What is in vitro fertilization (IVF)?
For many couples who have exhausted traditional clinical and surgical treatments for infertility, Assisted Reproductive technologies (ART) may offer the best hope for pregnancy. Through these procedures, women with otherwise untreatable infertility have given birth to healthy babies. IVF or In-vitro Fertilization means fertilization outside the body. In ICSI (Intra Cytoplasmic Sperm Injection), the sperm is directly injected into the egg.

Who needs IVF - ICSI?

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Absent or blocked fallopian tubes (Previous tubal pregnancy or infection (STD, or Tuberculosis).
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Endometriosis.
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Reduced sperm count or motility.
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Patients where all other treatments such as ovulation induction with intra uterine insemination have failed
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Unexplained infertility.
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Patients who want to become pregnant by the procedure of egg donation.
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Patients who want to become pregnant by the procedure of embryo donation.

Procedure of IVF
The main steps in the IVF embryo transfer sequence are as follows:

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Giving Fertility injections for growing of eggs in the ovaries.
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Monitor the development of ripening egg(s) in the ovaries.
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Administration of HCG injection, (Human Chorionic Gonadotrophin) when the eggs are ready for maturity.
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Collection of eggs under anesthesia.
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Obtaining the sperm from husband.
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Putting the eggs and sperm together in the laboratory, and providing correct conditions for fertilization and early embryo growth.
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Transferring the embryos into the uterus.

To control the timing of egg ripening and to increase the chance of collecting substantial number of eggs, fertility drugs are prescribed according to each individual case. These drugs work by stimulating the woman's ovaries with fertility injections to produce oocytes (eggs). Before determining the egg retrieval schedule, we perform transvaginal ultrasound of the ovaries to monitor the development of eggs and a blood/urine test to measure hormone levels. When these eggs are ready, they are then removed by a simple technique using ultrasonographic control under general anesthesia. We ask the husband to give us a semen sample and this is specially processed for ART. These eggs are then mixed with the husband’s sperms in the laboratory. This technique is called In-Vitro Fertilization (IVF). In the case of Intra Cytoplasmic Sperm Injection (ICSI) the sperm is robotically injected into the cytoplasm of the egg. The resultant embryo that is produced in the laboratory is then inserted into the woman's uterus for continuation of the pregnancy. Assisted Reproductive Technologies are methods by which a man's sperm and a woman's egg are combined in a culture dish. Once fertilization is established, the resulting embryos are left for 1- 4 days to check that they are growing and then transferred into the woman's womb. If the treatment has been successful, one embryo will implant in the lining of the uterus and will develop into a fetus and placenta. Occasionally more than one embryo may implant and result in multiple pregnancies. We try and prevent this as much as possible but may not be successful always.


Often husbands of patients undergoing treatment cycles may not be around at the time of the IVF treatment (due to the nature of their jobs eg.: expats, staying and coming from abroad, sailors etc). In these cases the sperms are obtained earlier and frozen sperms are used for the fertilization procedure. Occasionally, in cases of male factor infertility, donor sperm is required and this can also be provided from a registered sperm bank.

To Summarize – IVF/ICSI – ET cycle involves the following

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Suppression of the patients pituitary using a second set of fertility drugs called as GnRH agonists or antagonists.
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Controlled Ovarian stimulation with fertility drugs to produce more than one egg.
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Monitoring of follicles and egg development with the aid of vaginal sonography and serial Estradiol hormone estimations.
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Administration of HCG injection, when at least two leading follicles are 18mm in diameter.
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Oocyte or egg retrieval under short general anesthesia, 35 -36 hours after HCG injection.
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Identification and isolation of eggs in the laboratory.
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Sperm collection and processing in the lab.
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Fertilization of the egg with the sperm with leaving them together in the fertilization dish for IVF or using micro-manipulator with robotic arms to inject a single sperm in a single egg (ICSI).
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Embryo formation 2 to 5 days after fertilization.
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Embryo transfer of good quality embryos back to the womb, after 2 (four cell embryo), 3 (six-eight cell embryo) or 5 (blastocyst stage) days after egg removal.
In-Vitro Fertilisation (IVF)