Challenges to IVF

Fortunately, infertility can be treated with new reproductive technologies such as in-vitro fertilization where the eggs and sperm  are combined and fertilized in-vitro or outside the body. IVF is a complex series of procedures mostly involving processes like ovarian stimulation, egg retrieval, sperm retrieval, fertilization and embryo transfer. It takes two to three weeks and sometimes more than one cycle is required for one successful IVF.

 Infertility leads to tremendous financial and emotional stress to couples. World Infertility and IVF Center Delhi is advanced in managing such complications. 

Success of IVF and chances of giving birth to a healthy baby after using IVF depends on various factors

  • Age of the mother
  • Embryo status
  • Women’s reproductive history 
  • Cause of infertility
  • Medication stoppage if any 
  • Stopping  the unhealthy lifestyle habits if any 

 After the success and development of the embryo, many medical conditions must be controlled and managed as they can affect IVF and may decrease the success rate. 

These medical conditions sometimes affect the IVF or on other hand get aggravated due IVF. In such conditions, pregnancy should not be carried on as it could be life threatening for the mother. Infertility rates are increasing immensely which further increases the chances of medical illness. These conditions are outlined below:

Hypertension 

The hormones that are used in IVF for ovarian stimulation affects the renin angiotensin aldosterone system responsible for the increase of blood pressure. Physiological blood pressure changes during pregnancy, normotensive women usually experience about 5 to 10 mmHg fall in their BP starting from their first trimester. This is a vasodilation which can overcome the increment of blood volume in this period. Severity of hypertension can be pre existing hypertension i.e., before pregnancy which can persist in IVF. History of pregnancy induced complications–gestational hypertension, pre-eclampsia, gestation diabetic, premature menopause, increased blood pressure level in babies  born by IVF. Antihypertensive medication like angiotensin receptors inhibitors ARBs increases the risk of placental complication. Women suffering from hypertension are more prominent to risk IVF. However choice of hypertensive drugs bases on its efficiency, side effects, and teratogenic potential can be considered safe to control blood pressure during IVF treatment 

 Diabetes mellitus

Diabetes mellitus type 1 lowers the chances of IVF by interfering with secretion of essential hypothalamic hormone called gonadotropin releasing hormone and luteinizing hormone.women suffering from type 2 diabetes mellitus are likely to develop polycystic ovaries Syndrome (PCOS) during the IVF treatment which is characterized by Obesity and affects IVF. risk of congenital malformation. In foetus is high in diabetic women. During IVF main goal is to treat type 1 and type 2 with diet modification, exercise 

Cardiovascular diseases 

Challenges come in the way of IVF in women suffering from Cardiovascular disease such as Coronary heart diseases, Obesity, dyslipidemia, glucose intolerance, and Hypertension all the comorbid condition is common in infertile women particikartydiagonised with PCOS. In such patients IVF treatment such as Ovarian stimulation should be done in a controlled manner to avoid Ovarian hyperstimulation syndrome which can be potentially life threatening. During pregnancy women goes through physiologic changes, those with heart disease need a thorough pre pregnancy risk assessment and counselling, regular Cardiology consults yin, and if IVF fails surrogacy can be a option 

Epilepsy 

Epilepsy may affect the reproductive function of hypothalamus pituitary Ovarian axis causing elevation in luteinizing hormone, low progesterone, and increased androgen.it also decreases libido and is associated with hyposexuality. Neurologist fitness should be obtained before IVF treatment. Standard protocol for Ovarian stimulation should be used. Prevention should be taken before the development of ovarian hyperstimulation syndrome. Episodic seizure should be treated first before IVF. Pregnancy women with epilepsy should consult neurologists for its control and use appropriate medication which are safe in IVF pregnancy 

Thromboembolic condition 

It is a rare disease but can be a life threatening condition in IVF. Deep vein thromboembolism and above 40 years with thrombophilia or history with a previous disease prophylaxis should be done to prevent thrombosis. Thromboembolic condition increases the chances of OHSS. Low molecular weight heparin, aspirin, and compression stockings should be used to treat under proper guidance. 

Systemic lupus erythematosus

Women suffering with Systemic lupus erythematosus may face ovario. Reserve and implantation failure due to autoimmune antibodies. Cyclophosphamide which is used for its treatment may cause premature Ovarian failure. Pregnancy induced Hypertension, premature babies, stillbirth, renal damage, with fetal abnormalities such as intrauterine growth restriction and neonatal death occurs in a women suffering with SLE which may have high risk of complication during pregnancy so it’s very important to have pre pregnancy counselling and continuous monitor. 

Obesity 

Obesity in women may aggravate gallbladder diseases, asthma and osteoarthritis, high requirement of hormones in IVF and difficult instrumentation during procedures. Obesity impairs the response of women to assisted conception treatment leading to lower reproductive outcomes. 

Thyroid disorder

Thyroid hormones have a direct affect on the reproductive hormones. Hypothyroidism decreases the plasma concentration of estrogen and androgen. With deficient luteinizing hormone secretion . Reduced libido and anovulation are reduced in hyperthyroidism. In hyperthyroidism there. At inadequate mid cycle  luteinizing hormones surges  leading to anovulation. That’s why Thyroid function is a must for better reproductive outcomes.thyroids drugs with least side effects are recommended during IVF treatment. 

Thyroid antibodies screwing should be done in euthyriod women whicheady to recurrent IVF failure and intravenous immunoglobulins can be given for positive success. During IVF, HCG for ovulation should be very helpful to compensate for the low luteinizing  hormone levels. Good luteal support must be given after an embryo is transferred. 

Hyperprolactinemia

The fertility is reduced by inhibiting 5alpha – reductase activity and increasing adrenal androgen secretion leading to the anovulation and also induces hyperinsulinemia. It is the most common endocrine cause of infertility. To reduce the prolactin levels and improve IVF success rate prior identification and preparation to avoid the complication IVF specialist in Delhi ncr  is the necessary agent.

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