What happens during IVF?

In vitro fertilisation is a method of assisted reproduction in which a man’s sperm and a woman’s egg are combined outside the body. Upon fertilisation, one or more fertilised eggs (depending on the client’s choice); are transferred into the woman’s uterus where they attach to the uterine lining and begin to develop naturally. 

There are several causes of infertility in both men and women and while female-related problems account for about 70 per cent, male related problems take a 30 per cent portion. About 15 percent of women that suffer miscarriages develop blocked tubes, according to Dr Ssali Tamale, a gynaecologist at Women’s Hospital International and Fertility Centre in Bukoto, Kampala. 

Causes

“This contributes to 50 percent of infertility rates among women in Uganda,” he says, adding that infections after termination of pregnancy can also lead to failure to conceive in most women. Also, he says, some fibroid operations can instead cause tubal blockage while low sperm count in men contributes 30 per cent of impotence in men.

He also mentions the rare case of a girl who underwent premature menopause at 19 years of age. Such abnormalities are another cause of infertility in women.

“Polycystic syndrome (PCOS), a problem with hormones that affects women during their childbearing years also causes blocked tubes.  Reports say, a number of women suffer from this infection unknowingly but its causes are also unknown,” he says.

Infertility is the failure for a couple to conceive in a period of one year if they have had frequent unprotected sexual intercourse without using contraceptives.

It is important to note that not all causes of infertility can have signs and symptoms but there are some visible signs that one can watch out for.

Signs of infertility

“If one has some parts of the body that are not fully grown, especially the breasts or has a male pattern of hair distribution, this is a sign of a hormonal imbalance. This can also be accompanied by irregular periods where a woman can have her period once in a year or unevenly distributed within the months of the year,” Dr Ssali says.

He adds that if a woman has abdominal swellings and pain, it could be a sign of an underlying problem such as fibroids, which greatly affect fertility. 

Tests

According to Dr Joseph Kasirye, a gynaecologist at Women’s Hospital International and Fertility centre in Bukoto, Kampala, before a woman starts IVF treatment, there are certain tests that are required including a hormonal profile test, fallopian tubes (HSG) test and a pelvic (Trans vaginal) scan.

Because she suffered from blocked tubes, Honoranta Nakato gave birth to five children after undergoing IVF treatment. For more than 20 years, she had tried to conceive in vain. After diagnosis, Dr Ssali realised that Nakato’s chances of conceiving naturally were minimal.

“We removed six eggs from her uterus and sperms from her husband using the Intra Cytoplasmic Sperm Injection. We then left the eggs for about five days to fertilise and form an embryo.”

The intra cytoplasmic sperm injection is part of an IVF treatment cycle where a single sperm is injected into each egg to assist fertilisation using very fine micro-manipulation equipment. After three days, six embryos had developed, which were then transferred to the cervix through a catheter using an ultrasound for accuracy into the womb.

What happens?

In multiple pregnancies, Dr Ssali says, some foetuses shrink from the womb and a few remain but in Nakato’s case, they all attached. “In medical school, we are taught that you can reduce the number of foetuses for fear of the mother miscarrying but being a Christian, I refused to terminate any. I let them live,” he says.

“If the uterus becomes overloaded, the cervix opens so the mother is at risk of losing the babies. We usually recommend a stitch to close the cervix but this was not the case with Nakato. Hers remained closed despite carrying five babies,” he adds.

The cost

According to Dr Ssali, the cost of IVF depends on a number of factors but the whole process may cost about $5,000 which is equivalent to Shs18.5 million. A couple may pay less or more, depending on the complexity of their case. In some cases, a woman may need an egg donor and doctors are usually selective about the likely physical appearance of the donor. IVF can also be used when a man has low sperm count.

The success rate of IVF ranges between 35 and 50 percent. The success of an IVF procedure largely depend on factors such as a woman’s hormonal imbalance, high-quality eggs, sperms, and embryos. 

‘‘A younger woman seeking IVF has a better chance of producing high-quality eggs that maximise her chance of getting pregnant when compared to an older woman. However, this does not mean that older women seeking IVF always fail,’’  he says.

Before the procedure, Dr Ssali recommends that a couple undergoes professional counselling to prepare them psychologically, especially seeing that a number of things, such as their finances will be affected. 

Stages 

The process of IVF involves monitoring and stimulating a woman’s ovulatory process, removing an ovum or ova (egg or eggs) from the woman’s ovaries, and letting sperm fertilise them in a laboratory. According to Kenya’s Mediheal Hospital’s IVF guidelines, the steps of an IVF procedure are:

Ovarian hyper-stimulation for follicle development: This is done to produce more eggs than usual. There is a greater chance of obtaining embryos to increase the chances of pregnancy with more eggs. Until retrieval of the eggs, this process can take up to fifteen days.

Egg retrieval: This procedure takes one day and is performed under general anesthesia. 

Sperm collection: This is usually done on the same day of egg retrieval.

Fertilisation: Retrieved eggs are stored in a culture dish. The sperm is prepared for fertilisation. The eggs and sperm are then combined for fertilisation.

Embryo development: After fertilisation, the fertilised egg (zygote) undergoes embryo culture for two to five days.

Embryo transfer: Between days three and five after fertilisation, the best embryo with the highest implantation potential is selected for transfer.  The embryo is then inserted into a thin catheter and transferred into the uterus through the cervix. The woman is able to resume her normal duties and activities 24 hours after the embryo transfer.

Pregnancy test: Blood tests are conducted two weeks after the embryo transfer to confirm pregnancy.

Possible side effects

During and embryo transfer, it is possible for the woman to suffer side effects including uterine or tubal infection, cervical bleeding, cramps, backache, miscarriage and tubal pregnancy.

After egg retrieval, the woman may be asked to start taking progesterone medications which can cause nausea, cramps, fatigue, and bloating. The woman may also have vaginal spotting or bleeding after the embryo transfer and before a pregnancy test is conducted. This spotting does not always mean the pregnancy was unsuccessful.