Five steps that would make the dream come true
Dreams come true with patience and positivity , and though there are no precise statistics about IVF and other assisted reproductive techniques, choosing the right method and continuous follow up depending on several factors most importantly the age of the couple especially the wife results in successful trials of having at least one baby in more tha half of couples .
Those who are aged less than 34 should seek help after 1 year of unsuccessful natural conceiving trials , after the of 35 medical advice and evaluation should be done after 3 to 6 months maximum .
Studies showed that 7% of couples aged younger than 30 are sub fertile , rises up to 11% at 35 to be 33% around the age of 40 , and around 90 of women older than 45 are unable to conceive naturally .
It is well known that the ovarian reserve of ovum decreases with time after the age of menarche , and there a difference between males and females in the ability to detect this reserve , hence age is one of the most important factors of successful trials of either natural conceiving or assisted reproductive techniques .
There are many forms of assisted reproductive techniques that are getting more advanced with tome , such as ovulation induction , intracytoplasmic sperm injection as well as pre-implantation genetic diagnosis . Embryos are kept in incubators that are made to ensure their safety so that they would be used whenever there is a need to use invetro fertilization due to multiple reasons such as subfertility for more than 5 years especially when it’s unexplained , semen abnormalities , fallopian tubes obstruction , or endometriosis in females , hence the next five steps are what need to be done by the medical team to reach pregnancy .
1- Ovarian Stimulation :
Done upon a program that has to do with the womans’ age , BMI , and having certain medical conditions such as PCOS or endometriosis .
Woman is given daily injections either SC or IM starting from tha first day of menstruation or couple of days before till there is adequate number of ova, and this might last for 10 days to 2 weeks and a follow up is made by ultrasound and hormonal tests .
2- Ova pick up :
Mature ova are picked up vaginallyafter34-48 hours of giving the induction injection using the guidance od an ultrasound under moderate or local sedation
3- Fertilization:
Done at the same day of pick up , in which a sample is taken from the husband or an already frozen sample is used incase he’s not present , sperms are injected microscopically into the ovum which would be chosen carefully to avoid abnormalities .
The fertilized ovum is kept for 24 hours to ensure that the operation was successful then it’s kept for 2-5 days for cell divisions to happen and the fertilized egg is mature enough .
4- Embryo Transfer :
An embryo or maximum 4 are allowed to be transferred , by simple pain free vaginal catheterization
5- luteal Phase Support :
Certain injections and suppositories have to be given following embryo transfer to ensure that the embryos would be implanted in the uterine endometrium and this step is the most risky and most related to the failure of pregnancy trial , since more than 90% of wives undergo the embryo transfer operation but implantation occurs in only 50% of them regardless to all the precautions taken to avoid the failure of implantation .
A pregnancy test is done 14 days following the embryo transfer by serum B-HCG level test , hormonalsupps and injections courses are continued for 4 months or till the placenta is completely formed .
Some embryos are frozen iftheir number is more than what’s allowed to be transferredfor a minor increase in the cost , and are kept for up to 10 years and transferred after special preparations .
The psychology of couples and their desire to have babies help in increasing the chances of pregnancy , and this what studies are emphasizing on day by day .
By : Dr. Majeda Al-Jallad
Obs & Gyne Consultant