Challenges in Invitro Fertilization (IVF)

 Challenges in Invitro Fertilization (IVF)




Infertility is a cause for many young couples to be concerned about. It not only affects their relationship emotionally but also can create tension between them physically as well. Usually, when a couple comes out as being infertile it is assumed that the female factors are responsible for it, but male factors are accountable for infertility in about fifty percent of the couples that undertake treatment for infertility. Couples who undergo fertility treatments experience emotional stress, which is deepened by unsuccessful results. In modern days numerous couples are going for Assisted Reproductive Technology (ART) to fulfill their dream of being parents, IVF is one of the arts that is widely used to treat patients with infertility. Since 1978 after the birth of the first IVF baby, it has been a huge success in the medical field and over eight million babies have been born via IVF around the world to date.

In Vitro Fertilization (IVF) is an assisted reproductive technology. It is a series of elaborate medical procedures used to aid fertility.

In the IVF procedure, the mature eggs are retrieved from ovaries and fertilized by sperm in a specially designed laboratory. Then the embryo(s) are implanted into a uterus. On average one full cycle of IVF completes in about three weeks. In some cases, because of some specific requirements, it can take a little longer. Therefore, the experience of every couple can vary. 

IVF is the most used and productive assisted reproductive technology. It can be done with the parent's eggs and sperm or the eggs and sperm of any known or anonymous donor. Sometimes, couples also opt for a surrogate or gestational carrier- who has their embryo implanted into their womb and carry their child for nine months.  

There are many factors determining healthy and successful IVF treatment. Some of them include the cause of infertility in both the parents, their age, and their lifestyle. A medical expert can assist hopeful parents to understand the details of the IVF procedures, the potential risks involved, and whether this method is the right choice for them or not.

Depending on various factors many risk factors are included in the IVF procedure.  

Risks of IVF include:

  • Multiple births: In IVF the risk of having multiple births increase in case of multiple embryos implanted into the uterus. Pregnancy with more than one fetus generates a greater risk of premature birth and low birth weight. 

  • Premature birth and low birth weight: Some research suggests that with IVF there is a somewhat heightened risk for a baby to be born prematurely and with low birth weight.

  • Ovarian Hyperstimulation Syndrome: Ovarian hyperstimulation syndrome (OHSS) is a medical condition in which ovaries become swollen and painful. It is because of an inflated response to surplus hormones, which usually happens in women receiving injectable hormone medications to invigorate the development of eggs in the ovaries. 

OHSS symptoms include mild abdominal pain, nausea, vomiting, diarrhea, etc. and they may last a few weeks. The major severe symptoms of OHSS include immense ovarian swelling and multiple cysts, hemoconcentration, and accumulation of fluid; these alterations scarcely lead to renal failure, hypovolemic shock, thromboembolic episodes, and acute respiratory distress syndrome.

Mild OHSS develops in approximately 25% of patients, and the critical form of OHSS develops approximately in 0.1% to 0.2% of all IVF cycles. The medical symptoms for OHSS usually emerge after 5-10 days of the first dose of ovulatory trigger (human chronic gonadotropin [hCG]). For females who are at higher risk for OHSS GnRH antagonist protocols are chosen. To minimize the risk of OHSS in patients undergoing controlled ovarian stimulation Dopamine agonists may also be used. 

  • Miscarriage: For women who conceive via IVF, the abortion rate is similar to that of those who conceive naturally, about 15%-25% - but this can be increased according to the maternal age.  

  • Complication during the egg-retrieval procedure: To collect eggs from ovaries extracting needle is used which can cause bleeding, infection in the pelvis or ovaries, or an injury to the bowel, uterus, ovaries, bladder, or a blood vessel. But, since the process is done with utmost care and precision under ultrasound guidance by experts, the risk of a serious issue is extremely minimal. There are some risks associated with the use of sedation or general anesthesia.

  • Ectopic pregnancy: Ectopic pregnancy is when the fertilized egg gets transferred outside the uterus, usually in the fallopian tube. The embryo can not develop outside the uterus, therefore pregnancy can’t be continued. Approximately 2%-5% of women using IVF can have Ectopic pregnancy.

  • Birth defects: As per some previous research, maternal age plays an important role and is considered a primary risk factor in the development of birth defects in a child, regardless of how the baby is conceived. Using IVF might increase the chances for certain congenital anomalies, but more studies and research is needed to adjudge.

  • Stress: The procedure of IVF can be challenging for hopeful parents emotionally, financially, and physically. This can drain them out and leads to stress and rarely in case of unsuccessful treatment can also lead to depression. 

The possibility of giving birth to a healthy baby via IVF relies on varied factors, including:

  • Maternal age:  Maternal age plays a crucial role in IVF treatment. Being at a young age, say in the late 20s or early 30s increases the chances of conception and delivery of a healthy baby. With increasing age, the complications may increase depending on the mother's health. Sometimes, because of the age factor especially for women above 41 years of age, it is counseled to consider going with donor eggs during IVF to increase the possibilities of success.

  • Embryo status: Implantation of the more developed embryo can be accompanied by increased pregnancy rates in comparison to less developed embryos. However, a specialist doctor can counsel more according to the specific needs of the expecting couple.

  • Reproductive history: For women who have given birth previously the chances to get pregnant via IVF are higher than the first time being a mother. Also, for women who have tried previously to conceive via IVF multiple times but did not get successful, the success rate is lower.

  • Cause of infertility: The reason for infertility also affects the chances of conception.

  • Lifestyle: Smoking can cause fewer egg retrieval during IVF, and it can decrease the chances of success using IVF by 50%. Obesity, use of alcohol, recreational drugs, excessive caffeine, and certain medications can also be proven harmful.

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