Category: All About IVF

As infertility rates continue to rise, especially amongst the urban, middle-aged demographic, in vitro fertilisation (IVF) has become the default choice of fertility treatment. IVF has remained the gold-standard of treatment for infertility and has offered a viable path to parenthood for thousands of couples worldwide.

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However, as widely as it may be prevalent and as successful as the results may have been, there are still misconceptions and misgivings that people continue to harbour about IVF as a viable treatment for infertility. These misconceptions aren’t just far from reality but also remain bereft of any scientific basis, and yet, are widely accepted and also perpetrated. These misconceptions and misinformation is both dissuading and dangerous for those who wish to opt for IVF to realise their dreams of becoming a parent.

Here are some of the most common misconceptions associated with IVF and the actual reality behind them.

IVF Increases The Chances Of Multiple Births

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Actually, this is exactly in contradiction to what IVF does. While natural birthing offers no control over the number of embryos that will get implanted in the uterus, IVF allows parents-to-be complete control over the number of embryos that can be implanted. Yes, it is true that multiple embryos may be fertilised and can be implanted, but that alone doesn’t make it necessarily a risk that leads to multiple births. However, the chances of multiple pregnancy increases if a couple opts for two embryos to be transferred.

IVF Depletes Ovarian Reserves Of A Woman
No. Firstly, the ovarian reserve is fixed and continues to deplete naturally during the course of a woman’s reproductive cycle. Yes, in an IVF cycle, multiple eggs are harvested and used for the purpose of fertilisation, but that doesn’t mean that there is a depletion of the ovarian reserve, much less the possibility of future infertility caused by low ovarian reserve. In the natural course of selection, a group of eggs become available each month for maturation, with one of them eventually available for ovulation. In an IVF cycle, the similar process is followed with one distinction – instead of one egg, MOST of the eggs IN THAT GROUP are available for ovulation. Thus, none of the eggs that are actually earmarked for the future are used or ill-used in an IVF cycle.

IVF Cycles Can Eventually Lead To Cancer

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The use of gonadotropins for the stimulation of ovaries is misunderstood as one of the causes of ovarian cancer. However, one must underscore the fact that the use of hormonal treatment has always been associated with certain unavoidable side effects. Also, there is currently no direct causal link between the growth of ovarian tumours and the use of gonadotropins.

IVF Cycle Hyperstimulation Is Uncontrollable
While there is a concern with hyperstimulation of ovaries during IVF, there is no reason to believe that such hyperstimulation is beyond control. As fertility science improves and there are improved management methods of the ovarian response, it is now possible to regulate ovarian response and ensure that the same doesn’t breach any unwanted or unwarranted levels.

IVF Is A Solution To All Infertility Issues

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No. While IVF provides a very viable and tested method of conception, it is not a foolproof and all-inclusive treatment option for infertility. There are various other modes of treatment, as well as improved versions of IVF itself such as intracytoplasmic sperm injection (ICSI), which may and can be deployed based on the needs and requirements of the individual in question.

In addition to the above, there are several other misgivings that people have as they seek infertility treatment. Many believe that it is only helpful for younger individuals, while others say that waiting a while wouldn’t hurt – neither of these are correct. While older individuals can become parents via IVF, there is no reason to keep waiting till you cross a particular age.

Thus, before you consider IVF as a treatment option for your infertility, it is best to have an open, honest conversation with your doctor. Consider all the options, weigh in all the possibilities that exist. In the age of information that we live in, it is misinformation that can end up being our Achilles heel.

Assisted Reproductive Technology (ART) is a boon for couples who tend to face fertility issues while embarking on the journey of parenthood. There are many doubts and misconceptions surrounding the field of ART that need to be addressed.

Assisted reproductive technology (ART) alleviates the burden of infertility on couples who have been trying to conceive naturally, but have not been successful. Many couples believe in myths regarding ART-related treatments and avoid opting for it. We help you to separate fact from fiction by answering all your queries regarding ART. Read on to know why there is absolutely no harm in seeking a fertility consultant’s advice before planning for a baby.

Myth #1: Meeting A Fertility Expert Is The Last Resort
Fact: Every woman has a fertility career, and it is best to plan pregnancy at an early age. Fertility depends on the egg quality, the number of eggs, sperm quality, uterine polyps and many other factors. Some of these such as low ovarian reserves or low Anti-Mullerian Hormone (AMH) cannot be assessed without specific tests. AMH is a hormone that is secreted by cells in developing egg sacs (follicles). There are no signs or symptoms of low AMH. Taking an AMH test can help to determine the egg reserve and one’s chances of conceiving. All these factors will be missed unless the couples visit a fertility expert and get themselves evaluated holistically. If a couple is planning for a baby or if they are planning not to have a baby and delay the process, they should definitely meet a fertility expert. The expert will be able to assess the situation and make sure that the couple is not losing any opportunity when they decide to plan for pregnancy or delay it. Be assured that you will be provided the best possible solution. A couple will come to know if they should delay pregnancy, plan now or how and when they should be planning.

If a woman reaches a fertility expert at the end of her fertility career then there is not much that a fertility consultant will be able to do, owing to various other factors such as low egg reserve, etc. Hence, a fertility consultation should be a priority right after the marriage.

Myth #2: IVF Is The Last Option To Choose

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Fact: There are different reasons for which a couple may opt for an IVF treatment. For example, the couple will be advised IVF, if the sperm count is low and cannot be improved with the help of medication. Even a recently married couple may need IVF when they plan conception. As helpful as it is, IVF is not magic by which fertility can be assured. It is a process to make sure that the couples scientifically overcome all the obstacles and hurdles and carry a good pregnancy. A consultation with a fertility expert if planned early will definitely give couples better chances of conceiving. Planning for IVF should not be left till all the other options are explored. If IVF is needed, doing it early gives you a better chance of pregnancy rather than doing it later when things will not be conducive owing to advanced age and other factors.

Myth #3: A Woman Needs To Give Enough Time To Herself For Natural Conception Before Planning Fertility Treatment

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Fact: While this stands true for younger women, waiting for nature to take its course is not recommended for women of all age groups. If a woman belongs to a higher age group, getting pregnant is a difficult task. Hence, when a couple decides on fertility, they should also take the age of the woman into consideration. If a woman is on the older side, then the couple should not wait for too long and plan pregnancy under medical guidance. It is imperative for a couple to seek help in a timely manner to ensure the best possible outcome.

Myth #4: Fertility Treatment Or IVF Will Result In Multiple Pregnancies

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Fact: IVF is a process whereby eggs and sperms are fertilised in the laboratory by highly-skilled embryologists to produce embryos. Then, the embryos are implanted in the woman’s womb. The couple along with the doctor can choose how many embryos they wish to transfer and successfully plan for a single pregnancy. It is usually advised to not transfer more than one or two embryos at a time, in order to avoid any further complications with the potential pregnancy. The process of IVF is not at all risky as it is done step-by-step by Doctors to assure a healthy and safe pregnancy.

Myth #5: IVF Pregnancies Cause Abnormal Babies

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Fact: In fact, it’s quite the opposite. The chances of having abnormal children are the same in the overall population which is 1-2%. The risk of abnormality in children is associated with the mother’s age at the time she conceives and not with the type of treatment she has undergone. In IVF, the best sperms and eggs are selected and fertilised, resulting in embryos. Selecting the most competent of the healthy embryo to transfer reduce the chances of abnormalities in babies. Pre-Implantation Genetic Testing (PGT) is a cutting-edge diagnostic technology that involves testing embryos created through in-vitro fertilization (IVF) and then transferring healthy embryos. Hence, a pregnancy will be healthy and as normal as a natural pregnancy if done in the right manner.

To conclude, it is imperative that a couple plan their journey of parenthood and seek advice from a fertility specialist on how to plan and execute it. Reaching out to a fertility specialist should not be the last resort, but in fact, should be the first option to explore for any couple who wants to embark on the journey of parenthood at any given point in time.

Fertility treatment is ideally recommended for a couple who have not been able to conceive after trying for one year or more. “It may be needed early for some women who are nearing the end of their reproductive potential or men who have a gradually failing sperm production. As conception is aided by both the partners, the testing and treatment also involve both partners,” tells Dr Richa Jagtap, Clinical Director, Consultant Reproductive Medicine, Nova IVF Fertility, Mumbai. There can be many reasons why a fertility treatment is required. Dr Madhuri Roy, Gynaecologist and IVF Consultant, founder, and managing director of Conceive IVF, Pune notes them down:

• Female factors like advanced maternal age, blocked fallopian tubes, PCOD, endometriosis, fibroids, etc.

• Male factors like abnormal sperm parameters, erectile dysfunction due to diabetes, hypertension, psychological, blocked vas deferens due to infection or family planning operation in the past, varicocele hydrocele in the scrotum which damages sperms

“Beyond providing healthy sperms for conception, a husband is also expected to extend support, mental strength, understanding and lots of tender loving care for their partner,” Dr Jagtap notes, “And of course, vice versa for women too. A one-sided treatment is never helpful.” The health of both eggs and sperms are equally important for success. “So, lifestyle changes are recommended and medications to improve eggs and sperms quality are given to both. Involvement of both partners to support each other in the exercises, diet, stress management, stimulation injections, hospital visits to understand the correct treatment plan, managing the finances and maintaining work-life and treatment balance is needed,” Dr Roy points out.

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Building A Support System
Infertility itself comes as a big setback and brings with it emotional trauma and negativity. At this time a woman needs assurance and love from the entire family. “She needs to know that’s it’s a journey where she has support from all her family members and she is not a lesser person because of what she is going through,” Dr Jagtap shares, “In fact, more than other times, before preparing for a treatment she needs a good mental state, less stress and happy thoughts for future.” The spouse and family members can support in many ways. Help them take care of the chores at home, or even work pressures. Dr Roy notes that support and care are important during this time, and you can do so by helping them with their chores or any other work. By spending quality time together and encouraging them through the doctor-recommended diet and exercise.

Fighting The Stigma
“For ages, it’s the woman who bears the cross of infertility. However now we know that men contribute to an equal incidence of infertility amongst couples,” points out Dr Jagtap. “Women are often blamed and harassed for not being able to bear a child while men hesitate to accompany women to the clinic and get tested,” Dr Roy adds, “Even today, after the path-breaking technology and medical advances, there is a stigma about fertility-related treatments. But it’s a time to break this stigma.”

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“Many people feel that the child born through IVF is someone else’s baby and not their own and this misconception needs to be cleared,” says Dr Roy, “It is essential to educate the couple regarding infertility treatments. Do not be afraid to seek help via fertility expert.” Dr Jagtap further adds, “Awareness is the biggest way to improve the myths and stigma around fertility treatment.”

Dr Roy advises, “Don’t feel embarrassed to come out in open and discuss your infertility problems with your fertility expert. Do not engage in a self-blame game instead, fight it out. Infertility can occur in anyone, it’s not in your hands, but taking timely treatment is what you can surely do.” “There is no shame or fear to take a fertility consult. The fear of the unknown and the fear of failure keep us back. But the hopes of a happy successful journey get us going,” notes Dr Jagtap who also adds that it’s very important to take the first step. She points out that for women, the egg numbers decline with age and timely action is needed. Her advice is that “we fear the unknown. Once we know it, we can tackle it.”

IVF has helped many women to achieve their dream of motherhood when they were not able to conceive naturally. It is an efficient method to help a couple get pregnant with a series of procedures with a doctor. Several factor come into play when a couple thinks of opting for IVF, and age of the woman is among the foremost. Dr Aindri Sanyal, Fertility Consultant at Nova IVF Fertility, Kolkata discusses at length its impact over the procedure.

Mother’s Age Directly Impacts The Success Of IVF

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It has repeatedly been said that relatively older aged women (and men) face fertility issues. This is because with age the number and quality of eggs in a woman keep deteriorating. So, age does matter, for both men and women. With age, it keeps getting more difficult for a woman to get pregnant naturally as well as through IVF. After the age of 35, the percentage of getting pregnant even though an IVF, falls to 25 to 30 per cent, and after the age of 40, the percentage falls further to around 15 to 20 per cent. According to a few doctors’ chances of giving live birth to a baby after the age of 40 drop to around 10 per cent. So, as the woman ages, the eggs in her body also age along with her and it gets difficult to get pregnant with age.

How IVF Treatment Has Evolved Over Time

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IVF was first introduced in the 1970s to treat a woman who had blocked/damaged fallopian tubes. This was a huge scientific breakthrough for those times and still is one of the greatest procedures in medical science. Since the first test-tube baby in the 1970s, millions of babies have taken birth through this procedure.

• Initially, laparoscopy was used to retrieve eggs from the ovaries, however, it has been discontinued and they now use transvaginal ultrasound-guided oocyte retrieval. By using the method, the risk of anaesthesia-related issues and the cost due to a laparoscopy also reduces.
• Earlier there were no medications given to women prior to the procedure, however with time and with enhancement in studies, it is known that hormone therapy two to three weeks before the egg retrieval would be an efficient method to get a greater number of healthy and mature eggs for the IVF.

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• With the advancement of technology and medicine, something else also came to light. This was that through ultrasound and a few blood tests the doctors could establish an ideal time to retrieve the eggs.
• Not only can the doctor now retrieve multiple eggs, but they can also freeze the spare eggs for a later time if the patient even wanted or needed another IVF.

Assisted reproductive techniques like IVF, IUI, etc have evolved a lot over the years due to better technology and better tools and have helped many infertile couples to complete their family.

Common Myths About IVF

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1. Age is just a number: In IVF, we just saw it matters. Couples feel that they can get the IVF treatment done anytime, but this is not true. With age the ability to conceive reduces and hence the success rate of an IVF also declines.
2. IVF will be painful: The fact is that the injectable medicines in the procedure of an IVF are administered by a technologically advanced pen, which makes it painless for the patient. The egg retrieval procedure is done while the patient is sedated. Hence IVF is not a painful procedure.
3. IVF babies will have health problems: As mentioned earlier millions of babies have been born through an IVF and they are normal and just like babies who have been conceived naturally. This is a huge misconception that people have in their minds which is not at all true.

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4. Bed rest will be required throughout the pregnancy: This is not true. Neither the treatment nor the pregnancy that results from an IVF entails bedrest. So, the woman can go to work or for a holiday after she conceives.
5. It is extremely expensive: This is something that people feel about IVF. However, the cost of an IVF has come down over the years as technological advancement has made it much easier than before. The minimal cost of an IVF lies between one lakh to a lakh-and-a-half.

When you have been trying to become parents for a for a long time, IVF can come as a beacon of hope. It has been a path to parenthood for many couples across the globe. Of the couples who have undergone an IVF cycle, most would have been successful, but there would be a few who would have faced a failed treatment.

Dr Anil Chittake, Director and IVF Specialist, EmBrio IVF Centre, Baner, Pune
“In these situations, couples generally go through a roller coaster of emotions – anger, frustration, hopelessness and despair and making one unsure of what should they do next,” says Dr Anil Chittake, Director and IVF Specialist, EmBrio IVF Centre, Baner, Pune.

Let’s take a peek into the success factors of IVF before understanding the next steps of a failed IVF

How Successful Is IVF And What Is The Success Percentage?

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“The success ratio rate for IVF depends on the age of the woman, cause of infertility, years of infertility, type of embryo transfer, quality of the sperm and whether self-eggs or donor eggs were used,” informs Dr Chittake. He says that the success rate is higher when frozen embryos are used as opposed to fresh embryos. Success is higher in younger women, so even when a woman has an embryo transfer, say in her 40s with embryos that were created when she was in her 30s, her chance of success is that of a woman in her 30s. Frozen cycles tend to have a higher success rate as the embryos that survive the thawing process will be more robust, resulting in higher chances of achieving a pregnancy. Donor eggs likewise come from a younger donor who is medically fit and hence tends to give better success rates. Better the sperm quality better the success rate.

Success in IVF is measured in various parameters for audit purposes. The fertilisation rate, implantation rate, clinical pregnancy rate, take home baby rate etc. Of significance is the live birth rate as this is the chance that any couple having treatment will take a baby home.

Irrespective of the age of the patient, a live birth rate of around 30 per cent is considered as gold standard around the world.

What Really Happens When One Has A Failed IVF Cycle?

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A failed IVF cycle doesn’t mean you should not try again – there is still hope
“We have to understand that the probability of a pregnancy after one embryo transfer is only about 40 to 50 per cent, so we need to look at the cumulative pregnancy rate which is approximately 87.5 per cent after three transfers, which is a common finding,” Dr Ruhi Yasmin, Director – Metro IVF, Darbhanga, Bihar, says. 

Dr Ruhi Yasmin, Director – Metro IVF, Darbhanga, Bihar

Also, one of the most common reasons is the age of the woman. As a woman grows older, her body produces fewer eggs and the quality of her eggs deteriorates as well. This number and quality begin to decline when a woman reaches her 30s.There could be other factors at play too, like weight gain, unhealthy lifestyle, poor uterus lining, and/or abnormalities in the interaction between endometrium and embryo.

Experts advise that in such a situation, a couple should support each other while grieving over emotional as well as financial trauma. They should take a break to relax. It is critical to not lose hope as for many couples, their family and friends are involved in this process too. Everyone must understand that one failed cycle doesn’t mean that the next one won’t succeed too.

What Next?

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Have a detailed discussion with your fertility doctor to understand why your first cycle failed to begin with. It is important to know whether the causes are recurrent – and if they can be corrected – and what modifications need to be done before and during the second IVF cycle.

The specialist may either suggest trying the same cycle all over again or additional technologies or medical adjustments can be made like suggested below:
• Different medication protocols
• Genetic screening like PGD/PGS
• Immunotherapy
• Adding in ICSI
• Assisted hatching
• Testing the chromosomal make-up of the couple (karyotyping). The signs of genital TB must be looked for carefully

Apart from understanding the causes and learning how to optimise the success of your second attempt, it’s also important to discuss realistic expectations with your doctor and know how likely you are to get pregnant after your next cycle.

In The Next Attamept…

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While going in for a second IVF attempt might seem like a no-brainer one must keep these three things in mind:
1. Whether or not there are clinical indications for another IVF cycle
2. Your mental and emotional preparedness
3. Financial implications of undergoing another IVF procedure

Yes, You Have More Than Just Two Chances

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When it comes to IVF, one must also know that repetition is the key to success – so one can
really have to look at that cumulative number of 87.5% at the end of three embryo transfers,” Dr Divyashree elucidates.

That said, there are many factors that contribute to how many IVF cycles you as a couple are eligible for. “For repeated embryo transfers, we need to have a good number of embryos resulting from one egg pick-up,” she says, adding: “If we have a good number of embryos from a good number of eggs obtained from a single IVF, then even one cycle can be enough.”

So from a purely medical point of view, you can have as many IVF cycles as the number of viable embryos. There is no upper limit to this number, says Dr Divyashree, stressing that perseverance, mental fortitude, and financial conditions of the couple are the driving factors for more and more cycles.

Before You Go In For The Next Cycle, Avoid These

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There is no denying that failure with IVF can be heart-wrenching. But if you have made the brave decision of going in for another cycle, then it’s important to get things right and avoid some common mistakes, like:

1. Don’t Google too much about IVF: Delving deep into the world of the internet to research about IVF is understandable. But being obsessed with what Google says about success rates, hacks to get pregnant and so on, isn’t going to help. Says Dr Divyashree: “Google cannot replace a doctor. It can, however, give you unwanted information about your medical condition, giving rise to anxiety. And anxiety is not good if you want IVF success.”

2. Don’t take to the bed after an IVF cycle: “Taking bed rest after an IVF procedure is totally unwarranted for,” explains Dr Divyashree. You see, when you move about, you give all your organs a good blood supply. This blood supply is important for the uterus too, especially for embryo implantation. “It is very important to be physically active after an IVF cycle. In fact, contrary to popular belief complete bed rest after a cycle can lead to life-threatening complications like blood clots and embolism,” she adds.

3. Choose a doctor and clinic wisely: A failed IVF cycle might leave you doubting your doctor and clinic’s credentials, wanting a switch. And there’s nothing wrong with that, as long as you choose someone who has the desired experience. “Choose a doctor who has the specified qualifications and experience with infertility and is associated with a reputed IVF clinic with good success rates,” says Dr Divyashree. If you do decide to switch clinics and doctors, carry all your reports with you because it will have a treasure trove of information for your second IVF.

In The End, Remember…

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In the four decades that IVF has been around, science has jumped ahead by leaps and bounds. So, there is absolutely nothing that you need to be worried about. “IVF is totally safe and there is no reason to panic. Millions of babies have been born throughout the world through IVF, and they are as normal as babies born naturally. You just need to have realistic expectations and consult your doctor about the next steps for you,” Dr Divyashree concludes.

Reports of Lina Alvarez giving, who is a doctor herself, giving birth to a healthy child after IVF at the age of 62 years created controversies, fostered dreams and busted several myths about becoming a mother at an advanced age. In 2016, 72-years old Daljinder Kaur, who is considered to be the oldest women in the world to give birth after IVF prompting hues and cries from the Indian Medical Council for an age limit of the recipients of fertility treatments.

In Britain, women above 42 years of age aren’t eligible to receive fertility treatments including IVF, at NHS. However, there are cases where women seek IVF treatments in private, so where does the controversy surrounding IVF in older couples stem from? Kshitiz Murdia, Medical Director, Indira IVF busts five myths regarding IVF in older women.

Myth: Pregnancy in older women always lead to complications before and during birth.

Reality: Over the years, doctors have spoken extensively about the complications that arise in older women during pregnancy. Older mothers tend to suffer more from high blood pressure, pre-term labour and diabetes than their younger counterpart during pregnancy. However, according to a study by Reichman et al, published in the American Journal of Obstetrics and Gynaecology, there is not enough evidence to link advanced maternal age to preterm delivery. As per another study published in the Maternal and Child Health Journal (Cavazos-Rehg et al), complications during pregnancy and delivery were highest among women between the ages of 11 and 18.

After Proper medical evaluation before IVF, it’s possible to find out high-risk patients among older women. And by offering IVF only to low-risk patients reduces the risk of complication that may happen during the antenatal period. Moreover, women of every age should consider these challenges before and during pregnancy, but there is not enough scientific evidence that suggests that these health concerns only affect older women going through IVF.

Myth: Pregnancy in older women harms the child.

Reality: Natural pregnancy in older women, although rare, increases the chances of the foetus developing chromosomal disorders including Down’s syndrome. During IVF medical professionals screen each embryo for possible Genetic abnormalities via Pre-Implantation Genetic Screening, and only implant the healthiest one(s) in the mother’s uterus. These screening tests and diagnostic tests can detect chromosomal abnormalities beyond Down’s syndrome

According to a 2019 study published in the Acta Obstetricia et Gynecologica Scandinavica, the health of an embryo depends upon the health of the mother, which, in many cases, is independent of a woman’s age. There are options where an older woman can choose to go through IVF with the eggs from a younger woman. In such instances, the health risks of the foetus due to chromosomal abnormalities can be nullified and can achieve genetically normal pregnancy like a younger woman.

Myth: IVF isn’t successful in older women.

Reality: It is a popular belief that IVF in older women is likely to fail. It may come from the fact that older women are less likely to become pregnant without fertility treatments. It is true that when older women use their own eggs (ova) the chances of successful pregnancies diminish drastically. However, when women receive donor eggs, the success rate increases drastically, as pregnancy rate is inversely related to mothers age if; IVF is done with self-egg.

An older woman can have the same success rate as a younger woman irrespective of her ethnicity as long as the donor eggs come from a young and healthy woman. It also reduces the chances of the baby having chromosomal disorders.

Myth: Being older parents can be harmful to the child.

Reality: The average life expectancy of men and women in India is on the rise. So, leaving a young child fatherless or motherless at a tender age is only a distant possibility. Some believe that older women are unable to meet the physical demands of motherhood. However, that is also true for younger women due to physiological and psychological limitations.

In many countries, especially in India, children receive attention and care from their grandparents. These children typically thrive in academics and beyond. Age is not a bar in motherhood and the attitude of people towards older women becoming mothers through IVF is changing rapidly.

Myth: Older women can’t bear children using their own ova.

Reality: Earlier, it was almost impossible to even think that women above 35 years of age could become pregnant, but IVF is changing that notion. Women’s of advanced age having low egg count can now fulfil her dreams of having own biological child, thanks to newer Stimulation protocols, Cryopreservation & PGD technology.

Now, the doctors are considering using healthy frozen ovum for IVF in older women. This is how it can work. A woman in her early or late 20s can choose to have her ova aspirated and frozen. Later in life, maybe after 35 or even 40 years of age, she can choose to undergo IVF. The doctor can use the frozen ova for subsequent fertilization and implantation. This reduces the risks of implanting an ovum with chromosomal abnormalities due to degrading DNA in older eggs. And it gives a chance to older women to become mothers using their own eggs.

Becoming a mother is a choice. While one should always consider her health before opting for IVF, age should not be a limiting factor.