In vitro fertilization is the common name for in vitro fertilization and embryo transfer, which involves taking the eggs and sperm of an infertile couple out of the body, fertilizing them under in vitro culture conditions, and developing them into embryos. Finally, embryos with developmental potential are selected and transplanted into the mother’s uterine cavity to allow them to implant and develop in the uterus to give birth to babies. The current IVF technology is very mature and can be divided into the first, second, and third generations. To date, it is estimated that more than 8 million children have been born through IVF and its derivative technologies worldwide. A large amount of research evidence suggests that singleton children born through IVF technology have similar neurological development outcomes to those conceived naturally, that is, they are similar in terms of psychomotor, cognitive, behavioral, and socio-emotional development, as well as whether they suffer from mental disorders.
Target Group
IVF is suitable for women with fallopian tube diseases and endometriosis, and men with oligospermia, asthenospermia, and teratospermia. In addition, patients with immune infertility, unexplained infertility, unruptured follicle syndrome, and those with genetic diseases who need pre-implantation diagnosis can also achieve the purpose of reproduction through IVF.
Taboo group
1. Either the man or the woman suffers from a serious mental illness, acute infection of the urinary and reproductive system, or a sexually transmitted disease.
2. Those who suffer from genetic diseases that are not suitable for reproduction as stipulated in the Maternal and Infant Health Care Law and for which pre-implantation genetic diagnosis is currently not possible.
3. Either party has serious bad habits such as drug abuse.
4. Either party has been exposed to teratogenic amounts of radiation, poisons, or drugs and is under the effects of the drug.
5. The woman suffers from irremediable uterine infertility.
6. The woman suffers from a serious physical illness and cannot bear pregnancy.
Technical/surgical risks
1. Ovarian hyperstimulation syndrome: In in vitro fertilization technology, women need to undergo ovulation induction treatment, which may lead to the occurrence of ovarian hyperstimulation syndrome, with symptoms such as abdominal distension, abdominal pain, nausea, vomiting, etc. In severe cases, it can be life-threatening.
2. Spontaneous abortion after intrauterine pregnancy: Because the granulosa cells in the follicles are sucked out during the IVF egg retrieval operation, the patient often shows luteal insufficiency, which is the main factor for post-IVF miscarriage. In addition, poor embryo quality and poor endometrial receptivity are also common reasons. The cause and treatment of threatened late miscarriage after surgery are the same as those of natural pregnancy, and no special treatment is required. It is important to prevent infection and screen for cervical relaxation as early as possible.
3. Ectopic pregnancy: The incidence of ectopic pregnancy in IVF technology is significantly higher than that of natural pregnancy. When transferring embryos, stimulation should be minimized. Since most patients have blocked fallopian tubes or inflammatory diseases, and some patients have undergone multiple curettages, the endometrium is not conducive to implantation, and the embryo is easily retained in the fallopian tube for implantation and development, forming a tubal pregnancy or a cervical pregnancy.
4. Multiple pregnancy: In order to improve the success rate of IVF technology, multiple embryos are usually transplanted, which increases the possibility of multiple pregnancy, which may lead to premature birth, low birth weight and other complications. Generally, twins can continue the pregnancy, pay attention to rest, prevent miscarriage and premature birth, strengthen nutrition, and prevent gestational hypertension. For those with three or more pregnancies, vaginal B-ultrasound reduction surgery should be recommended to reduce the number of pregnancies to twins or a single pregnancy.
5. Bleeding: In IVF technology, it is not uncommon to see bleeding from the vaginal vault puncture point after egg retrieval. After a few minutes of tight compression, there are no surgical sequelae. The reported rate of severe intra-abdominal bleeding is less than 0.1% of cases. Causes sufficient to cause intra-abdominal bleeding may be bleeding from the ovarian or iliac vessels caused by follicle puncture. Huge retroperitoneal hematomas requiring emergency laparotomy may occur from bleeding from the iliac veins.
6. Pelvic infection: Vaginal puncture egg retrieval causes a risk of pelvic infection of less than 1%. The infection may be in the form of infection after pelvic surgery, or pelvic abscess, which requires surgical drainage in some cases. Prophylactic antibiotics should be used before egg retrieval, especially in high-risk patients, such as those with salpingitis, endometriosis, pelvic adhesions, hydrosalpinx, or a history of pelvic surgery. Intravenous antibiotics may be considered.
7. Emotional and psychological pressure: The IVF cycle is long, and women need to undergo a series of medical procedures, such as hormone therapy, ovulation induction, egg retrieval, etc., and there is a certain risk of failure, which will make women feel anxious and uneasy. Patients can relieve themselves by learning relevant knowledge, reading books, listening to music, and talking.
8. Others: Although IVF technology can solve the problem of infertility, it cannot completely avoid the risks of birth defects and genetic diseases.
Postoperative Care
After IVF surgery, attention should be paid to local care, diet conditioning and lifestyle behavior management.
1. Ensure the vulva is clean and dry to avoid infection.
2. Dietary adjustment: Eat a balanced diet, ensure the intake of protein and vitamins, and avoid eating spicy and irritating foods.
3. Lifestyle management: After the transplant, you can rest in bed for 1-2 hours in the outpatient clinic. After leaving the hospital, you should avoid strenuous exercise, sexual intercourse, and high-temperature environments such as sitting baths and saunas. In addition, you should also have regular checkups to understand the embryo implantation status.
Preoperative precautions
1. Communicate with the doctor before the operation to understand the specific process, related risks, program design, etc. of IVF, and be mentally prepared.
2. Complete relevant examinations, such as routine physical examination, gynecological examination, laparoscopy, hysteroscopy, salpingography, B-ultrasound, genetic examination, immune and autoimmune related examinations, reproductive endocrine examinations, sperm related examinations, infectious diseases or sexually transmitted diseases related examinations, blood biochemistry, urine routine, electrocardiogram, etc., to confirm that there are no serious systemic diseases and that the indications for IVF are met.
3. Do a good job of psychological preparation and avoid too much psychological pressure. You can communicate more with family and friends and seek their support and encouragement.
4. Maintain a healthy lifestyle, including diet, exercise, rest, etc.
5. Quit smoking and drinking.
Surgical Procedure
The current IVF technology is very mature and can be divided into the first, second and third generations. The first generation of IVF is also called conventional IVF. It is to place sperm and eggs in a certain ratio in the same culture environment to allow them to naturally combine and fertilize. It is mainly suitable for women with diseases such as fallopian tube obstruction, endometriosis, and immune infertility. The second generation of IVF is intracytoplasmic sperm injection, which uses micromanipulation technology to inject sperm into the cytoplasm of the egg to fertilize the egg and develop it into an embryo in vitro. It is mainly suitable for men with oligospermia, asthenospermia or obstructive azoospermia. The third generation of IVF is also called preimplantation genetic diagnosis, which refers to the extraction of a small amount of cells from the test embryo for genetic testing before embryo implantation to screen out embryos without genetic diseases or other genetic defects for transplantation. It is mainly suitable for couples who have chromosomal abnormalities or genetic diseases or repeated IVF failures. Here, the first generation of IVF is taken as an example. Its operation process mainly includes egg retrieval, sperm processing, in vitro fertilization and embryo culture, embryo transplantation, etc.