A word test tube baby was used generally because the embryo was formed outside (In-vitro) the body in the fertility laboratory rather than inside (In-vivo) the woman’s fallopian tube.

The term test tube baby is usually used by a layman due to lack of knowledge about its scientific term but as the technology is modernized, the common term is gradually diminishing and the In-vitro fertilization term is used today.

To clear your confusion, read and understand the elaborated definition, terms, and processes of IVF also known by the earlier layman terms test-tube baby as mentioned below.

What is IVF in Fertility?

IVF is In-vitro Fertilization in which a female egg is mixed with male sperm outside the body ( in a petri dish in a fertility lab) and gets fertilized and transferred to the woman’s uterus to get pregnant.

Process of In-vitro Fertilization (IVF):

In-vitro Fertilization is one of the most commonly used forms of assisted reproductive technology by intended parents, couples, LGBT partners, and individual parents who are biologically infertile or due to medical or health issues in conceiving a child. This assisted reproductive technology manages those patients to get pregnant and conceive a baby of their own linked genes and fulfill their dreams.

IVF step-wise techniques and process:

• Controlled Ovarian Hyperstimulation(COH):
  The initial cycle of IVF begins with ovarian stimulation, in this cycle, multiple protocols are been utilized that includes no stimulation to various levels of ovarian stimulation using Clomiphene citrate, letrozole, and exogenous gonadotropin i.e Follicle-stimulating hormone(FSH) and luteinizing hormone (LH). One of the most commonly used is gonadotropin-releasing Hormone (GnRH) where the secretion of gonadotropin is suppressed to prevent premature ovulation. After an optimal suppression is achieved then followed by recruiting multiple follicles by regular injections of gonadotropins.
  
  Follicular development is monitored using ultrasound imaging and hormone assessments. Once the lead follicles reach their required appropriate size, the final maturation of the egg is done by administration of HCG. The egg is retrieved after 34-36 hours after HCG injection.


• Oocyte/Egg retrieval:
  Mature eggs are retrieved within 34-36 hours after HCG administration. It is performed in a surgical suite under ultrasound-guided transvaginal aspiration and intravenous sedation. The ovarian follicles are visualized using a vaginal ultrasound probe( Transvaginal ultrasonography). Then follicular fluids are scanned by embryologists and locate the position of all available mature eggs. The eggs are kept in a special media and cultured in an incubator until insemination by the sperms.
  
  Insemination: 50,000 to 100,000 motile sperm are transferred to the culture dish containing the eggs if sperms are normal, this transfer of sperms is called standard insemination.


• Embryo Fertilization:
  Insemination or ICSI technique is used to fertilize the mature eggs for abnormal sperms, it is performed under a high-powered microscope. The semen samples are prepared by isolating the sperm by density centrifugation and washed with high protein concentration media for promoting capacitation and the sperms become fertilizable. The embryologist selects and picks a single spermatozoa with a fine glass microneedle and directly injected it into the egg cytoplasm, directly bypassing the requirements of sperm to penetrate the zona pellucida (the glycoprotein matrix surrounding the eggs). If the semen sample has less sperm count or poor motility, poor morphology, poor progression then the ICSI technique assures the possibilities of fertilization. In case there is no sperm to ejaculate, sperm can be obtained by surgical procedure. If the sperm is obtained via surgical procedure then the ICSI technique is commonly used and achieved fertilization.


• Fertilization is achieved and accessed after 16-18 hours after insemination or ICSI.


• Embryo Culture:
  The fertilized eggs called zygotes are cultured in a special formulation media which helps zygotes grow, they are cultured up to 2-3 days and are accessed after its retrieval, they are selected for the blastocyst stage only if the embryo shows sufficient growth and development and are cultured in blastocyst culture medium. There are more advantages in blastocyst culture:
  
  Embryos have a higher implantation potential. On the 5th day, only a few embryos are transferred to avoid multiple pregnancies. Therefore day 3 embryos are recommended to transfer.


• Embryo Quality:
  Assessing the quality of the embryo is critically important for selecting the best Embryo to transfer. The embryos are evaluated carefully and pictured by the embryologist early in the morning. Your physician and embryologist select the Embryos based on the rate of development and their appearance to transfer. Usually, it is transferred at the cleavage stage ( day 3 oocyte retrieval) or day 5 blastocyst stage.
  
  
  • Cleavage stage transfer (Day 3)
    When the embryos develop approximately 4-8 cells on day 3 is called the cleavage stage. During this stage, the embryos are analyzed its number of cells and how symmetrical, and whether there is any fragmentation of the embryos. Fragmentation is not preferable while some are transferable. When fragmentation occurs the cells divide unevenly that results in a cell- like structure that crowds the embryo. In labs, these qualities of embryos are graded as 1.
  
  
  • Blastocyst stage transfer (Day 5)
    The 5th-day Embryos are called blastocyst where the size of embryos increased and are even more developed than day 3 Embryos, they look similar to a ball of cells containing fluids inside. At this stage, the most important thing to evaluate is its expanded form because the more expanded the better is its quality of embryos. Grade 6 represents the best blastocyst in the lab.
  
  


• Embryo Transfer:
  After the selection of the best quality embryos and the stages by your physician and embryologist. Embryo transfer is a simple procedure and does not need anesthesia. Embryos are loaded in a catheter and transferred under transabdominal ultrasound guidance into the uterus by a catheter passing through the cervix. The embryos are placed 1-2cm from the uterine fundus and after transferring the catheter is checked under a microscope to see whether all the embryos have been successfully transferred in the Uterus. The number of embryos transferred will depend on the embryo stage, embryo quality and maternal age, and patients requirements.

Benefits of In-vitro Fertilization:

IVF is the ultimate gateway for intended parents, LGBT partners, and individual parents in achieving a successful healthy pregnancy and healthy childbirth. IVF assures you in fulfilling your dreams into reality to become a parent of your child.

Here are the ways, In-vitro fertilization(IVF) exponentially benefits you:

• Where other infertility fails, IVF works: There are some cases where intended patients move through a variety of fertility treatments such as fertility medications, intrauterine insemination, and so before reaching for IVF. It is always recommended to seek a fertility specialist doctor and avoid waste of money and your time in other treatments.
  If you have infertility diagnoses such as
  • Blocked fallopian tubes.
  • Severe male infertility factor.
  • Reduced ovarian reserves.
  • Advanced maternal age (woman over the age of 38).


• IVF is beneficial to anybody: Ivf is not only restricted to the mother of the baby, it is used by single women, same-sex couples, individual parents, and even surrogate or gestational carriers. They can have pregnancy and labor experience, and give birth to a child.


• You can use donated eggs or donated sperms from healthy donors: If your partner’s eggs or sperm fertilization chances are low, fertility specialists recommend using a donor (eggs/sperms) which increases your possibility of getting pregnant in the first or the second round.


• You can utilize your timings accordingly: Patients who focus primarily on their careers or have unique life situations and still willing to have a baby in the future IVF makes it possible. Their eggs or embryos are cryopreserved for future use, you can choose your time frame when you want to get pregnant and give birth. It also helps you to choose the age gap of your children which works best for your family planning.


• IVF increases your chances of having a healthy baby: Genetic Screening helps to ensure your baby is born healthy. Genetic screening called preimplantation genetic testing(PGT) ensures the fetuses are free of known genetic markers which could be linked to life-threatening medical conditions. PGT test is done only if they have positivity of these diseases or if they have a family history of genetically-linked disease such as:
  
  • Cystic fibrosis
  • Down syndrome
  • Sickle-cell anemia
  • And Tay Sachs disease.


• Low chances of miscarriage:Genetic abnormalities are the most common causes of miscarriage, it makes the body terminate the pregnancy biologically. PGT test determines the genetic viability of an embryo ahead of time and ensures that mothers have a good chance of having a healthy pregnancy and carry the baby normally, full-term without miscarriage.


• Rate of conception is increased: IVF with PGT has a higher success rate of conception than other assisted reproductive technology. To achieve higher chances of women’s fertilization, multiple cycles are used if necessary and to have a healthy pregnancy and live birth of a child.

Risk Factors of IVF

IVF has been fulfilling the dreams of many intended parents, LGBT couples, and individual parents by giving them birth to a child, which eradicates their emotions, stresses them for conceiving but not conceiving naturally due to infertile, health issues, or medical issues. But there are certain risk includes in IVF, some of which are mentioned below:

• Single-cycle IVF can Fail: Sometimes a patient can undergo more than one cycle of the process for successful IVF. Failure in a single cycle depends on a woman to woman but there is positive success after more than one cycle of treatment.


• Risk of Multiple Births: In IVF there is often more than one embryo implanted into the uterus it increases the risk of multiple births which is not of your choice. The Chance of multiple births is very less around 20-30%. To avoid multiple births, fertility specialists precisely do their best to transfer a single embryo into the uterus.


• Risk of Premature birth and low birth weight: A pregnancy with multiple fetuses carries a higher risk of having early labor and low birth weight than a pregnancy with a single fetus.
  
  Also, infertility specialists and Researchers said that IVF slightly increases the risk of premature birth ( before time) and low birth weight.


• Risk of Ovarian Hyperstimulation syndrome: IVF is a medical treatment and there can be very little chance of having side effects such as Ovarian hyperstimulation syndrome from the use of injectable fertility drugs ( such as Human chorionic gonadotropin) to induce ovulation. This syndrome causes the ovaries to be swollen and painful.
  
  Ovarian hyperstimulation syndrome typically last for a week, mild symptoms include:
  • Abdominal pain
  • Bloating
  • Nausea
  • Vomiting
  • Diarrhea
  
  

  However, the symptoms may last for several weeks, if you become pregnant and rarely it may develop a more severe form of ovarian hyperstimulation syndrome which may also cause rapid gain weight and shortness of breath.



• Miscarriage: Women conceiving through Ivf with fresh embryos will have a similar rate of miscarriage about 15-25% to that of women who conceive naturally without Ivf. But the rate of miscarriage increases with maternal age.


• The complication of Egg-retrieval: Using an aspirating needle to collect eggs could cause bleeding, infection, or damage to the bowel, bladder, or blood vessel. The use of sedation and anesthesia is also associated with related risks.


• Slightly higher chance of Ectopic pregnancy: When the fertilized egg is implanted outside the uterus, usually in the fallopian tube is known as ectopic pregnancy. The fertilized egg will not survive in the fallopian tube as the pregnancy will not continue.
  
  Women with damaged fallopian tubes who use IVF may have a very minimal rate of about 1-5% of Ectopic pregnancy.


• Risk of Birth defects: One of the primary factors of birth defects depends on the maternal age (more than 38 years), no matter whether the child is conceived naturally or through Ivf.


• Emotionally and Financially stress: IVF process is not an easy cost, it is highly expensive. It can lead to physically, financially, and emotionally draining. A great set of mind will be the support from your family and loved ones, also prior knowledge and management of the cost, physical stress, and your stern decision is a great option for successful IVF.