Can I choose in vitro fertilization if I am infertile?

Author: Xu Liqing, Liu Dun, Li Zitao, Guangdong Provincial Maternal and Child Health Hospital

Reviewer: Liu Fenghua, Chief Physician, Guangdong Provincial Women and Children's Health Hospital

In 1978, IVF was successfully used for the first time in the UK, and the world's first test-tube baby was born. So far, more than 8 million babies have been successfully born through IVF around the world. Even some very difficult infertility patients can successfully become pregnant through IVF and realize their wish to have a child.

Let us now learn about in vitro fertilization, which has benefited many people.

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1. What are the stages of in vitro fertilization?

In vitro fertilization refers to moving the "work" that should have been done in the fallopian tube - "fertilization" - outside the body and performing it in an embryo laboratory.

This process can be divided into 5 stages:

Phase 1: Ovarian stimulation, also known as controlled ovulation therapy

Generally speaking, only one follicle or egg develops and matures in each menstrual cycle of a woman. Since the timing of egg retrieval in the natural cycle is not easy to grasp, the possibility of egg retrieval failure is high. There are also situations such as abnormal eggs and unfertilized eggs. Therefore, in order to improve the efficiency of in vitro fertilization, ovulation-stimulating drugs will be used each time egg retrieval to obtain relatively more qualified eggs.

Stage 2: Egg retrieval and fertilization

The egg retrieval operation is performed under the guidance of a vaginal ultrasound probe with a special puncture stand while the patient is under sedation or general/local anesthesia. The egg retrieval needle passes through the puncture stand and pierces the ovarian follicle through the vaginal vault. The follicular fluid is easily sucked out under the suction of negative pressure. Afterwards, the operator looks for the eggs in the follicular fluid under a microscope.

After the egg is taken out, it is first cultured in vitro for 3 to 5 hours, and then the operator will add sperm to the egg culture dish, allowing the sperm and egg to "fall in love" freely and then fertilize. This is the first generation of test tube baby technology, namely IVF. If the man has serious sperm quality problems, he needs to switch to the second generation of test tube baby technology, namely ICSI. The operator will remove the granulosa cells on the surface of the egg shortly after the egg is taken out in order to select mature eggs, and then select strong sperm, and inject a single sperm into the egg under a microscope to help the sperm and egg complete the fertilization process.

Stage 3: Embryo Culture

The fertilization status of the eggs can be known on the first day after egg retrieval, and transplantable embryos can be selected for transplantation on the 2nd to 3rd day after egg retrieval.

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If the embryos continue to be cultured in the laboratory until 5-6 days, that is, the blastocyst stage, it is conducive to the selection of better quality embryos and a higher implantation rate, because even an embryo that looks good on the 3rd day may stop developing and fail to develop into a blastocyst.

Stage 4: Embryo Transfer

At this stage, the embryo is transferred into the uterine cavity through a syringe and a thin transfer catheter. On the day of transfer, the patient needs to hold her urine so that the location of the embryo implantation can be more accurately seen under ultrasound. The embryo transfer operation only takes 1 to 2 minutes and does not require anesthesia.

Phase 5: Post-transplant medication and follow-up

After embryo transfer, patients need to routinely supplement progesterone. If estrogen levels drop significantly after transfer, exogenous estrogen supplementation is also required. Two weeks after transfer, blood is drawn to test for human chorionic gonadotropin (hCG) pregnancy test. If the result is positive, continue to maintain pregnancy.

Four weeks after embryo transfer, vaginal ultrasound is performed to determine whether it is an intrauterine pregnancy. If the embryo develops normally, ultrasound examinations and prenatal examinations are performed regularly thereafter; if abnormal embryo development is found, artificial abortion is required in a timely manner; if it is an ectopic pregnancy (ectopic pregnancy), non-surgical treatment or surgical treatment is required according to the specific situation. Another possibility is that the blood hCG is positive, but the hCG level drops in the end, the B-ultrasound cannot see the sonogram of intrauterine or ectopic pregnancy, or no villi are found in histopathology. This situation is called biochemical pregnancy.

2. In what cases can in vitro fertilization be chosen?

Not all infertile couples can undergo in vitro fertilization treatment. This decision can only be made after a reproductive medicine specialist has fully evaluated the causes of infertility for both men and women.

Generally speaking, in vitro fertilization becomes the treatment of choice for women who are unable to become pregnant after treatment with medication, surgery, or artificial insemination with husband's sperm (AIH).

Conditions suitable for in vitro fertilization mainly include female pelvic fallopian tube lesions, endometriosis, ovulation disorders, advanced age, ovarian dysfunction, severe male infertility, and unexplained infertility.

Many infertile couples often have infertility caused by multiple factors. Therefore, reproductive doctors will comprehensively analyze the condition of the infertile couples, consider multiple aspects such as the age of both parties, the duration of infertility, the cause of infertility, the female ovarian reserve function, etc., and fully discuss with the infertile couples before deciding whether to perform in vitro fertilization treatment.

There are also some special cases where in vitro fertilization treatment is feasible, such as cancer patients who need to preserve their fertility. Unmarried patients need to freeze their eggs and do not need to complete all the steps of in vitro fertilization.

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3. Are children born from in vitro fertilization healthy?

Since the first successful application of in vitro fertilization in 1978, after more than 40 years of development, the success rate of in vitro fertilization has increased significantly. However, there may still be large differences between different countries and different reproductive centers, and there are also large differences in the success rate of different populations.

Factors such as patient age, cause of infertility, duration of infertility, professional experience of the reproductive center, number of transplanted embryos, etc. will affect the success rate, and age is the most critical.

As women age, their pregnancy rates decrease and their miscarriage rates increase because the aging process affects the quality of their eggs.

So are children born through in vitro fertilization healthy?

Many studies have confirmed that the outcomes of children born after IVF treatment are similar to those of natural pregnancies. Some studies have also shown that certain technologies may slightly increase the risk of offspring, but there is not enough scientific evidence.

Many studies have also pointed out that the infertility of the offspring's parents should be fully considered as an important influencing factor, because infertility itself is associated with a higher rate of offspring abnormalities and pregnancy complications. After IVF pregnancy, the most common maternal and infant complication is multiple pregnancy and premature birth.

In summary, not all infertile couples are suitable for in vitro fertilization. They need to go to the hospital to consult an expert and decide whether to choose in vitro fertilization to have offspring based on their own situation.