Interview with Dr Priti Arora Dhamija, Obstetrics & Gynecology and Fertility expert

 Could you explain the basic steps involved in the IVF process?

In vitro fertilisation (IVF) involves the fertilisation of gametes outside the body under controlled laboratory conditions. The process begins with administering medication to the female to stimulate the production of multiple mature oocytes, or eggs, in the ovaries. Once the eggs are ready, they are retrieved through a minor procedure performed under anaesthesia. These eggs are then carefully placed in incubators to maintain optimal conditions before being fertilised with the partner's sperm, completing the process.

What are the main factors that determine the success rate of an IVF cycle?

The success rate of an IVF cycle depends on various individual factors. Key influences include the ages of both partners, their medical conditions, and how long they have been undergoing treatment. The underlying reason for their infertility also plays a critical role, as does the nature of the medications used in the process. Additionally, the condition of the ovaries—such as inflammation, infections, previous surgeries, or conditions like PCOS or endometriosis—can impact outcomes. These factors cannot be generalised, as each case is unique and requires a personalised approach to treatment. IVF boasts one of the highest success rates in assisted reproductive technologies, with approximately 4 to 5 successful pregnancies out of 10 cycles, compared to a 1 to 2 in 10 success rate for natural conception. This is largely due to the ability to select the healthiest embryo. Moreover, specific tests can be conducted to address the root causes of infertility, thereby increasing the chances of success with IVF.

Are there any age or health conditions that would make IVF a better or worse option for certain women?

IVF is generally not recommended for younger women who still have viable chances of conceiving naturally, as the procedure is demanding and requires significant mental, social, and financial preparation. Instead, IVF is typically directed toward women with specific gynaecological conditions or those who, despite trying, have not been successful in conceiving, particularly as they reach the age range of 30 to 35 and beyond. This age group may face reduced success with other fertility treatments, making IVF a more viable option. IVF can also be an alternative for younger men who have undergone surgeries, treatments, or illnesses that have led to sperm-related fertility issues. When other methods fail, IVF becomes the preferred choice, and in some cases, third-party assistance, such as donor sperm or eggs (especially eggs), may be needed. However, older women should be advised that egg quality often declines with age, which can affect outcomes. Legal regulations typically restrict IVF to women up to 50 years old and men up to 55 years old.

How does IVF affect a woman’s body physically, both during the treatment and long-term?

IVF has both immediate and long-term physical, social, and financial impacts, making thorough counselling essential. Physically, a woman undergoing IVF will need daily injections for about 10 to 12 days during her cycle, along with frequent monitoring visits for ultrasounds and blood tests to track egg maturation. Once the eggs are ready, she will undergo an egg retrieval procedure under anaesthesia, which is painless but invasive. During the process, she may feel heaviness in the lower abdomen, tiredness, drowsiness, and experience some discharge. While IVF procedures are highly individualised and generally safe, there can be minor risks of infection, pain, or discomfort, which might require antibiotics or painkillers. Women with conditions like PCOS may have an exaggerated response to the treatment, experiencing bloating and fluid retention that requires close monitoring. Overall, while IVF is safe, the physical and emotional demands highlight the importance of preparation and support.

Are there any long-term health risks associated with IVF for the mother or baby?

Long-term studies indicate that IVF does not cause health issues in mothers or babies. In the case of multiple pregnancies, premature births are more common. IVF clinics take precautions to minimise this risk. Over many years and cycles, frequent hormone injections could theoretically predispose women to certain ovarian issues after 20 years; however, when administered in the correct amounts and under careful moderation, these medications generally do not have lasting negative effects. Additionally, babies born from IVF are found to develop normally in the long term.

Can multiple IVF cycles negatively impact a woman’s health?

Multiple IVF cycles can indeed have negative effects on a woman’s health, both physically and psychologically. The repeated use of fertility medications over multiple cycles can be physically taxing, requiring frequent monitoring and surveillance. Additionally, the emotional and psychological demands of undergoing several rounds of treatment can be draining, making it essential for women to have strong support and counselling throughout the process.

How do fertility medications used in IVF affect the reproductive system?

Fertility medications used in IVF work by mimicking the body’s natural hormones, but they are administered at levels designed to stimulate the development of multiple follicles in the ovaries, which is essential for the procedure's success. The hormones released by these follicles also impact the uterus, preparing it for embryo implantation. However, the fallopian tubes are not affected by these medications, as IVF was originally developed to assist women with tubal issues. Since its inception, IVF indications have expanded to address a wider range of fertility challenges.

Is there a difference in the health outcomes for babies born through IVF compared to natural conception?

Babies born through IVF generally have similar health outcomes to those conceived naturally, aside from prematurity-related issues that can arise in cases of multiple births. IVF itself does not cause health complications. However, if the parents carry a genetic disorder, there is a risk that it could be passed to their children. To address this, a genetic test can be performed on the embryo before implantation to assess for potential inherited conditions.

What are some common myths or misconceptions about IVF that you encounter in your practice?

In practice, several myths and misconceptions about IVF often concern couples. One common concern is the high cost, as many are unaware that the specialised medications, equipment, and fine-tuned procedures contribute to the expense but also enhance success rates. Couples may also fear that IVF babies will be abnormal, though research shows that these babies typically have normal health outcomes. Another misconception is that the IVF process is very painful, when, in reality, it involves fine needles that generally do not cause significant pain, infection, bleeding, or bruising. Some worry that IVF could be harmful to their bodies long-term; however, the procedure is generally safe with proper follow-up. The IVF process does require discipline, as patients must maintain a healthy diet, avoid drugs and alcohol, reduce stress, exercise (such as yoga), and get adequate sleep to support success. A major myth is that completing an IVF cycle guarantees conception, but in reality, lifestyle and health management are crucial to success. Another misconception is that fertility issues primarily concern women, though male factors account for about one-third of cases, with another third attributed to female factors, and the remaining third involving both partners.

What are some of the most important factors couples should consider before opting for IVF?

Before opting for IVF, couples should undergo a thorough evaluation of their social and familial circumstances, as well as a detailed review of both partners’ medical histories and lifestyle habits. Both partners must commit to a healthy lifestyle, including proper diet, stress management, abstaining from drugs, and regular exercise, as these factors significantly impact IVF success. Counselling is essential to address considerations like weight, medications, mood, and food discipline. All necessary tests should be conducted to assess any gynaecological or other health conditions, as these need to be prioritised and treated before starting IVF. Ensuring the health of the uterus, ovaries, and sperm is vital, as is the absence of chronic diseases that might interfere with the process. IVF encompasses a diverse set of conditions and protocols, so understanding specific aspects is also crucial for making informed decisions.