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Written By: Editorial Team | Updated : August 4, 2022 11:31 AM IST
IVF or in vitro fertilization is a treatment option not just for male and female factor infertility, but for non-fertility reasons as well. So, let's talk about the newer indications for IVF.
In Vitro Fertilization (IVF) is a form of assisted reproduction that had originally started for infertility cases, especially during fallopian tube blockage. That means when the fallopian tube cannot naturally pick up the egg and bring it inside the uterus. IVF involves retrieving eggs from the ovaries and fertilizing them with the husband's sperm in the laboratory. So, it bypasses the need for the fallopian tube to transport the egg and allows the egg and the sperm to meet. In due course of time with the development of Intracytoplasmic Sperm Injection (ICSI), the indications for IVF expanded to involve male factor infertility where the sperms are too few to fertilize the eggs either naturally or by conventional IVF.
Other indications for IVF include ovulatory disorders like polycystic ovarian syndrome (PCOS), endometriosis, and declining ovarian reserve. However, there are cases where the couple is not necessarily infertile and yet may benefit from IVF.
Human embryos are not always chromosomally normal. There is always a percentage of embryos that might have chromosomal abnormalities and this percentage increases with the increasing age of the female partner. The percentage of aneuploid eggs in a woman's ovaries (means eggs with chromosomal abnormalities) increases with age. An egg that is chromosomally abnormal can lead to failed attempts of pregnancy, miscarriage, and abnormalities in the babies. Therefore, women above 35 having a higher chance of eggs with chromosomal abnormalities might decide to opt for IVF not only from the fertility point of view but also to avoid these risks.
With IVF, there is an option of testing the chromosomes of embryos before transferring them back into the uterus. This process is called PGT-A which stands for preimplantation genetic testing for aneuploidies. Once the embryos have reached the blastocyst stage, a few cells are taken from its outer layer called the trophectoderm and sent for chromosomal testing. If the report indicates that the embryo has abnormal chromosomes, then it is not replaced in the woman's uterus. If the report indicates that the chromosomes are normal, such an embryo can be transferred into the woman's uterus minimizing her risk of miscarriages or having an abnormal baby due to her age factor.
Other genetic indications for IVF include cases where the couple has a hereditary genetic disease in the family that can pass on to the child. For example, if the husband and wife both have thalassemia minor then there is a 25 per cent chance of the child having thalassemia major which is incompatible with a healthy life. In such cases, although the couple is not infertile, and they could have conceived naturally, however they can avoid the risk of having a child with thalassemia major by opting for IVF with PGT-M (preimplantation genetic testing for monosomic disorders). Here, the embryo is specifically tested for thalassemia before transferring back to the uterus.
Also, couples who have repeated miscarriages can benefit from IVF when they also opt for PGT-A as one of the causes of repeated miscarriages is abnormal chromosomes.
Other indications for IVF also include couples where the husband is either the traveling often or works in a different city or country, thereby reducing their chances of conceiving naturally as the time spent together is limited. They may only spend 1-2 months in the whole year together and therefore when they try naturally, the chances of getting pregnant are low. Intrauterine insemination (IUI) is also an option in such cases but success rates with IVF are higher and some couples prefer to opt for it directly, to maximize the chance of conceiving in that limited time frame when the husband is available or when the husband and wife are together.
The article is contributed by Dr. Sulbha Arora, Clinical Director, Nova IVF Fertility, Mumbai.
