Not Many Aware Of IVF
By Piyumi Buddhakorala
In Vitro Fertilisation (IVF) is a last resort” said Professor Deepal S. Weerasekera, Clinical Director of the Prarthana Centre for IVF.
It is a process by which egg cells are fertilized by sperm outside the womb. It is a major treatment in infertility when other methods of assisted reproductive technology – such as medication to induce ovulation, tablets to improve sperm count and certain operations to relieve obstructions in the womb – have failed. IVF involves hormonally controlling the ovulatory process: removing eggs from the woman’s ovaries and letting sperm fertilize them in a fluid medium in order for the embryo (fertilized egg) to form. After three days the embryo is then transferred to the patient’s uterus in an attempt to establish a successful pregnancy. The first “test tube baby,” Louise Brown, was born in 1978 in London.
Dr. Weerasekera explains the advantages of IVF treatment which is that even if a fallopian tube is blocked or the woman has a disease which prevents her from conceiving, she can still get pregnant in such a way that it is possible to take an egg from another woman, the sperm of the husband, fertilize it and deposit it in her womb. This is called oocyte donation.
There are two main methods of conceiving; IVF, which is standard and ICSI. Intro Cytoplasmic Sperm Injection is the process by which a needle is injected straight through to the egg with the sperms in it.
Even with such optimism for conceiving present, when all else fails, Dr Weerasekera points out that there is a 30-40% success rate for IVF, not only in Sri Lanka but worldwide.
The process of Controlled Ovarian Stimulation is done so as to extract more than one egg from the womb. If ten were to be extracted all 10 will be fertilised. Two of the fertilized eggs, at the most, are put back into the womb and the rest are frozen. By this procedure, if the fertilization is not successful, the couple may resort to one of the frozen embryos which, according to Dr. Weerasekera, can last for five years. This method is known as Frozen Embryo Transfer (FET).
There are three methods involved before the IVF procedure takes place; Laparoscopy, Hysteroscopy, and Dye Insufflation. Laparoscopy involves insertion of a camera through a small cut in the naval. Hysteroscopy is a procedure that involves insertion of a small camera through the vagina to visualize the cavity of the womb. Dye Insufflation is done to test whether the fallopian tubes are blocked or not. Such methods can be used to find out the exact state of the cavity of the womb, patency and function of the tubes, diseases affecting the function of the tubes, state of ovaries and any diseases affecting the ovaries. All these are important factors to diagnose early when there is a delay in conceiving so that early treatment can be instituted. Dr. Weerasekera advises that after six months of ‘trying’ a couple should seek medical help.
A major drawback of IVF is the cost — Rs. 200,000 at the least. IVF is not available in state hospitals. The people of this country are not too aware of such a facility available and therefore go abroad. ‘Prarthana’ has delivered 60 babies within the span of five years.
When questioned of the risks involved with IVF procedures he states that during the process of Controlled Ovarian Stimulation too many eggs may be produced and this can cause the stomach to swell up. Another is that with the deposition of two embryos-in order to ensure successful pregnancy-both embryos growing will result in twins. Therefore, the norm now is to deposit one embryo.
Speaking to Dr. Madara Ralapanawe, Clinical Embryologist with an MD. Masters in Clinical Embryology (Monash, Australia) one finds that Apollo Hospitals aim to make IVF a patient-friendly procedure.
He explains that in order to make it more affordable and available nation-wide, there is a simpler method. For patients coming from say, Anuradhapura, Apollo sends the necessary injections to their General Practitioner (GP) so that the patient need only to come to Colombo for the scans and the egg pick-ups. Dr. Ralapanawe states that during the process of IVF, which takes upto 20 days, no hospital admission is necessary. There are three protocols concerning IVF; Natural Cycle, Short Cycle/Protocol and Long Protocol. The natural cycle is where hormonal tablets are given, a process which involves less medication and less cost. The Short Cycle involves eight injections given by the family doctor and the Long Protocol takes up to 1.5 months.
Patients, who have difficulty in paying up front, are not expected to do so. They may pay during the process as and when it is required, for example, paying for the initial injections.
The centre consists of a team of doctors, gynaecologists, embryologists, endocrinologists, urologists and radiologists who conduct comprehensive diagnostics to identify fertility problems and their root causes, with emphasis on non-invasive and minimally invasive procedures.
Apollo has delivered an impressive number of 15 babies, with 115 pregnancies within the last year.
With problems of infertility prevalent the Sri Lankan man and woman ought to know that there is still hope for conceiving.
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