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: In Vitro Fertilization IVF
In vitro fertilization IVF is one of the infertility treatments that helps patients to fertilize and reduces the risk of genetic disorders in newborn.  During IVF mature eggs are extracted from ovaries and manually fertilized by retrieved sperm samples in a laboratory. The fertilized egg or embryo is placed inside the uterus to increase the chance of pregnancy.

The full cycle of IVF takes about three to four weeks. The IVF procedure could be perform by using couple’s own egg and sperm or it could involve using eggs and/or sperm from a donor. In some rare cases IVF procedure may require a surrogate uterus for the embryo to be transferred into.

The success rate of IVF depends on various factors including the age of the couple undergoing the procedure and the cause of infertility. IVF treatment is time-consuming and expensive but also is a proper procedure that greatly increases the success rate of pregnancy.

Why IVF is done?

In vitro fertilization IVF is a relatively invasive procedure recommended to those who were unsuccessful with other less invasive treatments such as medication. IVF is considered as a primary treatment for women over age 40. IVF can also be done when you have some specific health conditions, such as:

Fallopian tube damage or blockage
Ovulation disorders
Endometriosis
Uterine fibroids
Previous tubal sterilization or removal
Impaired sperm production or function
Unexplained infertility
Preventing genetic disorders from being transmitted to the child
Fertility preservation in cancer treatments or other health conditions

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: Best methods of infertility treatment

Nowadays due to advances in medical sciences and various methods for infertility treatment, the joy of having a child is within the reach of almost anybody. Medical treatments along with assisted reproduction techniques has improved the chance for many men and women with infertility problems to have children. This article gives you useful information about prominent methods of infertility treatment.

The process of infertility treatment:

After various diagnostic tests, different methods of infertility treatment will be applied in accordance with the cause of infertility. After explaining each method and its success rate, doctor provides the couple with different treatment options to choose the one that suits them the most regarding their situation and preferences.

• In vitro fertilization or IVF:

IVF is a prevalent method to treat infertility problems and consisted of a complex series of procedures. During IVF, after stimulating ovaries and ovulation, mature eggs are retrieved from ovaries and fertilized by sperm outside the uterus in a lab. After the conception of embryo in the lab, the embryo is then placed inside the uterus.

This method is usually offered in conditions where sperm can’t reach the egg naturally, such as blocked fallopian tubes, pelvic adhesions, low sperm count or low sperm mobility.

• Intrauterine insemination IUIDuring intrauterine insemination IUI which is a simple and painless procedure to facilitate fertilization, the sperm is placed inside the uterus. For IUI to work(hazf) , the fallopian tubes need to be healthy. In this method the egg is not retrieved from ovaries and the process of ovulation and conception occurs naturally.
• Ovulation stimulation by advanced protocols:
• Ovulation stimulation is helpful for women with irregular ovulation, ovulation disorder or polycystic ovary (PCO) and mostly used to increase the quantity and quality of eggs and boost the chance of fertilization. There are medications that induce the same effect on egg quality and quantity which are known as ovulation induction medicine.
• Micro injection or intracytoplasmic sperm injection ICSI
• Micro injection is an infertility treatment method that a sperm cell is injected directly into the cytoplasm of an egg and cultivate it for a specific period of time in an incubator. After conception and cell division, embryo is made.
• In vitro maturation IVM:
• With IVM, instead of increasing follicle growth in body (metaphase 2), immature eggs are extracted from ovaries using a vaginal sonography. Afterwards, extracted eggs are grown in a laboratory and fertilized before being replaced into the womb.
• Gamete intrafallopian transfer GIFT:

• GIFT method is mostly used in cases of surrogate womb and is similar to IVF in terms of egg retrieving and sperm preparation. Afterwards, the egg along with adequate amount of sperm are placed directly into the fallopian tubes using a laparoscope.

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IVF: success rate

What is IVF success rate in Iran?

IVF success rate is an important point you should notice before performing IVF.

IVF is an infertility treatment technique for infertile couples with appropriate and high success rate in Iran compared to other countries.

What is IVF success rate in Iran compared to other countries?

Fortunately, Iran has a lot of experience in infertility treatment science with high IVF success rate compared to countries all over the world and many patients travel to Iran to treat their infertility problems every year.

To evaluate IVF success rate, patients are divided into 2 groups: women age less than 35 years old and women age more than 35 years old.

The success rate of IVF in first group (women <35 y/o) is approximately 40 % and the success rate of IVF in second group (women > 35 y/o) is 15- 20% on average.

IVF success rate differs in fertility clinics and centers depend on many factors.

IVF success rate in Iran is equal or more than global statistics.

IVF in Iran has affordable costs which make Iran an attractive destination for infertility treatment and medical travelers.

High medical care experiences along with fair prices highlight Iran as a leading destination for infertility treatment all over the world.

What affects IVF success rate?

IVF is a technique to treat infertility problems such as sperm count, shape or motility problems or insufficient egg production.

IVF is done in special laboratory environment and many factors affect IVF success rate which mentioned as below:

Age:

First and most important factor affecting the success rate of IVF is age. The older you get, the lower your chance of successful IVF. In younger people, the chance of access to fresh and young egg and sperm is higher.

Previous successful pregnancy:

If you had a successful pregnancy previously, the success rate of IVF is more for you compared to others.

The reason of infertility:

Infertility reason affects the IVF success rate. IVF success rate decreases in some infertility causes.

Donated egg quality:

If the woman has an ovulation problem, the solution is using donated egg.

Young and fresh eggs have more success rate.

Life style:

Some daily habits have a negative impression on IVF success rate including smoking, obesity, high daily stress, etc.

Infertility clinic quality:

Experienced fertility specialists and embryologists along with high-tech laboratory equipment will increase IVF success rate to a great extent.

Iran is an attractive destination for IVF & infertility treatment regarding all positive points we explained.

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IVF : Infertility treatment

as medical science has been advancing substantially, infertility treatment success rate increased over years. Many men and women with fertility problems have been treated successfully through well-known and reliable methods verified by infertility specialists.  Actually with current state of infertility treatment, there is absolutely no fertility problem that is not curable through existing methods. Iran is one of the pioneers in treating infertility for men and women. To learn more about these methods, some of main approaches to infertility treatment are explained below.

Common methods of infertility treatment:

Given the main cause of infertility, there are various options to treat fertility problems. Treatment usually begins with methods with lowest risk and in case of lack of progress, other methods would be applied.

• Medication:

In some cases, infertility is caused by disorderliness of hormonal balance or reduction of hormonal storage. In these situations, treatment would be sought through medication. Taking fertility medicines can effectively improve the function of reproductive organs in men and women. Even in some occasions that the cause of infertility is unknown, it is possible to achieve natural fertilization by taking medication.

• IUI:

Another treatment for infertility is intrauterine insemination IUI. This method involves placing sperm samples inside woman’s uterus helping sperm to reach fallopian tubes thus increasing the chance of fertilization. This method is applied when sperm is unable to reach to the eggs.

• Surgery

Another approach to infertility treatment is laparoscopy or other extensive abdominal operations. This approach is pursued when infertility is caused by blocked fallopian tubes or diseases such as uterine fibroids, ovarian cysts, endometriosis or anatomical problems in genitals.

• Assisted reproduction techniques:

In cases where infertility is caused by low sperm count or blocked fallopian tubes, the treatment is very exceptional. It’s called In Vitro Fertilization or IVF. IVF is used only when other treatments proved to be ineffective. In this method infertility specialist collects sperm and egg and unites them in a laboratory using advanced equipment, a process that naturally occurs inside fallopian tubes. IVF is one of the prevailing methods for infertility treatment and assisted reproduction techniques.

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IVF : history of IVF in Iran

The history of IVF in Iran has been shaped by the interaction between the pioneers of IVF and an interdisciplinary group of experts, together with the endorsement and strong support of the Shia jurists.

• 1992 – Birth of the first baby following retrograde ejaculation using intrauterine insemination (IUI) first started in 1989 in Aban Hospital by Dr. Jalil Pakravesh (personal communication).
• 1994 – Birth of the first baby resulting from intracytoplasmic sperm injection (ICSI) and the birth of the first baby through egg donation carried out in Yazd by Dr. Mohmmad-Hossein Amir Arjomand (personal communication).
• 1996/97–Use of ICSI + percutaneous epididymal sperm aspiration (PESA) resulting in the birth of a baby at Shariati Hospital, Tehran, carried out by Dr. Hojat-Allah Saeedi (personal communication).
• 1998–First case of transferring an embryo produced from testicular spermatozoon by microinjection carried out by Dr. Akhondi (the author).
• 2004–Birth of the first baby born following pre-implantation genetic diagnosis (PGD) Royan Institute, Tehran, carried out by Dr. Leila Karimian (personal communication).

Indeed, the use of IVF in a range of contexts such as PGD(more…) (as a preventive measure for diseases with a genetic basis or for ....... selection); sperm, egg and embryo donation; surrogacy; fertility preservation; and animal conservation (freezing of egg, sperm and embryo), are commonplace in Iran.

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IVF : Infertility treatment in Iran

According to the World Health Organization (WHO), infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months of trying.

Infertility affects an estimated 20.4 % of couples globally.

The figure will drop to 12.4 percent after two years of trying, adding it shows that many infertile couples can have a baby if they keep trying.

The couples aged 35 years and above are not recommended to use the method because any delay in childbearing would aggravate their infertility problems(more…).

Iranian couples no longer need to travel abroad for consultation or treatment for infertility as advanced methods of treatment for couples who have problems to conceive, are available in the country.

There are 3 million infertile couples in the country.  Around 3-4% of young Iranian women suffer from recurrent miscarriages. Infertility rate is about 2.5% and secondary infertility is more prevalent than primary infertility. When a woman is not able to conceive at all, (due to infertility in either spouse), it is referred to as primary fertility. Secondary infertility is when a woman is unable to conceive again after the first successful pregnancy and childbirth. While causes of secondary infertility vary, the most important risk factors are advanced reproductive age, weight gain, abdominal surgeries, sperm quality and quantity, and smoking.

Microsurgical reconstruction for male infertility, new methods of male infertility treatment(more..) (medication, surgery, and Intracytoplasmic Sperm Injection (ICSI)(more…)), the role of complementary therapies and medicines to improve fertility, and new imaging techniques for assessment of infertility problems in both genders, are among the main important topics that will be discussed.

At present, there are 80 infertility centers across the country and 20 more will be launched by the end of the current year.

Additionally, 35 state-run universities of medical sciences have equipped with new laboratory equipment and devices for identification and treatment of infertility problems.

IVF is never the first step in the treatment of infertility. Instead, it’s reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination haven’t worked.

On average, an IVF cycle costs ,300-,900 in the country, while the majority of women have per-cycle success rates of 20-35%, which means they may need multiple tries to get pregnant.

IVF may be an option if one of the spouses or both has been diagnosed with problems like endometriosis, low sperm count, problems with ovulation, antibody problems that harm sperms or eggs, and unexplained fertility problems.

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IVF: side effects

Typical side effects include:

• Passing a small amount of clear or bloody fluid shortly after the procedure — due to the swabbing of the cervix before the embryo transfer
• Breast tenderness due to high estrogen levels
• Mild bloating
• Mild cramping
• Constipation

If you develop moderate or severe pain after the embryo transfer, contact your doctor. He or she will evaluate you for complications such as infection, twisting of an ovary (ovarian torsion) and severe ovarian hyperstimulation syndrome.

About 12 days to two weeks after egg retrieval, your doctor will test a sample of your blood to detect whether you’re pregnant.

• If you’re pregnant, your doctor will refer you to an obstetrician or another pregnancy specialist for prenatal care.
• If you’re not pregnant, you’ll stop taking progesterone and likely get your period within a week. If you don’t get your period or you have unusual bleeding, contact your doctor. If you’re interested in attempting another cycle of in vitro fertilization (IVF), your doctor might suggest steps you can take to improve your chances of getting pregnant through IVF.

The chances of giving birth to a healthy baby after using IVF depend on various factors, including:

• Maternal age. The younger you are, the more likely you are to get pregnant and give birth to a healthy baby using your own eggs during IVF. Women age 41 and older are often counseled to consider using donor eggs during IVF to increase the chances of success.
• Embryo status. Transfer of embryos that are more developed is associated with higher pregnancy rates compared with less developed embryos (day two or three). However, not all embryos survive the development process. Talk with your doctor or another care provider about your specific situation.
• Reproductive history. Women who’ve previously given birth are more likely to be able to get pregnant using IVF than are women who’ve never given birth. Success rates are lower for women who’ve previously used IVF multiple times but didn’t get pregnant.
• Cause of infertility. Having a normal supply of eggs increases your chances of being able to get pregnant using IVF. Women who have severe endometriosis are less likely to be able to get pregnant using IVF than are women who have unexplained infertility(more…).
• Lifestyle factors. Women who smoke typically have fewer eggs retrieved during IVF and may miscarry more often. Smoking can lower a woman’s chance of success using IVF by 50 percent. Obesity can decrease your chances of getting pregnant and having a baby. Use of alcohol, recreational drugs, excessive caffeine, and certain medications also can be harmful.

Talk with our doctors about any factors that apply to you and how they may affect your chances of a successful pregnancy.

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Typical side effects include:

• Passing a small amount of clear or bloody fluid shortly after the procedure — due to the swabbing of the cervix before the embryo transfer
• Breast tenderness due to high estrogen levels
• Mild bloating
• Mild cramping
• Constipation

If you develop moderate or severe pain after the embryo transfer, contact your doctor. He or she will evaluate you for complications such as infection, twisting of an ovary (ovarian torsion) and severe ovarian hyperstimulation syndrome.

About 12 days to two weeks after egg retrieval, your doctor will test a sample of your blood to detect whether you’re pregnant.

• If you’re pregnant, your doctor will refer you to an obstetrician or another pregnancy specialist for prenatal care.
• If you’re not pregnant, you’ll stop taking progesterone and likely get your period within a week. If you don’t get your period or you have unusual bleeding, contact your doctor. If you’re interested in attempting another cycle of in vitro fertilization (IVF), your doctor might suggest steps you can take to improve your chances of getting pregnant through IVF.

The chances of giving birth to a healthy baby after using IVF depend on various factors, including:

• Maternal age. The younger you are, the more likely you are to get pregnant and give birth to a healthy baby using your own eggs during IVF. Women age 41 and older are often counseled to consider using donor eggs during IVF to increase the chances of success.
• Embryo status. Transfer of embryos that are more developed is associated with higher pregnancy rates compared with less developed embryos (day two or three). However, not all embryos survive the development process. Talk with your doctor or another care provider about your specific situation.
• Reproductive history. Women who’ve previously given birth are more likely to be able to get pregnant using IVF than are women who’ve never given birth. Success rates are lower for women who’ve previously used IVF multiple times but didn’t get pregnant.
• Cause of infertility. Having a normal supply of eggs increases your chances of being able to get pregnant using IVF. Women who have severe endometriosis are less likely to be able to get pregnant using IVF than are women who have unexplained infertility(more…).
• Lifestyle factors. Women who smoke typically have fewer eggs retrieved during IVF and may miscarry more often. Smoking can lower a woman’s chance of success using IVF by 50 percent. Obesity can decrease your chances of getting pregnant and having a baby. Use of alcohol, recreational drugs, excessive caffeine, and certain medications also can be harmful.

Talk with our doctors about any factors that apply to you and how they may affect your chances of a successful pregnancy.

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IVF: Ovulation induction

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If you’re using your own eggs during IVF, at the start of a cycle you’ll begin treatment with synthetic hormones to stimulate your ovaries to produce multiple eggs — rather than the single egg that normally develops each month. Multiple eggs are needed because some eggs won’t fertilize or develop normally after fertilization.

You may need several different medications, such as:

• Medications for ovarian stimulation. To stimulate your ovaries, you might receive an injectable medication containing a follicle-stimulating hormone (FSH), a luteinizing hormone (LH) or a combination of both. These medications stimulate more than one egg to develop at a time.
• Medications for oocyte maturation. When the follicles are ready for egg retrieval — generally after eight to 14 days — you will take human chorionic gonadotropin (HCG) or other medications to help the eggs mature.
• Medications to prevent premature ovulation. These medications prevent your body from releasing the developing eggs too soon.
• Medications to prepare the lining of your uterus. On the day of egg retrieval or at the time of embryo transfer, your doctor might recommend that you begin taking progesterone supplements to make the lining of your uterus more receptive to implantation.

Your doctor will work with you to determine which medications to use and when to use them.

Typically, you’ll need one to two weeks of ovarian stimulation before your eggs are ready for retrieval. To determine when the eggs are ready for collection, your doctor will likely perform:

• A vaginal ultrasound, an imaging exam of your ovaries to monitor the development of follicles — fluid-filled ovarian sacs where eggs mature
• Blood tests, to measure your response to ovarian stimulation medications — estrogen levels typically increase as follicles develop and progesterone levels remain low until after ovulation

Sometimes IVF cycles need to be canceled before egg retrieval for one of these reasons:

• Inadequate number of follicles developing
• Premature ovulation
• Too many follicles developing, creating a risk of ovarian hyperstimulation syndrome
• Other medical issues

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·         IVF 

FAQs

1. How many embryos will be transferred? The number of embryos transferred is typically based on the age and number of eggs retrieved. Since the rate of implantation is lower for older women, more embryos are usually transferred — except for women using donor eggs. Most doctors follow specific guidelines to prevent a higher order multiple pregnancies — triplets or more — and in some countries, legislation limits the number of embryos that can be transferred at once. Make sure you and your doctor agree on the number of embryos that will be transferred before the transfer procedure.
2. What will you do with any extra embryos? Extra embryos can be frozen and stored for future use for several years. Not all embryos will survive the freezing and thawing process, although most will. Cryopreservation can make future cycles of IVF less expensive and less invasive. However, the live birth rate from frozen embryos is slightly lower than the live birth rate from fresh embryos. Or, you might be able to donate unused frozen embryos to another couple or a research facility. You might also choose to discard unused embryos.
3. How will you handle a multiple pregnancy? If more than one embryo is transferred to your uterus, IVF can result in a multiple pregnancy — which poses health risks for you and your babies. In some cases, a fetal reduction can be used to help a woman deliver fewer babies with lower health risks. Pursuing fetal reduction, however, is a major decision with ethical, emotional and psychological consequences.
4. Have you considered the potential complications associated with using donor eggs, sperm or embryos or a gestational carrier? A trained counselor with expertise in donor issues can help you understand the concerns, such as the legal rights of the donor. You also may need an attorney to file court papers to help you become legal parents of an implanted embryo.

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IVF

When choosing an in vitro fertilization (IVF) clinic, keep in mind that a clinic’s success rate depends on many factors, such as patients’ ages and medical issues, as well as the clinic’s treatment population and treatment approaches. Ask for detailed information about the costs associated with each step of the procedure.

Before beginning a cycle of IVF using your own eggs and sperm, you and your partner will likely need various screenings, including:

• Ovarian reserve testing. To determine the quantity and quality of your eggs, your doctor might test the concentration of follicle-stimulating hormone (FSH), estradiol (estrogen) and antimullerian hormone in your blood during the first few days of your menstrual cycle. Test results often used together with an ultrasound of your ovaries, can help predict how your ovaries will respond to fertility medication.
• Semen analysis. If not done as part of your initial fertility evaluation, your doctor will conduct a semen analysis shortly before the start of an IVF treatment cycle.
• Infectious disease screening. You and your partner will both be screened for infectious diseases, including HIV.
• Practice (mock) embryo transfer. Your doctor might conduct a mock embryo transfer to determine the depth of your uterine cavity and the technique most likely to successfully place the embryos into your uterus.
• Uterine cavity exam. Your doctor will examine your uterine cavity before you start IVF. This might involve a sonohysterography — in which fluid is injected through the cervix into your uterus — and an ultrasound to create images of your uterine cavity. Or it might include a hysteroscopy — in which a thin, flexible, lighted telescope (hysteroscope) is inserted through your vagina and cervix into your uterus

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