In-Vitro Fertilization, IVF, ( also called test tube baby) and Embryo Transfer is an assisted reproductive technology where eggs and sperms obtained from the intended couple are fertilized in the laboratory resulting in embryos which are placed inside the womb of the intended mother to result in pregnancy.

> Blocked or flawed fallopian tubes

> Poor ovarian reserve,

> Stage 3 or 4 endometriosis,

> Genital tuberculosis

> Women with ovulation troubles at an advanced age, premature ovarian failure or uterine fibroids

> Male factor infertility with diminished counts, motility or morphology

> Individuals with a genetic disorder

> Women with removed fallopian tubes

> Unexplained infertility

> Repeated IUI failures

Step 1: Fertility medications and hormones are given to the woman for about 10 – 12 days which stimulates the growth of multiple eggs in the ovary. Serial transvaginal ultrasound scans and hormone analysis is done to know the status of growing eggs.

Step 2: Once eggs are grown sufficiently and matured with trigger injections, eggs are extracted through a minor surgical procedure that uses ultrasound to guide a hollow needle through the pelvic cavity to extract the eggs. Medication is provided to decrease or eliminate potential discomfort.

Step 3: The male counterpart is asked to produce a sample of semen, which is readied for combining with the eggs.

Step 4: The sperms and eggs are put together in a dish and stored in the laboratory to encourage fertilization. In certain cases where there is a lower possibility of fertilization, intracytoplasmic sperm injection (ICSI) can be used. In this procedure, a single sperm is injected directly into the egg in an attempt to attain fertilization. The eggs are monitored to ascertain that fertilization and cell division are taking place. Once this happens, the fertilized eggs are considered embryos.

Step 5: The embryos are usually transferred into the woman’s uterus three to five days after egg retrieval and fertilization. A catheter or small tube is used to transfer the embryos into the uterus. This procedure is usually painless for most women, although some women may experience mild cramping. After successful transfer of embryos, implantation takes place inside the uterus resulting in pregnancy which can be detected by blood tests after 16 days of embryo transfer.

Although one may need to take it easy after the procedure, most women can resume normal routine and activities the following day. Some side effects which are common and often harmless after IVF may include:

> A small amount of fluid (may be clear or blood-tinted) after the procedure

> Mild cramping and heaviness

> Constipation

> Mild bloating

> Breast tenderness

> If one experiences any of the following symptoms one should consult the doctor immediately:

> Heavy vaginal bleeding

> Urine with blood or less urine output

> Severe pain in abdomen and distension

> Swelling of limbs and face

> Excessive nausea, vomiting, breathing difficulty

> A fever over 100.5 °F

Like most medical procedures, there are potential risks in IVF. Fertility medications can have certain side effects including headaches, mood swings, hot flashes, abdominal pain and bloating, amongst other side effects. Although it is uncommon, fertility medications may lead to ovarian hyper-stimulation syndrome (OHSS). Symptoms of OHSS may include abdominal pain or a feeling of being swollen. More severe symptoms may include the following:

> Nausea or vomiting

> Reduced urinary frequency and output

> Shortness of breath

> Faintness

> Severe stomach pains and puffiness all over the body

> Ten-pound weight gain within a week

OHSS can be well avoided with the change of protocols and with careful monitoring of patients. This condition has become quite rare now with the introduction of antagonist protocols. Patients need not panic as these conditions can be well avoided. The whole process of IVF takes place over 15 to 20 days. The procedure is mostly painless, safe and very effective in giving desired results of achieving pregnancy. Children born of IVF are as healthy as children born of natural pregnancies which have been proved in recent studies.