Artificial Insemination – New Hope for Childless Couples

What exactly is IVF?
IVF or In-Vitro fertilization is a process by which the eggs or the oocytes of the women are fertilized by the sperm of male partner outside the human body in the laboratory. Though it is commonly called as test tube baby the eggs are actually fertilized in small dish. In nature, this process of fertilization takes place in the fallopian tube of the women. This is called in-vitro fertilization.

After fertilization an embryo is formed which grows for 4 days in the fallopian tube and then it is transported by the fallopian tube into the uterus or the womb where it grows into full term baby in 9month time. In IVF this process happens in a small dish outside the human body and the embryo or embryos are transferred directly into the womb or the uterus thus bypassing the fallopian tube. It is important to know that not all embryos grow into a child. Some stop developing at an early stage and the pregnancy does not continue and this is one of the major reasons why multiple embryos are transferred into the uterus in the process of IVF.

How long should I wait before consulting a fertility doctor?
According to the world health organization (WHO) Infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12months or more of regular unprotected sexual intercourse.”… (WHO-ICMART glossary1). “Infertility is the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year. If you have been having regular sexual intercourse and are not using any contraception and cannot get pregnant after a year you should consult a fertility specialist. These definitions and timelines are modified in special circumstances for example if you are over 35 do not wait for longer than six months and if over 40 years then it is better to seek guidance sooner than later as fertility is highly dependent on the age of the female partner. This is called as biological clock and as the human body ages there is damage to the DNA inside the cells which makes pregnancy difficult and many couples will need assistance. In some cases the woman is born without a uterus called as MRKH syndrome and needs IVF Surrogacy to achieve a pregnancy. In other conditions for example if you have a history of genetic disorders in your family you should seek fertility counseling to determine the risk of transmission to your body.

How successful is IVF?
The success rates of IVF vary from high (50 to 70%) in young couples to very low (less than 10 percent) in woman aged above 42 years using their own eggs. It also depends on the quality of sperm of the male partner but in general techniques like micro test have now made it possible for men with zero sperm count also to achieve fertility by surgically finding sperm in the testis. The success rates also depend on the uterus and uterine lining for example women with uterine damage after tuberculosis infections may find it difficult to achieve a pregnancy.

How long does IVF take?
An IVF treatment involves 3 stages:
1.       Pre IVF investigations which take a few days or a week (some special tests can take 3 to 4 weeks to get result but these are in rare circumstances).
2.       The IVF procedure of injections and regular ultrasound san and blood tests monitoring and the egg collection and embryo transfer process into the uterus. This takes 2 to 4 weeks depending on whether your doctor has put you on the short or long protocol.
3.       Post procedure waiting for the pregnancy test results which is 2 weeks.

What happen if I become pregnant?
If you are fortunate to achieve pregnancy you will first need to find out if this is a singleton pregnancy or a multiple pregnancy (twins/triplets). The first 2 months of the pregnancy are crucial and you will be advised some extra medication like progesterone in addition to routine medications given to women who conceive naturally. The purpose of these medications is to support the pregnancy. After this time period the pregnancy is then considered as any routine pregnancy with its monitoring. However IVF pregnancies tend to have a slightly higher rate of complications like bleeding in pregnancy high blood pressure diabetes etc. So your doctor will probably monitor you more closely as compared to a spontaneous pregnancy.

Are there any effects associated with IVF?
Side effects of the IVF medications include short term once like stomach upset headaches breast tenderness mood changes feeling of bloating etc. These are generally short term and pass off in the first 2 months if you are pregnant. If you do not get pregnant these pass off in 2 weeks when you get your next period. Many studies have looked at the link between cancer and infertility. A woman who is infertile and doesn’t breast feed her baby has a slightly higher risk of ovarian cancer. No link between IVF and cancer has been established in fact one cloud argue IVF is protective to women with infertility.

What about in India IVF Market?
 India by virtue of its large population projected to be 1.25 billion has a large number of couples who require assistance to achieve a pregnancy. Infertility in the country is rising in line with a global trend in rise in infertility. According to the ICMR Publication approximately 1.8 million couple in the country needs infertility treatment. The ICMR study put the incidence of infertility in India at approximately 4% which is lower than approx. 10% seen in Western countries. To put things in perspective some numbers are below: India projected population – (2009) – 1166 million. 604 million male and 562 million female. Age group 15 to 49 years – Rural – 3.38 million, Urban – 4.82 million total 8.2 million married female population 15 to 49 years – 216 million (38.5%) Prevalence of Infertility approx. 3.8% (Source: Registrar General of India 2005/ Sample registration system / ICMR Study 2011) Countries which have a population of approx. 8.2 million or lower include Austria, Hong Kong, Libya, Finland, Denmark, Norway, New Zealand, Singapore, Israel, Switzerland. India’s demographic shows population that is young and thus a greater need for fertility treatment options. Today, at approx. 1.2 to 1.5 lakh IVF cycles a year, India performs only approx. 90 cycles per million population compared with 3,000 per million populations in Israel, 1,500 in Australia, 500 in the US and 220 in Egypt. Varying reports put the Assisted Reproductive Technology (ART) market in India to be worth at $1 billion (Rs. 5000) in the next 1-2 years and forecast to cross the Rs. 10,000 crore marks by 2018. In 2012, global IVF market had a value of $9.3 billion which is projected at %21.6 billion by the end of 2020. A worldwide decline in sperm parameters, late marriages and pregnancy, decline in egg quality, environments factors like pollutions, pesticide use, even mobile phone use or stress may play a role in the environmental factors contributed to rising rates of infertility. Along with these increasing availability even in small towns of advanced fertility treatment and options of third party reproduction like Donated gametes and surrogacy offer more options to couples unable to achieve pregnancy by other means such a conversational IVF increased demand is mainly due to current trends of late child bearing, environmental factors etc. Increased availability with even smaller towns and semi rural areas having new fertility centers, plus scientific advance leading to a range of treatment options to treat infertility are readily available in India. These include medications for ovulation induction, endoscopic surgery to correct or minimize anatomical and medical conditions, and the assisted reproductive technologies, include IUI, IVF, ICSI (Intra cytoplasmic sperm injection) and many more. India has foreign trained highly skilled doctors and fertility treatments are available at very competitive prices which is why many more people are able to access it now. Patient awareness camps that are being regularly conducted by corporate and medical institute along with celebrity real life stories of success with fertility treatments have given acceptance to this in the Indian context and have raised its profile. Medical Tourism in the country for fertility treatment is also rising.