IVF Treatment Cost in India

Know More About Procedure & Surgery

What is an IVF?

In vitro fertilization (IVF) is a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child. During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs (embryos) are transferred to a uterus. One full cycle of IVF takes about three weeks. Sometimes these steps are split into different parts and the process can take longer. IVF is the most effective form of assisted reproductive technology. The procedure can be done using your own eggs and your partner's sperm. Or IVF may involve eggs, sperm or embryos from a known or anonymous donor. In some cases, a gestational carrier — a woman who has an embryo implanted in her uterus — might be used.

Why it is done?

IVF may be an option if you or your partner has:

• Fallopian tube damage or blockage. Fallopian tube damage or blockage makes it difficult for an egg to be fertilized or for an embryo to travel to the uterus.
• Ovulation disorders. If ovulation is infrequent or absent, fewer eggs are available for fertilization.
• Endometriosis. Endometriosis occurs when the uterine tissue implants and grows outside of the uterus — often affecting the function of the ovaries, uterus and fallopian tubes.
• Uterine fibroids. Fibroids are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. Fibroids can interfere with implantation of the fertilized egg.
• Previous tubal sterilization or removal. If you've had tubal ligation — a type of sterilization in which your fallopian tubes are cut or blocked to permanently prevent pregnancy — and want to conceive, IVF may be an alternative to tubal ligation reversal.
• Impaired sperm production or function. Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. If semen abnormalities are found, your partner might need to see a specialist to determine if there are correctable problems or underlying health concerns.
• Unexplained infertility. Unexplained infertility means no cause of infertility has been found despite evaluation for common causes.
• A genetic disorder. If you or your partner is at risk of passing on a genetic disorder to your child, you may be candidates for preimplantation genetic testing — a procedure that involves IVF. After the eggs are harvested and fertilized, they're screened for certain genetic problems, although not all genetic problems can be found. Embryos that don't contain identified problems can be transferred to the uterus.
• Fertility preservation for cancer or other health conditions. If you're about to start cancer treatment such as radiation or chemotherapy that could harm your fertility, IVF for fertility preservation may be an option. Women can have eggs harvested from their ovaries and frozen in an unfertilized state for later use. Or the eggs can be fertilized and frozen as embryos for future use. Women who don't have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using another person to carry the pregnancy (gestational carrier). In this case, the woman's eggs are fertilized with sperm, but the resulting embryos are placed in the gestational carrier's uterus.

Preparations

Before beginning a cycle of IVF using your own eggs and sperm, you and your partner will likely need various screenings, including:

• Ovarian reserve testing. To determine the quantity and quality of your eggs, your doctor might test the concentration of follicle-stimulating hormone (FSH), estradiol (estrogen) and anti-mullerian hormone in your blood during the first few days of your menstrual cycle. Test results, often used together with an ultrasound of your ovaries, can help predict how your ovaries will respond to fertility medication.
• Semen analysis. If not done as part of your initial fertility evaluation, your doctor will conduct a semen analysis shortly before the start of an IVF treatment cycle.
• Infectious disease screening. You and your partner will both be screened for infectious diseases, including HIV.
• Practice (mock) embryo transfer. Your doctor might conduct a mock embryo transfer to determine the depth of your uterine cavity and the technique most likely to successfully place the embryos into your uterus.
• Uterine exam. Your doctor will examine the inside lining of the uterus before you start IVF. This might involve a sonohysterography — in which fluid is injected through the cervix into your uterus — and an ultrasound to create images of your uterine cavity. Or it might include a hysteroscopy — in which a thin, flexible, lighted telescope (hysteroscope) is inserted through your vagina and cervix into your uterus.

Before beginning a cycle of IVF, consider important questions, including:

• How many embryos will be transferred? The number of embryos transferred is typically based on age and number of eggs retrieved. Since the rate of implantation is lower for older women, more embryos are usually transferred — except for women using donor eggs or genetically tested embryos.
• What will you do with any extra embryos? Extra embryos can be frozen and stored for future use for several years. Not all embryos will survive the freezing and thawing process, although most will. Cryopreservation can make future cycles of IVF less expensive and less invasive. Or, you might be able to donate unused frozen embryos to another couple or a research facility. You might also choose to discard unused embryos.
• How will you handle a multiple pregnancy? If more than one embryo is transferred to your uterus, IVF can result in a multiple pregnancy — which poses health risks for you and your babies. In some cases, fetal reduction can be used to help a woman deliver fewer babies with lower health risks. Pursuing fetal reduction, however, is a major decision with ethical, emotional and psychological consequences.
• Have you considered the potential complications associated with using donor eggs, sperm or embryos, or a gestational carrier? A trained counselor with expertise in donor issues can help you understand the concerns, such as the legal rights of the donor. You may also need an attorney to file court papers to help you become legal parents of an implanted embryo.

What you can expect?

You may need several different medications, such as:

• Medications for ovarian stimulation. To stimulate your ovaries, you might receive an injectable medication containing a follicle-stimulating hormone (FSH), a luteinizing hormone (LH) or a combination of both. These medications stimulate more than one egg to develop at a time.
• Medications for oocyte maturation. When the follicles are ready for egg retrieval — generally after eight to 14 days — you will take human chorionic gonadotropin (HCG) or other medications to help the eggs mature.
• Medications to prevent premature ovulation. These medications prevent your body from releasing the developing eggs too soon.
• Medications to prepare the lining of your uterus. On the day of egg retrieval or at the time of embryo transfer, your doctor might recommend that you begin taking progesterone supplements to make the lining of your uterus more receptive to implantation.

Typically, you'll need one to two weeks of ovarian stimulation before your eggs are ready for retrieval. To determine when the eggs are ready for collection, your doctor will likely perform:

• Vaginal ultrasound, an imaging exam of your ovaries to monitor the development of follicles — fluid-filled ovarian sacs where eggs mature
• Blood tests, to measure your response to ovarian stimulation medications — estrogen levels typically increase as follicles develop, and progesterone levels remain low until after ovulation

Sometimes IVF cycles need to be canceled before egg retrieval for one of these reasons:

• Inadequate number of follicles developing
• Premature ovulation
• Too many follicles developing, creating a risk of ovarian hyperstimulation syndrome
• Other medical issues

If your cycle is canceled, your doctor might recommend changing medications or their doses to promote a better response during future IVF cycles. Or you may be advised that you need an egg donor.

During Procedure

Step 1- Investigations

Investigations Required- So in this case, firstly the couple would require special clinical investigations which may include:

1. Wife – Hormonal tests ( S.FSH,S.LH, S.AMH)- Tests to be done on Day 2 /3 periods
2. Wife- Ultrasound Pelvis
3. Husband’s Semen analysis
4. Both husband and wife’s – HIV, HBsAg, HCV, vdrl.

STEP 2- IVF Treatment.

• After the outcome of the investigations, the Couple would benefit from In Vitro Fertilization Procedure with Donor sperm.
• In vitro fertilization Procedure (IVF) which is a reproductive technology in which an egg is removed from a woman, joined with a sperm cell from a man in a test tube (in vitro). The cells fuse to form single cell called a zygote, which then starts dividing, becoming an embryo.
• For IVF- The couple should come 7 days prior to the date of menses of the female partner. The treatment will be done on the OPD basis. The patient will be admitted in Daycare for the procedure.

Note : Stay In India: The Patient will require 30 days in India for complete work-up
Diagnosis for performing IVF Treatment

• IVF is performed in cases of infertility which may be due to
• Advanced age of the woman
• Damaged or blocked Fallopian tubes
• Decreased sperm count and blockage causing male infertility
• Unexplained infertility
• Endometriosis
• Ovulation disorders ,uterine fibroids

Procedure of IVF Treatment

I: Stimulation of ovaries also called super ovulation

• Medicines, called fertility drugs, are given to the woman to boost egg production.
• Blood tests for hormone levels and ultrasounds to examine ovaries are performed regularly .

 II: Egg retrieval/ follicular aspiration

• Procedure called follicular aspiration, is done to remove the eggs from the woman's body.
• The is performed as an  outpatient procedure under sedation with  no incision only by using ultrasound images as guide, a thin needle is inserted into the ovary and sacs (follicles) containing the eggs. The needle is connected to a suction device, which pulls the eggs and fluid out of each follicle, one at a time.
• The procedure is repeated for the other ovary.
• In few  cases  laparoscopy may be performed to remove the eggs .
• If a woman does not or cannot produce any eggs, donor eggs may be used.

 III: Insemination

• Sperm is placed together with the best quality eggs. The mixing of the sperm and egg is called insemination.
• Eggs and sperm are then stored in an environmentally controlled chamber. The sperm most often enters (fertilizes) an egg a few hours after insemination.
• In few cases the sperm may be directly injected into the egg. This is called intracytoplasmic sperm injection (ICSI).
• Many a doctors   routinely do ICSI on some of the eggs, even if things appear normal.

 IV :  Transfer of embryo to uterus

• When the fertilized egg divides, it becomes an embryo. Laboratory staff will regularly check the embryo to make sure it is growing properly. Within about 5 days, a normal embryo has several cells that are actively dividing
• Embryos are placed into the uterus  3 to 5 days after  fertilization through a catheter
•  If an embryo implants in the lining of the womb and grows, pregnancy results.
• More than one embryo may be placed into the uterus at the same time, which can lead to twins, triplets, or more.

After the Procedure of IVF

• Rest adviced for the remainder day , most can return to normal activities by next day .
• Complete bed rest not required .
• Recommended daily hormone progesterone for 8-10 weeks for normal course of pregnancy and to avoid miscarriage.
• Pregnancy test  performed about 12 to 14 days after the embryo transfer.

Complications of IVF treatment

• Chances of multiple pregnancies as more than one embryo is placed in uterus ,leading  high risk of premature birth and low birth weight baby.
• Egg retrieval can  result in  bleeding, infection, and damage to ovaries and surrounding structures. 
• There may be temporary  cramping after egg retrieval which may last for a day or two.
• Many couples suffer psychological stress and depression especially if IVF not successful .
• Financially and emotionally challenging treatment .
• Rarely  fertility medications  may cause ovarian hyperstimulation syndrome (OHSS).

Factors affecting cost of IVF

• The cost to the patient depends on a variety of factors like
• The hospital, the patient chooses.
• Fee for the team of doctors.
• Extra Medicines.
• Standard test and diagnostic procedures.
• Cost of the procedure
• Cost of the follow –up care required after the procedure

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