IVF / ICSI / IUI / Tube Babies
IVF (In Vitro Fertilization) IVF or Invitro Fertilization (or tube baby) is the process of facilitating fertilization out of the human body, where fertilization is the act of the sperm penetrating the ovum, and “invitro” means “out of the human body”. This option is resorted to whenever there are obstacles for the in-body fertilization, such as weak sperm motility, among other causes of infertility. The process starts by induction of ovulation. This is enhancement and stimulation of the female’s ovary to produce more ova than usual. Usually, ladies produce one ovum every month. Special medications are given to the lady throughout one month that allow her to produce more than one ovum, up to 30 ova in some cases. The progress of ovulation (production of the ovum) is monitored every week by ultrasound and hormone level measurement. These medications have no side effects apart from some temporary water retention in rare cases. The production of a large number of ova at once has no side effect on the lady’s future fertility, since females enter menopause having used only 40% of their ova. The rest is wasted. When the ova are ready, they are extracted out of the lady’s ovum by a tiny needle that is inserted into the ovary without pain (under anesthesia). Introduction of the needle is guided by ultrasound. This is called “ovum pickup”. In the same day, fertilization occurs by injecting sperm from the husband into the ova. Only one live sperm is required for each ovum. This is called Intracytoplasmic sperm injection (ICSI). ICSI differs from regular IVF in that the sperm is injected into the ovum directly (ICSI) rather than left with the ovum for some time in a tight space hoping fertilization will occur (IVF).
The injected ova are observed for 48 hours, and those that turn into embryos are immediately transferred back to the lady’s uterus, by painless injection. Since many embryos are usually injected, the probability of twin and triplet pregnancy is higher than normal.
A pregnancy test should be performed after 3 weeks. Pregnancy occurs in 35-65% of cases. If it does not, the process can be repeated. Children born to IVF / ICSI are completely normal. There is not a higher probability of congenital abnormalities in ICSI babies as compared to those of natural conception. Thus, IVF / ICSI can achieve conception even in the most severe cases of infertility. For example:
- Very few sperm? ICSI only needs one sperm for each child
- No sperm at all? Sperm can be extracted from the testis and used in ICSI
- Sperm does not move? ICSI does not require the sperm to move (provided it is alive)
- No ovum? The medications used to stimulate ovulation can override this problem
- The lady’s fallopian tubes are obstructed? ICSI extracts the ovum directly from the ovary without the need for passage though the tubes.
In intrauterine insemination, fertilization occurs inside the uterus. Ovulation is stimulated by medications, and when the ova are ready, semen is prepared so as to purify sperm from possible harmful materials in the seminal fluid, and is injected into the uterus, so as to shorten the distance sperm have to travel to reach the ovum. Fertilization occurs normally. For IUI to succeed, it needs a minimum of 4 million highly motile sperm, and it needs the tubes to be patent. Success rate of IUI is about 15%.