recommend freezing, as embryos won't tolerate the freezing process.

The Deccan Hospital's team is delighted to discuss the matter with the couple if such a need arises, and we are glad to answer any inquiry.

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Negative Aspects Of IVF

Major losses from IVF

  • Failure to get pregnant. Success is never guaranteed.
  • Pregnancy with twins, triplets…
  • Financial burden.
  • Time consuming.
  • Psychological burden.
  • Cerebrovascular Disorders, Transient Ischemic Attacks, Stroke in Evolution

Lab Tests

Supervisors of the In Vitro Fertilization (IVF) program at The Deccan Hospital sympathize with wives who undergo many tests throughout the program. But we believe that - as a woman who got pregnant by IVF after 23 years of marriage said- motherhood deserves the effort.
Two types of tests are carried out, the first relating to the mother's health and is important for the baby if pregnancy occurs such as thyroid, hepatitis, Rubella, and HIV. These tests are taken once and there is no need to repeat them.
The other type are hormone tests, which are done repeatedly to gauge the degree of response of the mother to ovulation and its maturity such as E2, P4 (Estrogen and Progesterone).
The supervising team are careful not to exaggerate in carrying these tests to maintain the wife's comfort and take in consideration financial capabilities. They are also conscious not to be negligent with carrying these tests as dismissing one or two tests could render the entire process a waste. Thus we kindly ask parents to cooperate in this regard and members of the team are ready to answer all your questions regarding this issue.

Steps Involoved In IVF

  • The couple attend the clinic the second day of wife's cycle. During this visit, evaluation takes place of both husband and wife and includes: Ultrasound scan for wife to assess ovaries and uterus. Blood tests for wife to assess hormonal profile in addition to thyroid status, hepatitis screening… and the husband is asked to give semen sample to assess sperm reserve in addition to a routine blood test.
  • According to the information gathered, a treatment plan is selected. Not every couple get the same treatment plan since every case is unique and requires a different approach. A plan for example might suit a couple very well while on the other hand be detrimental for another.
  • The wife starts taking hormonal injections the dose and quantity of which are decided by the supervising team. The wife also undergoes routine ultrasound scans and blood draws to assess egg maturity and to assess inner lining of uterus (where embryo(s) implant).
  • When the follicles reach 16mm in diameter, HCG muscular injection is given the aim of which is to enhance final egg maturation.
  • 34-36 hours later, the wife is scheduled to have her eggs collected.
  • Once collected, the eggs are nurtured in a special medium until they are injected/placed with husband's sperm.
  • The eggs are then monitored in the lab hoping for embryos to develop.
  • Depending on the case, the best possible embryo(s) is/are transferred back to the uterus- usually 2-3 days after egg collection. As mentioned earlier, the number of transferred embryos depends on several factors mentioned earlier.
  • Two weeks after embryo transfer, the wife performs a pregnancy blood test.

Discontinuing the Program

The program passes through many stages, each stage in preparation for the next. The policy of the Assisted Reproductive & Technology Unit is to support the patient and maintain his/her physical and psychological health, in addition to taking in consideration the couple's financial capabilities. Sometimes we find ourselves forced to discontinue the program, whether at the stage of enhancing ovulation or extracting eggs or at any other stage. These moments reflect negatively on the psychology of the couple and the team who work relentlessly to avoid such a scenario.
None withstanding, and despite the high levels reached by developed centres in this field, there remain challenges at times when the team is forced to cancel a case temporarily while learning from what had occurred and resorting to another program at a later time. It is important in this regard that the couple expect any kinds of surprises and to be mentally prepared for such developments. We would like to stress that the understanding of this fact by the couple garners more commitment and sympathy from the team.

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