By Dr. Sulbha Arora, Clinical Director, Nova IVF Fertility, Mumbai
We recently had a couple come in seeking fertility treatment. The wife is 39 years of age, and the husband is 44. They had been married for 6 years, but had not conceived yet, inspite of undergoing a laparo-hysteroscopy and some planned relation cycles. After evaluating them, we found that her ovarian reserve was good inspite of her age, and his sperm parameters were normal. They underwent a self IVF cycle with us in the month of March. As advanced maternal age is associated with lower chances of success due to higher percentage of abnormal embryos, they opted for PGT. PGT or pre-implantation genetic testing involves checking the embryo’s chromosomes before transferring them. She had five embryos that were biopsied at blastocyst stage and frozen. The PGT result indicated that one embryo had normal chromosomes, whereas the remaining four were abnormal. The one normal embryo was thawed and transferred into the woman’s uterus in the month of August. Ten days later her Beta hCG test was positive, indicating a pregnancy, and her 6 week scan now has shown a single health.
Infertility is a silent struggle in India, and is most prevalent amongst 30-40 years of age group of couples in India. IVF is commonly opted by couples who want to become parents, but are not able to conceive naturally due to various fertility factors. In Vitro Fertilization (IVF) is one of the types of assisted reproductive technology (ART) that involves retrieving the eggs from the woman’s ovaries, fertilizing them with the man’s sperms and replacing the resulting embryo(s) back into the uterine cavity. First, the woman is prescribed a course of daily injections that starts from the first or second day of her cycle. These injections help to produce multiple mature eggs in both her ovaries. Next, the doctor performs a procedure called egg retrieval. This is a short procedure done under general anesthesia. The eggs are retrieved through the vagina, and there are no cuts or stitches involved.Post this, the sperms and the eggs are fertilized in the IVF lab. After that one or two embryos of good quality are transferred into the woman’s uterus and the woman may become pregnant if the embryo implants itself in the lining of the uterus. Some IVF clinics also transfer more than two embryos, but it is not advisable.
Infertility can take a toll on the couple’s relationship. Yes, you have heard it right! If any couple is identified with infertility then it could be stressful for the couple. Infertility mainly can be disturbing for the woman as there is still a stigma attached to it. Moreover, the treatment for infertility can be physically and even mentally challenging. The success rate of any ART-related treatment may depend on certain factors such as the age of the couple, the underlying cause of infertility, and the type of treatment they undergo. But, you need not worry as you will surely be able to turn your dream of becoming parents into reality and enjoy parenthood by inculcating habits that will benefit both your physical as well as mental well-being while undergoing an IVF treatment.
There is a common misconception among many couples that an IVF treatment requires an anonymous donor’s sperms/eggs to help them conceive. Understanding the time-sensitive aspect of IVF, if timely intervention is made, then the couple can opt for an IVF treatment with their own egg/sperms.
· Did you know? Treatment for infertility has evolved with time and has also helped to enhance the success rates. Physicians now have a variety of options to personalize the infertility treatment for individual couples owing to the advancements in technology and the better understanding of the physiological processes. In vitro fertilization (IVF) is one of the most advanced treatment options that are available currently.
· IVF may be offered as a ‘self-cycle IVF’ or a ‘donor cycle IVF’, depending on the requirements of the couple, after a thorough evaluation by a fertility expert.
· In self-cycle IVF, the couple’s own gametes (sperms and egg) are used, whereas we use either eggs or sperms from a donor in a donor cycle IVF. Donor cycle IVF may have a higher success rate as compared to self-cycle IVF in cases where the couple’s own gametes are low in quantity or quality.However, some couples may prefer to first try with their own gametes, opting for donor gametes only as a last resort. This usually comes from the desire for having a child who is biologically linked to them. At Nova, we understand and respect the couple’s choice. We understand that this is a deeply personal decision to make. Once we evaluate you, we discuss with you in detail the expected success rate and finances involved with both the options, and encourage you to make an informed decision based on what option you are more comfortable with.
· Consult an infertility expert to understand what method is best suited for you.
When are donor gametes indicated?
· Women with a good ovarian reserve as determined by the antral follicle count and Serum AMH levels, would have similar chances of conceiving with both her own as well as donor eggs. In such cases, donor eggs are not recommended. As the woman’s age advances, the quantity and quality of her eggs both starts to decline. This results in lower success rates with a self-cycle. When this ovarian reserve is completely depleted, donor eggs may become the only option. Usually a significant decline in the ovarian reserve starts after 30 years of age. However, as the aging process affects every woman differently, some women may have a very low reserve in the 20s itself, and some may have a good reserve well into their 30s. Overall, the success rate for self-cycle IVF is good among younger women and may decline beyond 35 years of age.
· Zero sperm count in the male partner, among men in whomeven the surgical means of extracting sperms (ex- testicular biopsy) have failed to yield healthy sperms.
Takeaway message: Couples must educate themselves and consult a fertility expert in order to make the best treatment decision when it comes to choosing between self or donor IVF cycles. Always be aware and choose what is right for you with the help of an expert and you will surely be able to conceive and fulfil your dreams of parenthood.