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    in vitro fertilisation (ivf)

    Test Tube Baby Process, Complications and Cost

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    • 4.5   (1 Votes)

    Baby conceived through an in-vitro Fertilization (IVF) treatment is called a Test tube baby. Fertilization of sperms and eggs, creating an embryo - leads to formation of a test tube baby. Some of the known complications with the process include multiple pregnancies, OHSS and ectopic pregnancy. The cost of IVF treatment cycle in India usually varies between Rs. 1,20,000 to Rs. 2,50,000 including the medicines and procedure.

    Test tube baby refers to a baby achieved from pregnancy with the help of an Assisted reproductive technology (ART). In simple terms, a baby born via the artificial method of conception is known as a Test tube baby. The term was originated back in the 20th century when the first test tube baby was born. Since then, 'test tube baby' was used as an alternative for artificial insemination. It was later expanded into Assisted Reproductive Technology (ART). The notion of test tube baby hit the headlines in 1960 when a test tube baby was born successfully. The artificial insemination was tested in several ways before implementing it for patients. The ART concept was later explored and certain modern advancements such as Intrauterine Insemination (IUI) and In Vitro Fertilization (IVF) treatments were added. The main aim was to help maximum cases of infertility in achieving test tube babies. There can be several reasons for infertility like age, PCOS, and less number of sperms in men, etc. The treatment refers to a process of combining eggs and sperms outside the uterus in a Petri dish to develop as an embryo. Once the test tube baby is developed, it is then implanted into the uterus of a mother or a surrogate.

    In this article we will be discussing the below-mentioned questions:

    The test tube baby process is the only method discovered by scientists about 40 years ago to eliminate infertility issues in individuals and couples. The first IVF baby was named Louise Brown. From that point of time, more than 2 million test tube babies are born till date. Many modern types of research and experiments, are still in practice at numerous universities, to expand ART treatment. Test tube baby process is a critical and most demanded medical treatment for infertile couples around the world. Hence, it is advised that proper investigation and research must be done while choosing the fertility center and infertility specialist.

    1. Who can get benefit from IVF treatment or test tube baby process?

    This process is used when sperms are unable to penetrate the female eggs or there is the presence of problems in female reproductive organs. In these cases, help from a donor can also be taken to support the process of fertilization. People suffering from below mentioned infertility reasons can take benefit from the test tube baby process. Infertility can be classified into 3 categories: male infertility, female infertility and unexplained infertility of couple.

    Test Tube baby

    Female infertility causes -

    • A cyst or tumor in the ovaries or uterus
    • Hormone imbalance (10)
    • Abnormal cervical mucus
    • Intake of regular drugs and alcohol
    • Thyroid imbalance
    • Overweight or obesity
    • Stress and Anxiety
    • Intense workout, which may damage the tissues of the body
    • disturbed menstrual cycle
    • Blocked fallopian tubes 

    Male infertility causes  -

    • Varicocele - Swelling of veins around the testicle.
    • Infection-causing inflammation
    • Retrograde ejaculation
    • Tumors (11)
    • Undescended testicles
    • Hormone imbalance
    • Defect in chromosome

    There can be some other reasons for the infertile couple-

    • Couple with old age
    • Unexplained Infertility - Couples who could not conceive after having regular unguarded sex beyond 1 year.

    Couples undergoing any of the ART treatment requires extreme patience throughout the process. Especially, the women who are injected continuously for several days, in the process of IVF to achieve test tube baby. A favorable outcome brings endless happiness in their lives, but the failure of the IVF cycle may abandon the women in depression. There is a huge scope of aiding infertility in men and women under in vitro fertilization treatment. The treatment is available under ART and one must definitely visit an infertility center in case they find any such symptom of infertility. 

    2. Success Rate of the Test tube babies in India

    Several countries are already competing to give better and more successful cases of IVF treatment in achieving test tube babies. India is nowhere behind in obtaining such great results with the best IVF trained professionals. These professionals possess expert knowledge as they practice on new cutting edge technology. It is believed that if IVF treatment if taken in the right manner, chances to have a baby may increase to more than 50 %. Recently in India, IVF success rate has increased above 30% - 35%. The significant increasing demand of different ART treatments have also increased in the past few years. Hence, it is advised to check the history of IVF success rate and doctor, before acquiring the finest treatment from their center. This treatment involves a high level of strength physically and mentally.

    Success Rate of the Test tube babies

    As per woman's age, the following is the success rate of IVF treatment in India:

    • Women under the age of 35 have approx 40 % success chances to have a baby.
    •  Women above the age of 40s approx have 30% to 35% success chances to have a baby.

    In India, the maximum expansion of fertility centers has occurred in the last decade as per high demand and success rates. There are certain guidelines for performing the treatment in India, but enforcement of the law is still missing. If IVF treatment is taken on time, in an accurate manner, then one may achieve more than 50 % of the gain rate. Women who have conceived in the past achieve higher success than the women who have never gone through pregnancy procedure. The success rate of today's IVF surgeries is substantially higher than before due to improved reproductive advance technology. The chances are better to get pregnant if the women use their frozen ova for fertilization at the time of IVF. The eggs obtained at a young age for freezing has more survival strength. Anyone planning pregnancy in their future is suggested to freeze their ova and sperms at a premature age. It increases the chances of getting pregnant from 30 percent to 60 percent, depending upon the egg freezing age. The eggs are then thawed for the fertilization process.

    3. Process of IVF treatment

    The IVF treatment is a lengthy procedure and demands persistence as several injections and medicines are given to the patient. The patient can suffer a difficult time during this process. Complete bed rest for 3-4 weeks is required along with care from family and friends. The patient should stay positive during this process so that hormonal imbalance does not affect the female parent. During this process, the patient is driven to an unconscious state with mild anesthesia. They should not experience any discomfort and stay relaxed while surgeries are being performed. The process of IVF endures the patient in the time-consuming and prolonged journey of tests and treatments, predicting a 50 % chance of positive results.

    The doctor will first familiarize the patient with suitable medical techniques. They will share the required ART treatment as per the necessities and cost of the procedure. The doctor will also examine the capability of the woman's body to deliver the test tube baby. In case, the woman is not medically fit for test tube baby, then surrogacy will be suggested for the couple. The evaluation of IVF treatment must involve uterus and fallopian tubes check-up. The medical examination is performed with a hysterosalpingogram (HSG, an x-ray of the uterus and fallopian tubes) or a Sono-hysterogram (ultrasound with fluid).

    Test tube baby procdure

    Primitively, the female partner is called twice in a 7-week procedure. The ovulation suppression process is done with the help of a birth control pill. A daily injection of Lupron for about 2 weeks is given to the patient to manage her hormonal levels.

    In the 6th week, several fluids are inserted, for the excessive production of hormones. The process is carefully completed under the surveillance of a quality ultrasound machine. Hormonal drugs like Follicles Stimulating Hormone (FSH) are inserted for the development of the eggs in the ovaries.
    After 7 weeks, if ovaries are observed to be in rest mode, then hormones are stimulated once again with fertility injections.
    After a complete check-up, an extremely thin syringe is inserted to retrieve eggs. Subsequently, the eggs and sperms are fertilized together in petri dish. The process is performed by an experienced embryologist. It requires a few hours for the patient to recover from the suction process.
    Once the eggs and sperms are developed into an embryo, it is implanted into the uterus.
     
    Embryo development, selection, and transfer to the uterus:
     

    • Fertilization of eggs and sperms: This process is performed in a medical laboratory in a petri dish. The process is observed under close surveillance through the microscope by the embryologist. The medical expert waits for 3-4 hours for the eggs and sperms to fertilize. The experts need to directly inject male gamete into the zygotes via Intracytoplasmic Sperm Injection (ICSI) procedure. 
    • Selection of the embryo: After the successful creation of an embryo, the doctors may monitor each embryo for selection. If any of the embryones reaches in the third day, then, those will be monitored for chromosomal defects. A morphological scoring system is currently implemented as a selection strategy. To achieve the pregnancy, fresh sperms received through testicular biopsy or frozen sperms can be used. In some cases, the embryo divides itself into two resulting in multiple test tube babies. Out of all the developed embryos, the best one or two fertilized embryo is selected for the transfer through morphological scoring.
    • Embryo transfer into uterus: The embryo is inserted with a soft catheter into the cervical canal and later into the uterine cavity. The fetus must attach itself, with the inner lining of the uterus (endometrium) for the pregnancy to occur. The endometrium of the woman is again injected with Human Chorionic Gonadotropin (HCG) or Progesterone for stimulation to adopting the embryo. Once the embryo is attached to the lining of the uterus, it leads to the successful implantation. In some cases, the embryo is transferred into the uterus in its cleavage stage.

    4. Possible Complications or Risks related to Test Tube Babies

    The abnormalities present in men or women must be cured, before beginning the test tube baby process for a healthy pregnancy. The latest infertility technology consists of a vast number of medical treatments which treats infertility in men and women. In Vitro Fertilization (IVF) is one of the signature treatments in ART along with other sub-treatments such as Intracytoplasmic Sperm Injection (ICSI) and Preimplantation Genetic Diagnosis (PGD). It additionally includes some of the tests like Testicular Biopsy and PGD or PGS to increase the success rate to achieve pregnancy. Failure of the IVF treatment develops a requirement for the surrogacy procedure which is the last resort for couples to have a baby. Here are the possible risks or complications associated with test tube baby procedure. 

    • Multiple pregnancies: If multiple embryos are placed inside the woman's body, then there is a possibility, that more than one embryo may grow and lead to multiple pregnancies. Natural embryo division inside the uterus also leads to multiple test tube babies. (1)
    • Ovarian Hyperstimulation Syndrome (OHSS): Identification of OHSS before starting the treatment may avoid the life-threatening iatrogenic complication of IVF treatment. It can happen during both the luteal phase (early-onset OHSS) or initial pregnancy (late-onset OHSS).  Aggressive treatment protocols may increase the risk of OHSS in women.
    • Ectopic pregnancy: When the embryo attaches itself, in the fallopian tubes or any part other than uterus is known as Ectopic pregnancy. Any other organ does not have enough space and resources to carry a pregnancy except the uterus. Uterus provides nutrition to fetus and aids to its healthy growth. Pregnancy growing in fallopian tubes may affect itself and fallopian tubes as well. Ectopic pregnancy encourages the risk of miscarriage and may also risk the life of a pregnant woman. Doctors treat these cases carefully due to several health risks. The success rate of ectopic pregnancies in the history of the IVF is low and painful. (2)

    5. Advantages of Test Tube Baby procedure:

    IVF is a revolutionary medical technique that has provided many couples a chance to have a baby. Many couples got encouraged and built many aspirations and believe in modern infertility and pregnancy treatments. It is a procedure of turning the dream into reality for having a complete family. Now people with unknown problems in their internal reproductive organs can take the required ART treatment. (3)

    Advantages of Test Tube Baby procedure

    Here are some of the common cases which are benefitted with test tube baby procedure: 

    • Females with blocked fallopian tubes: Test tube baby via IVF treatment is an effective solution for women to cure their infertility and conceive a baby. If the fallopian tubes are blocked, then it does not allow sperms to move freely through the fallopian tubes and reach the eggs for fertilization. Women with fallopian tubes can conceive with the help of test tube baby.
    • Poor Ovarian Reserve (POR): The problem refers to inadequate quality and quantity of Ovarian Primordial Follicular Pool (POR). It only occurs in women who have crossed their reproductive age. In some cases, young women are also affected. It degrades the quality and quantity of oocytes in women in their reproductive years. (7)
    • Infertility in men: In the case of male partner infertility, the sperms can be acquired from  'sperm washing technique' and by injecting a few hormonal injections to boost the sperm quantity and quality. (12)
    • Unexplained infertility: When a couple is not able to obtain pregnancy after one year of unguarded sexual intercourse, refers to unexplained infertility. To recognize the reason for infertility, both the partners must take a hormonal test and then try test tube baby treatment for positive results.
    • PCOS: A very common problem in females these days called Polycystic Ovary Syndrome (PCOS) is a major reason for infertility. As per Office on Women's Health (OWH), an U.S. health organization, every 1 in 10 women is suffering from PCOS condition across different parts of the world. It becomes difficult in conceiving a baby if a woman is diagnosed with PCOS. (8) Irregular period causes various health problems in women. PCOS can intensify the pain in the periods and lead to excessive flow and delay in the ovulation cycle. To fight with this complication, one must control her weight and diet.
    • Endometriosis: Early age of girls at menarche, inadequate and untimely periods, and taller height are correlated with endometriosis. Likewise, a greater Body Mass Index (BMI) and smoking are connected with increased risk of the same. Endometriosis affects fertility levels in women and extends pelvic pain. It can be treated with analgesics and Cyclic Oral Contraceptive Pills. Endometriosis also affects female reproductive organs such as the pelvic region, fallopian tubes, and ovaries. The tissue growth proves to become an obstacle for these organs. Insufficient blood flow may hamper the recovery of the organs and supply of oxygen resulting in infertility in the respective woman. This is a critical condition and surgery is required to remove the parts growing outside the womb. Once, endometriosis is treated, ART treatment can be effectively started.(9)

    6. Cost of Test Tube Baby in India:

    The financial expansion of ART treatments has encouraged infertile couples to attain infertility medical care. Affordable prices have demonstrated an enormous increase in fertility centers around the world. In fact, many Indian doctors working in fertility centers, possessing the knowledge have polished their skills over time. Medical care has another major concern, that this treatment does not incorporate insurance. Knowing the fact that only 30% - 40% of infertility cases produce success rates. The Indian government is more focused on giving financial help to maternal and child health, than infertility. Whereas, infertility cases also have, a huge number in India. Consequently, India is imparting only 1 % of its GDP on health care sector in comparison to China contributing 3 % and America is 8.3 %. It is clearly observed that India is spending an insufficient amount as per requirement. More efforts are now put to make sure that India also rises on the top of the list. (6)

    Test Tube Baby Cost

    One IVF cycle can cost up to Rs. 1,20,000 to Rs. 2,20,000, depending upon the type of procedure, medicines or drugs prescribed. If the case is more complicated, then advance IVF technology will be required along with other therapies. Below are the costs of various treatments and procedures (4) -

    • One IVF cycle - Rs. 1,20,000 to Rs. 2,20,000
    • One IVF cycle with additional Infertility sub-treatments - Rs. 3,00,000 to Rs. 5,00,000
    • FET (Frozen Embryo Transfer) - Rs. 1,20,000
    • Sperm donation - Rs. 8000 to Rs. 12,000
    • Egg Donation - Rs. 28,000 to Rs. 42,000.
    • Donation of the embryo - Rs. 36000 to Rs 54000
    • Freezing Charges of Embryo - Rs. 20000 to Rs. 30000
    • Freezing maintenance charges for the rest of the embryos - Rs. 4000  to Rs. 6000

    From the above costs, we have observed that-

    • The advanced IVF technology can be costlier than the other basic IVF treatments.
    • It should be considered that Frozen Embryo Transfer (FET) may charge Rs 1,20,000 separately, other than IVF treatment cost in India. 
    • When an IVF cycle is successfully completed, the parents have a choice to either donate the remaining eggs, sperms, and embryos to a needy couple or freeze them to obtain pregnancy in the future. There are couples, whose specific diseases possibly gets transferred to the test tube baby. These couples can benefit from Frozen Embryo Transfer (FET). It may add up to the IVF cycle but will save their child's health risks in the future. As per the above costs, it can be evaluated that, donation and performing these procedures may charge more than usual. Therefore, it is strongly suggested to take the IVF treatment, once the possibility of having a baby is confirmed. (4)

    IVF treatment prices vary from city to city. Some couples also prefer relocating to a new city to have a test tube baby at a low cost. For instance -

    • Delhi - Rs. 90,000 to Rs. 1,25000
    • Mumbai - Rs. 2, 00,000 to Rs. 3,00,000
    • Hyderabad - Rs. 70, 000 to Rs. 90,000    
    • Kolkata - Rs. 65,000 to Rs. 80,000

    There are few other factors that are also included in recognizing the cost of IVF treatment like women under 35 of age have a 32% chance of being successfully pregnant in the first IVF cycle. Whereas, women above 40 of age may need 5-6 cycles of IVF treatment for achieving success.  
    Here is the ranking of other countries preferred for IVF treatment after India as per the advancement in treatment used and there cost (5):

    • Australia  
    • Brazil   
    • Canada   
    • Germany   
    • India  
    • Japan  
    • Scandinavian countries   
    • South Africa
    • The United Kingdom  
    • United States   

    India seems to be the primary option for many medical IVF tourists around the world seeking the affordable and best treatment. India has specialized doctors and uses the most advanced technology of the ART, which is also used globally. India has also known for giving many successful IVF test tube babies. It has given robust competition to many renowned countries. India has the best well-maintained fertility centers. A few of them can be visited in the cities of Delhi, Mumbai, and Hyderabad. Most of the doctors in our country have achieved and learned advanced technology from abroad. This is also one of the principal reasons attracting medical tourists from western, middle eastern countries and even from Africa.

    India has the most competitive cost around the globe. It is reliable to have treatment from a country that has remarkably given numerous success numbers. Likewise, for surrogacy, there is an immense demand from overseas as well as from the country itself. Looking at the upcoming cost of the IVF treatment, the World Health Organization (WHO) is arriving forward and conferring concerns. WHO is trying to cost of infertility treatment affordable for patients across the world. WHO is finding new approaches to treat the patients around the globe in the budget. It is also learned that several non-profit health organizations want infertility to be a part of education, to bring more awareness in the world. As per the International Committee for Monitoring Assisted Reproductive Technologies (ICMART), multiple countries are recording their data of IVF procedure. Their data will help in finding the effectiveness of treatment routines and an appropriate number of successful pregnancies. India is reporting to ICMART as well for an improvement in costs and quality of IVF treatment.

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    Sangupt Vasi

    May 10, 2019, 2:09 p.m. 4.5

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