Definition of IVF

To put it simply the process of removing eggs from a woman’s ovary and combining them with sperm outside of the body to create embryos is called in vitro fertilization (IVF). After being developed in the lab for a few days, the embryos are either implanted into a woman’s uterus or cryopreserved (frozen) for later use.

Types of IVF methods in Iran

Different methods of IVF in Iran are as follows:

IVF Selective Single Embryo Transfer (eSET)

One embryo, as opposed to several, can be implanted into a woman’s uterus using an elective single embryo transfer procedure (eSET). eSET has the same success rate as IVF for people who satisfy prescribed treatment standards and have a favorable prognosis for success. A much lower chance of multiple births (twins, triplets, etc.) is the main benefit of eSET.

IVF intracytoplasmic sperm injection (ICSI)

Live sperm are injected into an individual’s eggs in a laboratory. An embryo, or fertilized egg, may be produced by this procedure. ICSI is a kind of in vitro fertilization (IVF), and it is most frequently used by medical professionals when a man’s infertility interferes with his capacity to become pregnant.

IVF and ICSI involve fertilizing eggs outside the body using sperm. ICSI is utilized when there is a male cause of infertility, while IVF is used for female infertility and infertility that is unexplained.

Mini IVF (minimal stimulation)

Mini IVF stimulates eggs and occasionally retrieves eggs using fewer dosages of fertility drugs than typical in vitro fertilization (IVF). Through mini IVF, one may often generate a limited number of high-quality eggs with less medication while also being less taxing on the body.

Terms like mini, miniature, micro, and low stim/stimulation could be encountered for this process.

Conventional IVF (in vitro fertilization)

In a laboratory petri dish, sperm surround the eggs that have been retrieved from the ovary during a conventional IVF insemination procedure. The idea is to replicate the process of spontaneous conception by having one sperm—typically the “best” sperm—fertilize each egg on its own.

IVF with egg donation (egg donation)

Using donor eggs means a woman utilizes the eggs of another woman. This technique is very helpful for people or couples who are dealing with issues pertaining to low-quality eggs, decreased ovarian reserve, or genetic abnormalities they would like not to pass on to their offspring.

IVF with donor sperm (sperm donation)

Any fertility clinic requires both viable eggs and sperm for IVF to be successful. In the event that the sperm is not practical, the clinic will utilize donor sperm. Through IVF with donor sperm in Iran, this process will be done anonymously.

IVF with donor sperm success rates typically range from 60% to 80%.

Gestational surrogate

Through the procedure of gestational surrogacy, an individual who did not donate the egg used in fertilization bears a fetus and gives birth to a child on behalf of another couple. Usually, in vitro fertilization is used for this technique. There is no genetic connection between the pregnant person and the unborn child.

IVF with Preimplantation Genetic Testing (PGT)

In vitro fertilization (IVF) embryos can undergo preimplantation genetic testing (PGT), a screening process that allows for a genetic analysis of the embryos before they are transferred.

Aberrant embryo genetics is one of the most frequent causes of an embryo transfer not leading to pregnancy. By guaranteeing that the embryo chosen for transfer possesses the appropriate amount of chromosomes, PGT can lower the likelihood of an unsuccessful IVF cycle and a miscarriage.

Frozen Embryo Transfer (FET)

In a frozen embryo transfer (FET) cycle, one or more embryos that were frozen during a prior treatment cycle are thawed and then transferred to the uterus in an attempt to conceive.

Who is a candidate for IVF?

A candidate for IVF should be generally healthy. Beyond that fundamental prerequisite, it truly depends on your particular circumstances. IVF is a successful treatment for a plethora of infertility-related conditions. The list of individuals for whom IVF is a viable option is provided below.

Fallopian tube damage or obstruction

For women who want to become pregnant but are unable to cure their blocked or damaged fallopian tubes, in vitro fertilization (IVF) is advised. A woman may be able to conceive via IVF even if she is no longer able to use her fallopian tubes.

Ovulation disorders

Infertility in women can often be attributed to problems with ovulation disorders. PCOS, pituitary adenoma, hypothalamic amenorrhoea, and early ovarian failure are examples of anovulation.

Your doctor can suggest IVF if you’re on anovulation medication but are still having trouble becoming pregnant.

Endometriosis

Endometriosis can cause abnormal growths, scarring, and inflammation that damage several pelvic organs. This can impede overall operation depending on the location.

For women with this diagnosis, IVF is equally effective as it is for those without endometriosis. You will require close monitoring when you start IVF, and you need to take your fertility drugs extremely carefully because they may momentarily exacerbate endometriosis symptoms.

Uterine fibroid

Fibroids can interfere with an embryo’s ability to implant itself in the uterine lining, decreasing the likelihood that the embryo will successfully attach and become pregnant.

That’s why, before starting an IVF cycle, women with fibroids should take care of their condition. It is feasible to use IVF with fibroids, but the chances of success are substantially lower.

They have poor egg quality

The quality of an egg has a major impact on the likelihood of a successful pregnancy in both spontaneous and IVF conceptions. For those attempting to conceive naturally or navigating the path of fertility therapy, ensuring optimal egg quality is crucial.

A customized method of IVF called the Flare-Up IVF Protocol is especially appropriate for women who have had problems with their egg quality.

They need a surrogate uterus

IVF and other reproductive procedures make it possible for a potential mother to bear a child on her own in many situations, but not always. When a parent is unable to bear the pregnancy, some intended parents resort to surrogacy.

Women with a history of tubectomy (closing the tubes) and want to re-fertilize

One recognized method of surgical sterilization for women is tubectomy, which is also referred to as permanent birth control. The goal of this medical operation is to prevent the developed egg from leaving the ovaries and entering the fallopian tubes. It’s common practice to use IVF following tubal ligation to improve your chances of becoming pregnant.

Sperm disorders

The main causes of sperm disorders are atypical sperm parameters, which include low sperm concentration, poor motility, aberrant morphology, and sperm DNA damage. For males with sperm disorders, assisted reproductive procedures such as IVF are very beneficial.

Infertility without reason

A diagnosis of unexplained infertility can be upsetting and perplexing. It implies that no one is able to ascertain the cause of your infertility. Many couples with unexplained infertility have found solutions through IVF.

A genetic disorder

People who have a genetic disorder in their family can utilize IVF to make sure their offspring don’t inherit it.

The process is called preimplantation genetic testing. Following fertilization and harvesting, the eggs are examined for specific genetic issues. However, not all of these illnesses are detectable. At the end, embryos that appear to be devoid of genetic abnormalities are implanted.

Fertility preservation for cancer or other health conditions

The treatment of cancer has a significant effect on a woman’s ability to conceive, frequently requiring the use of IVF to preserve fertility. This procedure is particularly important for women who want to become mothers after undergoing cancer treatment.

Women who do not have a functioning uterus or pregnancy is a serious risk to their health

Individuals who choose IVF with a gestational carrier may include those who don’t have a functioning uterus or for whom pregnancy offers a significant health risk. In this instance, the individual who consents to bear the pregnancy receives the couple’s embryo.

What are the measures before doing IVF?

It’s always best to stay away from junk food, alcohol, and tobacco. Instead, discuss the food plan with your gynecologist, and don’t forget to enquire about folic acid supplements.

To get your body ready for IVF, your fertility specialist probably prescribed several drugs. Never, ever skip taking those prescriptions, and ask your doctor for a substitute if any of them don’t sit well with you.

Stages of IVF

Upon completion of the necessary procedures, an IVF cycle may take two to three weeks. It can take more than one cycle. A cycle’s steps are as follows:

Ovarian stimulation

An IVF cycle begins with the use of lab-created hormones to stimulate the ovaries to generate eggs rather than the one egg that normally matures each month. Because some eggs will not fertilize or grow properly when coupled with sperm, many eggs are required.

Hormone injections that aid in the development of many eggs at once may be administered to you. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), or both may be included in the injection.

Egg retrieval

This is the method used to collect the eggs from one or both ovaries. It takes place at your doctor’s office or in a clinic. The procedure is carried out 34–36 hours after the last dosage of fertility medication and before ovulation.

You will be given medication to help you relax and prevent you from feeling discomfort before egg retrieval.

Sperm Retrieval

If you intend to utilize your partner’s sperm, a semen sample has to be obtained at your doctor’s office or clinic on the morning of egg retrieval. As an alternative, sperm can be pre-frozen following collection.

Masturbation is the most common method used to get the semen sample. If a person is unable to ejaculate or their semen is devoid of sperm, they might try alternative techniques. For instance, testicular aspiration is a technique that removes sperm straight from the testicle using a needle or surgery. Donor sperm may also be utilized. In the laboratory, sperm are isolated from the semen fluid.

In vitro fertilization

It is possible to attempt sperm fertilization of eggs using two popular methods:

Typical methods of insemination. Healthy sperm and mature eggs are mixed and kept in a controlled environment called an incubator.

Injection of sperm intracytoplasmically (ICSI). Each fully developed egg receives an injection of one healthy sperm. When semen quantity or quality is a problem, ICSI is frequently employed. Additionally, if previous IVF cycles’ attempts at fertilization failed, this option could be tried.

Prior to implantation of the embryos in the uterus, further treatments could be advised in some circumstances.

Embryo Culture

IVF requires embryo culture as a necessary precondition. It describes the procedure that results in a fertilized egg, which is the combining of the partner’s or donor’s sperm with the extracted eggs in a synthetic medium.

Finding out which embryos are the best and most likely to implant in the womb is the goal of embryo cultivation.

Embryo transfer

The process of implanting one or more embryos into the uterus occurs at a clinic or your doctor’s office. It usually happens two to six days following egg collection.

To help you relax, a small sedative may be administered to you. Although the process is usually painless, you might have some moderate discomfort.

Support for implantation (Luteal Phase Support)

It has been demonstrated that a variety of luteal phase supports (LPSs) can raise the pregnancy rate in the first cycles of intracytoplasmic sperm injection or in vitro fertilization.

The time between the day of ovulation and the start of menstruation two weeks later, or the start of a pregnancy, is known as the luteal phase. This stage of pregnancy development is vital for preparing the endometrium for the implantation of the blastocyst.

Pregnancy

You have a blood test to determine if you are pregnant at least 12 days following egg retrieval.

•       You will probably be referred for prenatal care to an obstetrician or other pregnancy expert if you are pregnant.
•       You’ll stop taking progesterone and probably start your period in a week if you’re not pregnant.

How long does IVF take?

Usually, IVF in Iran lasts six to eight weeks. An initial consultation, eight to fourteen days of ovarian stimulation, egg harvesting, fertilization, embryo transfer, and a pregnancy test are all included in the procedure. Five days following fertilization are usually when the pregnancy test and embryo transfer are carried out. 

IVF success rate

In vitro fertilization (IVF) is the most popular and successful form of assisted reproductive technology (ART) method. IVF is the umbrella term for a complex group of procedures meant to improve fertility, avoid genetic problems, and facilitate childbirth. Nearly all countries in the world have access to this procedure, and IVF in Iran has a high rate of success.

Over 8 million kids have been born globally thanks to in vitro fertilization (IVF), and over 2.5 million rounds of IVF therapy are performed every year, yielding over 500,000 live births.

Factors affecting the success of IVF

IVF is a multifaceted fertility therapy that depends on accurate and timely execution. A healthy live birth is the treatment’s ultimate goal, and all of these factors have a big impact on it.

Mother’s age

Women are reported to have the best chances of a successful IVF procedure between the ages of 24 and 34 because this is the period in which they are thought to be the most fertile. But the success rate declines when a woman becomes forty.

Fetal condition

Fetal condition is a crucial factor to take into account. It is essential to monitor the fetal state with routine prenatal care, ultrasounds, and other testing after a successful implantation and pregnancy following IVF to guarantee the general health and growth of the fetus.

Fertility history

An improved and increased likelihood of a successful IVF pregnancy result is indicated by a couple’s prior reproductive success. Conversely, a medical history of repeated or multiple losses and reproductive problems may indicate a more challenging IVF process.

Cause of infertility

IVF failure may be significantly influenced by factors such as genetic disorders, uterine receptivity, health conditions such as cancer, and embryo quality that contribute to infertility.

Lifestyle

The most significant external aspect of establishing a healthy and flourishing environment for an embryo is the patient’s lifestyle. A patient should give up alcohol and smoke at least three months before the IVF process. Maintaining a healthy weight is another aspect of living to take into account. It has been demonstrated that obesity alters the body’s ability to metabolize hormones and reproductive medications.

Potential risks and side effects of IVF

There is an increased risk of some health issues with IVF. Among these hazards, from the short term to the long term, are:

•       Stress: IVF may be physically, psychologically, and financially taxing. Through the highs and lows of infertility treatment, you and your spouse can have support from therapists, relatives, and friends.
•       Complications resulting from the egg retrieval process. Following medication to encourage the development of ovaries’ egg-containing sacs, an egg collection operation is performed. The needle might puncture a blood artery, the bladder, or the colon, resulting in bleeding or infection. There are risks associated with anesthetic medications as well. Anesthetic medications help you fall asleep and minimize pain during the surgery.
•       Syndrome of ovarian hyperstimulation. This is a painful and swollen disorder of the ovaries. To induce ovulation, injections of fertility medications like human chorionic gonadotropin (HCG) may be the reason.
•       Miscarriage. When utilizing fresh embryos for IVF, the loss rate is comparable to naturally occurring pregnancies, ranging from 15% for women in their 20s to over 50% for those in their 40s. The older the pregnant person, the higher the rate.
•       Ectopic conception. This is a situation when a fertilized egg, frequently in a fallopian tube, connects to tissue outside the uterus. There is no way to carry the pregnancy to term since the embryo cannot thrive outside of the uterus. An ectopic pregnancy occurs in less than 1% of IVF patients.
•       Multiple pregnancies. The likelihood of having multiple babies increases with IVF. Pregnancy with multiples increases the risk of high blood pressure, diabetes, low birth weight, early labor and delivery, and birth abnormalities compared to singleton pregnancies.
•       Low birth weight and early delivery. According to research, there is a tiny increase in the likelihood that an IVF baby may be born prematurely or with low birth weight.
•       Cancer. Early research revealed a possible connection between the development of a certain form of ovarian tumor and the usage of specific medications intended to promote egg growth. However, more recent research contradicts these conclusions.