Q. Is the baby ‘nor­mal’ in IVF?

IVF India - - Unplugged - DR. KABERI BAN­ER­JEE is an in­fer lity spe­cial­ist at Max Health­care, Adiva & IVF Ser­vices. She is based at New Delhi & can be reached at ban­er­jee.kaberi@gmail.com

A. Stud­ies have shown that there is no sig­nif­i­cant in­crease risk of ab­nor­mal­ity in IVF con­ceived ba­bies com­pared to those con­ceived nat­u­rally.

Q. What is ICSI? How safe it is? A. ICSI is In­tra­cy­to­plas­mic Sperm In­jec­tion. This is in­di­cated for cou­ples with very low sperm count. It is a safe pro­ce­dure. In men who have a ge­netic de­fect, there is a small risk of trans­mis­sion to the male off­spring.

Q. Are fresh sperms bet­ter than frozen? A. Marginally, we have al­most equal preg­nancy with fresh and frozen sperms. How­ever, it is pos­si­ble to per­form IVF with fresh sperms and with frozen its al­most al­ways ICSI.

Q. Is ICSI bet­ter than IVF? A. That has not been es­tab­lished. We per­form IVF with good sperms and ICSI with poor or frozen. Preg­nancy rates are the same. In IVF, num­ber of eggs avail­able are more since, ICSI can only be done in ma­ture eggs.

Q. How is a donor cho­sen? A. Donors are cho­sen ac­cord­ing to age, fer­til­ity and phys­i­cal char­ac­ter­is­tics al­most all donors are less than 26 years and have com­pleted their fam­i­lies. They are also thor­oughly med­i­cally in­ves­ti­gated and con­di­tions like Thal­lasemia, sus­cep­ti­bil­ity to rubella, HIV and Hep­ati­tis – B are ruled out. Once you for­ward your phys­i­cal pro­file we do the cor­re­spond­ing match­ing.

Q. What are the pre­cau­tions I should take af­ter the IVF pro­ce­dure? A. There are no spe­cial pre­cau­tions that need to be taken, but avoid stren­u­ous ac­tiv­ity. Try to be men­tally and phys­i­cally re­laxed as much as pos­si­ble. You can re­turn to work if you wish, but you may pre­fer to have a few days rest. There is no ev­i­dence of any ex­tra mea­sures that could pos­i­tively in­flu­ence the out­come of your treat­ment.

Q. What if IVF fails the first time? How many times can it be tried? A. You can go through IVF as many times as you wish, but we ad­vise upto five cy­cles at the most. The first cy­cle gives us an in­di­ca­tion whether it is worth­while try­ing again. We get a good idea about egg qual­ity, num­ber, em­bryo qual­ity and en­dome­trial thick­ness in the first cy­cle.

Q. Is IVF the last op­tion? A. IVF is the op­tion, which has the high­est suc­cess rate and is most ex­pen­sive. But, it is not the "end of the road". Many women have con­ceived nat­u­rally or with in­trauter­ine in­sem­i­na­tion, even af­ter IVF. How­ever, for those with blocked tubes and very poor sperm counts, it is the only op­tion.

Q. Is IVF very ex­pen­sive? A. IVF is not as ex­pen­sive as it is per­ceived to be in gen­eral. The cost of your IVF cy­cle is de­cided by the dose of drugs that would be needed for ovar­ian stim­u­la­tion. IVF is only as ex­pen­sive as per­haps a gall stone re­moval or re­moval of uterus surgery ! There is a myth amongst the pub­lic that IVF is hugely ex­or­bi­tant.

Q. Do we need to get ad­mit­ted in the IVF process? A. No, there is no need can go home af­ter the ef­fect of anes­the­sia weans off which takes about 2-3 hours. You need to visit again af­ter 2-3 days for the em­bryo trans­fer, who again takes about half an hour and you are free to go home af­ter rest­ing for one hour.

Q. Why is there so much con­cern about hav­ing twins or triplets af­ter fer­til­ity treat­ment? A. Mul­ti­ple births carry risks to both the health of the mother and to the health of the un­born ba­bies. Twins or triplets are more likely to be pre­ma­ture and to have a be­low-nor­mal birth for ad­mis­sion. Stud­ies show that the risk of death amongst triplets is seven times higher.

Q.Does IVF al­ways leave us with twin or triple preg­nan­cies? What is the aver­age num­ber of em­bryos trans­ferred? Please ex­plain. A.The doc­tor will make the de­ci­sion af­ter dis­cussing this with you. Gen­er­ally, two or three em­bryos will be trans­ferred, but the num­ber may vary slightly de­pend­ing on the qual­ity of the em­bryos and the age of the fe­male part­ner.

Q.When are the em­bryos trans­ferred? A.The em­bryos can be trans­ferred ei­ther the sec­ond third day of egg col­lec­tion or on the 5th day, which is known as the blas­to­cyst trans­fer. At our cen­tre we have seen al­most equal preg­nancy rates be­tween the two, how­ever, we have seen a slightly higher mis­car­riage rate on day 5 trans­fers. It is a mis­con­cep­tion that blas­to­cyst trans­fer is al­ways bet­ter than day 2 or 3 em­bryo trans­fer. Cul­ture upto day 5 does not pro­duce bet­ter em­bryos it only per­haps al­lows bet­ter se­lec­tion. Many coun­tries for spe­cially the Scan­di­na­vian coun­tries are go­ing back to day 2 trans­fer.

Q.I have poor egg qual­ity, can I im­prove it? A. A girl is born with a fixed no. of eggs, as she at­tains menopause her egg stores are com­pletely de­pleted. From the age of 35 the de­te­ri­o­ra­tion of egg qual­ity and quan­tity is very rapid, for some this de­te­ri­o­ra­tion is faster. The preg­nancy rates with poor egg qual­ity is very low. There have been some med­i­ca­tions like DHEA and dif­fer­ent pro­to­cols like the short pro­to­col that may im­prove egg qual­ity. If there is no re­sponse even with th­ese then donor eggs should be tried.

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