The introduction of in-vitro fertilization (IVF) has been a major breakthrough in the health study of conception and reproduction. IVF is no longer a strange topic in Nigeria as more centres continue to emanate to make sure that the dire needs of searching couples are attended to; especially in a continent like Africa where children are seen as the finishing touches to a marriage.
IVF is the process of fertilization by manually combining an egg and sperm in a laboratory dish, and then transferring the embryo to the uterus. In Vitro Fertilization of an egg from the wife with the sperm of her husband and the transfer of the fertilised egg back to the uterus of the wife is technologically possible, provided that the procedure is indicated for a medical reason and is carried out by an expert physician.
Below is a step by step guide to how the IVF works and some other vital piece of information you might like to know about IVF in Nigeria.
Step 1: Baseline Pelvic Ultrasound
Around the time of your expected period, you will have to take an ultrasound scan to examine the ovaries. If a cyst is detected, doctors may withhold further therapy until the cysts resolve spontaneously (usually in about a week). Occasionally, a cyst aspiration (drainage) is recommended. This is a procedure in which your doctor inserts a fine needle connected to a syringe, guided by ultrasound, into the cyst.
Step 2: Ovarian Stimulation
In general, ovarian stimulation begins after menstrual bleeding starts. To control the timing of egg ripening and to increase the chance of collecting a substantial number of eggs, fertility drugs selected for the woman’s individual situation are prescribed. Repronex, Gonal-F, Bravelle, Repronex, Follistim AQ pen and Lupron are some of the medications used to prevent premature ovulation and increase ovarian response. Although over stimulation may pose a health threat.
Step 3: Monitoring of Follicle Development
Follicular development is monitored with a combination of vaginal ultrasound and hormone measurements (blood tests). To check that egg development is satisfactory, IVF utilizes trans-vaginal ultrasound examinations of the ovaries (a painless method of seeing the image of the enlarging follicles containing the eggs).
Step 4: Final Oocyte Maturation and hCG Administration
Human chorionic gonadotropin (hCG) is a hormonal drug that stimulates the final maturation of the oocytes. Determining the proper day for hCG administration is critical. The time of the injection determines when the egg retrieval will be scheduled.
Step 5: Transvaginal Oocyte Retrieval
The retrieval procedure to obtain the eggs is performed trans-vaginally using a hollow needle guided by the ultrasound image (this is completely comfortable under adequate sedation and local anesthesia). Eggs are gently removed from the ovaries using the needle. This is called “follicular aspiration or oocyte retrieval” Its timing is crucial because the egg will not develop properly if it is collected too early or too late. The eggs also may develop poorly or may have already been released from the ovary and lost.
Step 6: Insemination of Oocytes and Embryo Culture
Sperm and eggs are placed together in specialized conditions (culture media, controlled temperature, humidity and light) in hopes of fertilization. Somewhere around this step is where the statement “IVF is a gamble” comes in.
Fertilization of the egg(s) may fail to occur if:
- Bacterial contamination or a laboratory accident may result in loss or damage to some or all of the eggs or embryos.
- Laboratory equipment may fail, and/or extended power losses can occur which could lead to the destruction of eggs, sperm and embryos.
- One or more eggs may be fertilized abnormally, resulting in an abnormal number of chromosomes in the embryo; these abnormal embryos will not be transferred.
- Other unforeseen circumstances may prevent any step of the procedure to be performed or prevent the establishment of a pregnancy.
Step 7: Embryo Transfer
After a few days of development, the best appearing embryos are selected for transfer. The number chosen influences the pregnancy rate and the multiple pregnancy rates. A woman’s age, her endometrial environment and the appearance of the developing embryo have the greatest influences on pregnancy outcome.
The embryo transfer procedure is usually performed three to five days after oocyte retrieval.
Step 8: Hormonal Support of the Uterine Lining
Successful attachment of embryo(s) to the uterine lining depends on adequate hormonal support. Progesterone supplements are routinely given by the intramuscular or vaginal route for this purpose. Progesterone supplementation can occur using vaginal, oral or injectable progesterone, and in some cases, a combination of methods. This daily medication will continue until your pregnancy test. If the test is positive, you may be advised to continue to take progesterone for several more weeks.
Step 9: Pregnancy Test
A pregnancy test is necessary regardless of vaginal spotting or bleeding: It determines if pregnancy has occurred and is done 9-12 days after the embryo transfer. This test is usually repeated 2 days later if positive. If the test is negative, the doctor may instruct you to stop the progesterone and any other medications.
Step 10: Early Pregnancy Follow-up
Close scrutiny or follow up of a pregnancy is necessary to try to identify early miscarriages or ectopic or heterotopic pregnancies and to help counsel the patient regarding the status and treatment of multiple gestations. Patients are generally released to their obstetrician after they are confirmed pregnant.