The natural process of fertilization involves the conjugation of an egg and sperm inside the woman’s body. In-vitro-fertilization (IVF) is the procedure that involves the conception of an egg outside the body in a laboratory.  IVF comes under assisted reproductive technology (ART) that involves the use of advanced medical technology to help with pregnancy in the woman.

Which conditions may need IVF support?

• Blocked Fallopian tubes
• Endometriosis
• Advanced age of a woman
• Decreased sperm count
• Failure of the treatment with fertility drugs

Types of IVF treatment

The different types of treatments available for IVF are:

• Natural cycle IVF procedure: In this treatment, the fertility drugs are not administered. The egg released during the normal monthly cycle is collected and then fertilized.
• Mild stimulation IVF procedure: The lower dose fertility drugs are administered and then the eggs are collected and fertilized.
• In vitro maturation (IVM): The immature ovaries are collected and then allowed to mature in the laboratory.
• Embryo transfer: The fertilized embryos are taken and transferred to the mother’s womb.
• Blastocyst transfer: The embryos are cultured in the laboratory until blastocyst stage and then transferred to the mother’s womb.

IVF with Laser Assisted Hatching

Assisted hatching is a technique used in IVF where a gap or a hole is created on the outer shell of the embryo called zona pellucida before transferring the embryo into the mother’s womb. Before the implantation of the embryo, the developing embryo should “hatch” out of its outer shell (zona pellucida).

Sometimes the embryo is thick, which decreases its ability to hatch on its own. Making a hole or thinning the outer layer may help the embryos to hatch, which increases the chances of pregnancy. Pregnancy cannot occur unless the embryo hatches. Thus, assisted hatching IVF success rates are higher than simple IVF success rates.

Because of the use of additional technology, IVF with laser assisted hatching cost is higher than just IVF cost.

IVF with laser assisted hatching is recommended when:

• The embryos do not have sufficient energy and nutrients to complete the hatching process
• The woman is older than 37 years as they are more likely to have thick zona pellucida due to increased levels of follicle stimulating hormones
• The candidate has had repeated IVF failure
• The quality of the embryo is poor and demonstrated slow cell division and excessive fragmentation

It is performed by using infrared 1.48-μm diode laser. The technique does not cause any blastocyte damage. Laser assisted hatching has several advantages such as minimal handling of the embryo,  fast delivery, and exact control over the drilling of the hole.

It is performed before transferring the embryo into the mother’s womb on day 3, 5, or 6 after fertilization. An opening in the zona pellucida is created by drilling it with acidified tyrode’s solution.

The embryo is held firmly using holding pipette and a microneedle is applied on the area of zona pellucida. The microneedle is preloaded with Tyrode’s acid using mouth-controlled suction before each micromanipulation.

The acid is expelled over a small area of zona pellucida until it is breached. Suction is applied immediately after the breach of zona pellucida to prevent excess acid entering the embryo. The patients should be provided with antibiotics after implanting the embryo to reduce the risk of infections. 

IVF with Egg Donation

This procedure Is exactly the same as the usual IVF procedure with a difference that the egg used for fertilization comes from a different candidate than the one undergoing IVF. This procedure involves a process known as female egg donation in which a suitable candidate donates an egg for successful fertilization with the retrieved sperms.

The egg donation procedure is similar to how the eggs are retrieved from the womb of the future mother. The only difference is that during egg donation process, the ovaries of the donor are stimulated prior to the collection of suitable number of eggs from the ovaries. All the remaining stems in the donor egg IVF process are similar to the rest of the IVF procedure.

IVF with egg donation is mostly performed in the case of women who have insufficient number of eggs or whose eggs are compromised with respect to quality. The IVF specialist advices the woman to opt for donor eggs in case they believe that there are minimal chances of IVF success because of poor quality of her own eggs.

IVF with ICSI

Intracytoplasmatic sperm injection (ICSI) is an IVF variation in which the sperm is directly injected into the egg for fertilization. The resulting fertilized egg is placed in uterus of the woman. It is the most successful infertility treatment used to treat sperm-related conception problems in couples.

ICSI procedure does not require the sperm to penetrate the layers of the egg. It is highly useful to treat infertility problems in couples who suffer because the male partner’s sperms are either not able to get into the egg or are unable to fertilize the egg even when they are able to get through it.

During IVF with ICSI procedure, the eggs are extracted and held in one place with the help of a glass tool. A single sperm is injected into each egg using a small glass tube. The eggs are cultured and checked for fertilization overnight. The fully fertilized eggs are selected. A few fertilized eggs selected are placed in the uterus with the help of a catheter. The leftover embryos are preserved for future use.

While in simple IVF, the eggs and sperms are mixed together and allowed to fertilize naturally, in ICSI, a sperm is forced into the sperm for fertilization.

ICSI success rates largely depends on the quality of sperms used for fertilization. Overall, the success rate of ICSI is greater than any other technique used as a variation in the IVF procedure.

IVF with ICSI and Donor Sperms

IVF with ICSI is also performed when the sperms come from a suitable donor and not from the male partner of the female undergoing IVF procedure. ICSI IVF treatment is the same when conducted with donor sperms as it is with sperms that come from the male partner.

ICSI treatment involves the injection of a single sperm directly into the egg from the female partner or a donor. In the case of ICSI with donor sperms, a semen sample from a suitable donor is retrieved. The sperm sample is processed and viable and good quality sperms are extracted from for further procedure.

Next, the entire ICSI procedure is conducted in a similar manner. ICSI success rates are the same whether the sperm comes from a donor or the actual male partner. ICSI treatment cost is separate from the cost of IVF.

IVF with ICSI and Optical Spindle View

Optical spindle view is a specialized technique used at the time of IVF and ICSI. This technique helps the fertility specialists view the division of cells carefully to ensure that the entire process goes on smoothly.

The optical spindle view technique is used after the fusion of the eggs and the sperms is complete using ICSI as a part of the IVF procedure. The use of this technique helps ensure that the ICSI procedure is successful and that no DNA damage taken place around the site of injection of the sperm.

IVF with ICSI and Testicular Biopsy

Sometimes during IVF and ICSI, the fertility specialist may order a testicular biopsy to assess testicular function in the male partner before using his sperms. During testicular biopsy procedure, a small sample of tissue from just one or both the testicles is removed and examined under a microscope. The specialist confirms whether the male partner is fertile or not and accordingly donor sperms are arranged for IVF and ICSI.

Endometrial ablation is an outpatient procedure that is used to remove the endometrial lining in the uterus of a woman suffering from unusually high menstrual bleeding. During the procedure, the endometrium is ablated or destroyed with the help of laser or microwave.

Endometrial ablation surgery is not recommended for women who wish to conceive in the future. This is because this procedure may permanently damage the layers of the uterus and the endometrium may no longer be suitable for the attachment of the developing fetus.

Uterine ablation is most commonly recommended for women who suffer from heavy menstrual bleeding and do not wish to undergo hysterectomy or the surgical removal of the uterus. This procedure is either conducted at the doctor’s office or at a hospital. It can be conducted under local or light anesthesia or general or spinal anesthesia.

Uterine ablation is not recommended for patients who have:

• Uterine, cervical, or vaginal infection
• Pelvic inflammatory disease (PID)
• Endometrial, uterine, or cervical cancer
• An intrauterine device (IUD)
• Pregnancy