Understanding IVF: Guide to Infertility Treatment

Did you know Dr. Subhas Mukherjee pioneered in-vitro fertilisation (IVF) in India in 1978? Almost 46 years later, IVF has evolved as one of the most effective fertility treatments in the world. While the treatment can feel emotionally draining, understanding more about IVF can help make the experience less stressful. From day one of doctor consultations to the procedure itself, knowing the steps involved will give you the strength to overcome uncertainty.

Wherever you are in your infertility journey, remember, you are not alone. In 2024 alone, India ran 2-2.5 lakh IVF treatments to help infertile couples in their journey of parenthood. In this article, we will help you understand everything there is to know about IVF as an infertility treatment

What is an IVF treatment? 

IVF, also known as in-vitro fertilisation, is a series of procedures that help couples get pregnant. Simply put, IVF is an assisted reproductive technology (ART) that helps couples overcome with infertility issues. It involves collecting eggs from a woman’s ovaries and fertilising them with the man’s sperm in a lab. 

During the procedure, the eggs are fertilised by the sperm, like a naturally occurring pregnancy. After 2–5 days, the fertilised egg, known as the embryo, is placed in a woman’s uterus, which attaches to the uterine wall. Using more than one embryo increases the chances of a successful pregnancy. 

A full IVF cycle typically takes 2 to 3 weeks but can vary depending on the type of infertility issue. While the procedure may work on the first try, many couples need more than one round of IVF treatment to conceive. So whether it’s your first try or third, remember everyone’s body responds differently—and so will your IVF treatment. 

Infertility is more common than you think. In India, 2.75 crore couples face infertility issues due to age, health conditions, genetics, and lifestyle choices. Understanding some of these causes will help you navigate your infertility treatment better. 

Male infertility causes: 

• Low sperm count and mobility
• Uneven sperm shapes
• Varicocele, which is a condition that causes enlarged veins in the scrotum
• Sexual conditions like erectile dysfunction
• Hormonal abnormalities
• Lifestyle choices like smoking and excessive alcohol consumption
• Genetic or chromosomal disorders
• Low testosterone
• Ejaculation issues
• Infections such as inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhoea or HIV.
• Certain medications, such as testosterone replacement therapy, long-term anabolic steroid use, and cancer medications

How common is female infertility?

Infertility is a common condition. At least 10% of women at birth deal with infertility of some kind.

Female infertility causes: 

• Ovulation disorders like Polycystic Ovary Syndrome (PCOS)
• Blocked fallopian tubes, uterine fibroids, and cervical issues
• Endometriosis, which is a condition where tissues similar to the uterine lining grow outside the uterus
• Low-quality eggs caused due to age
• Hormonal imbalance
• Pelvic Inflammatory Disease (PID), which is a bacterial infection affecting reproductive organs
• Autoimmune conditions like Lupus cause continuous miscarriages
• Genetic or chromosomal disorders
• Unexplained infertility

We spoke to Pooja, a mother of two after IVF success to understand her experience. "Before I began my IVF treatment my doctor suggested birth control pills. Initially, I was confused, but after learning how it prepares the body for the next steps, I felt confident."  

Before an IVF treatment for pregnancy begins, step zero involves hormone regulation. To help regulate your menstrual cycle, birth control tablets are recommended. It helps prevent the growth of ovarian cysts and increases the number of mature eggs needed during infertility treatment. 

Controlled Ovarian Stimulation

While women produce a single egg every month during their menstrual cycle, COS therapy enhances this process. Through hormone regulation, COS aims to improve the success of IVF by increasing the production of eggs. Sometimes, all eggs develop during a single cycle. 

We spoke to Priya, a woman undergoing IVF, who shared her thoughts on COS therapy. "The idea of hormone injections felt intimidating at first. But when my doctor explained how these hormones would stimulate my ovaries to produce more eggs, I knew it was an important part of the process. Once I saw the scans showing the eggs developing, I was reassured that everything was on track."

Using multiple eggs improves the chances of creating a healthy embryo during the IVF procedure. Regular blood tests and vaginal ultrasounds help track the growth of your eggs, assisting with timely retrievals.  

Egg Retrieval 

After approximately 36 hours of tests, transvaginal sonography retrieves the eggs. The retrieval procedure is not physically painful because it is done under general anaesthesia. However, feeling overwhelmed during a journey filled with anticipation and uncertainty is natural. 

The entire procedure can take 15 to 30 minutes, depending on the number of developed eggs available for retrieval. Since this is an invasive day procedure, you will experience slight discomfort afterward, but you can leave and rest at home. 

Some women continue to experience mild stomach pain or vaginal spotting, but these symptoms usually subside within a few days. 

Anita, a patient who recently went through IVF, shared her feelings about egg retrieval. "I was really nervous about the procedure, but my doctor assured me that it was quick and painless. I was sedated, and before I knew it, the eggs were retrieved. The anxiety was more emotional than physical—just knowing this step would bring me one step closer to becoming a mother was overwhelming."

Sperm Collection and Preparation

After your eggs are successfully retrieved, a semen sample is collected from your husband. Often, specialists ask for a fresh sperm sample on the day your eggs are harvested. However, previously frozen semen also works if a fresh sample cannot be provided. 

Rahul, whose wife is undergoing IVF, shared his experience. "I thought providing the sperm sample would be straightforward, but the timing was crucial. I was prepared to give a fresh sample on the day of my wife's egg retrieval, but just in case, I had already stored a frozen sample. It was a relief to know we had options, and everything was done so professionally."

Once the eggs and semen are collected, a specialist will mix the two in a petri dish to initiate natural insemination (IVF). If this procedure fails to result in a healthy embryo, Intracytoplasmic sperm injection (ICSI) is performed. 

ICSI is a male infertility treatment where a single sperm is injected into the egg for fertilisation.

Fertilisation and Embryo Culture

Now, it’s time for an embryologist to wait and watch. The eggs are checked after a day of insemination for fertilisation. During this time, embryologists also keep an eye out for embryo development. 

Since multiple eggs are used during infertility treatment, you can choose to freeze your extra well-developed embryos for a transfer later. 

Embryo Transfer

The entire process can take 3 to 5 days, from retrieval to fertilisation. Whether your embryo implant is done on day 3 or 5 depends on the development and viability of your embryo. An embryologist familiar with your IVF journey will decide your transfer day. 

Once ready, a thin catheter or tube is used to position the matured embryos in your uterus. A successful IVF treatment takes 6 to 10 days for the embryo to implant itself on a uterine wall. A course of physician-guided medicines will assist the transfer, boosting the chances of a successful pregnancy.

Deepa, who recently completed an embryo transfer, reflected on the final stage. "The embryo transfer was such an emotional moment for me. It’s quick, and while it’s not physically painful, the anticipation is intense. I remember my doctor gently reassuring me as they inserted the catheter. Now, I just have to wait for the results, hoping this embryo will grow into the baby we've longed for."

Radhika and Rajeev, who conceived after their second IVF cycle shared, 'We kept our hopes low, knowing the success rates weren't guaranteed. But when we finally heard that heartbeat, we knew it was worth it. We had been trying to get pregnant for 10 years and finally at 40, IVF helped complete our family.'

When it comes to success rates for IVF treatments, it is important to understand the treatment is influenced by various factors. However, on average, IVF as an infertility treatment in India has a success rate between 30 and 35%. 

• Age: Your age is not the only prominent factor, but research does show women under 35 years have a success rate of 52% for IVF. As your age increases to 45, IVF success rates fall to almost 3%.
• Lifestyle: As a couple trying to conceive through IVF, your overall health plays an important role. Lifestyle choices like smoking, excessive consumption of alcohol, and an unhealthy diet can affect your chances of a successful IVF transfer.
• Embryo Quality: Your age and lifestyle are contributing factors influencing the quality of your eggs. Younger couples following a healthy lifestyle tend to have a better chance of making a mature embryo through IVF. 

Anomalies in the uterus, ovarian dysfunction, low ovarian reserve, hormonal imbalances, tumours and select male fertility factors may influence the IVF success rate.

However, many couples, despite all odds, face infertility issues, making fertility testing a priority before beginning treatment.

Risks and Side Effects of IVF

An IVF treatment process, like any other medical procedure, does not come without risks. You may experience the following: 

• Discomfort like bloating, mood swings, headaches, and stomach cramps , breast tenderness from hormone injections.
• Ovarian Hyperstimulation Syndrome (OHSS) occurs in rare cases, causing the ovaries to react with your fertility medication. It leads to fluid retention in the abdomen.  It may be necessary to cancel your current treatment cycle and start again with a lower dose of fertility medicine
• Chances of multiple pregnancies from placing more than one embryo increase the risk of premature birth.
• Ectopic pregnancy is when the embryo plants itself outside the uterus.
• Elevated mood swings triggered by stress and anxiety.

As a couple undergoing infertility treatment, IVF offers you the promise of parenthood. While it feels like a ray of hope helping you welcome a new life into your world, the journey itself is challenging. You can feel a variety of different emotions while undergoing your infertility treatment, and it is OK. 

Pursuing positive activities like meditation and yoga can help reduce your feelings of anxiety, depression, isolation, and grief. You do not have to go through your IVF journey alone. Speak to your doctor if you need medical help.

Starting your infertility treatment isn’t easy. But it is also one of the most effective technologies in India that help infertile couples realise their dream of parenthood. Learning about the multiple steps involved during the process enables you to navigate your emotions better, leaving you feeling more confident about the experience.