By Dr Vaishali Chaudhary
Since the birth of Louise Brown in 1978, more than five million babies have so far been conceived in the laboratory with the help of In Vitro Fertilisation or IVF. Initially, IVF was a procedure that was done exclusively for women who had blocked fallopian tubes, but with technological advances, there are many more reasons and conditions where IVF needs to be done to achieve a pregnancy.
As these techniques of making babies in the laboratory are gaining popularity due to improved success rates, more and more women are now experiencing the IVF pregnancies. It wouldn’t be surprising if women were anxious to know if their pregnancy would be a normal pregnancy or a high-risk one just because they conceived their baby in a lab.
How does pregnancy occur in the lab?
In the traditional natural way, the egg gets fertilised by sperms deposited in the vagina, with the most able sperm entering the egg after travelling through the woman’s uterus and fallopian tubes. The fertilised egg then divides and forms an embryo in the fallopian tube which then travels back to the uterus to get implanted.
In an IVF cycle, the sperms that are obtained either from the ejaculated semen sample or sperms that are directly removed from the testis, are either kept in the close vicinity of the egg in petri dishes or are directly injected inside the egg by the embryologist and grown in the lab for five days under the strict supervision of the embryologist. No wonder that the embryologist is often called the IVF baby’s “first babysitter”. The best looking embryo is selected and transferred by the IVF specialist doctor into the uterus for implantation.
Confirmation of the pregnancy
Most women who conceive naturally realise that they are pregnant only after missing the period while a woman who has undergone IVF, would be aware of her pregnancy two to three days before missing the period as she would get tested earlier. The anxiety of being pregnant is much higher in an IVF pregnancy as it is a result of a lot of efforts and expenses. The doctors would advise the woman who has conceived naturally to only get a urine pregnancy test done to confirm the pregnancy while the IVF pregnancy is always confirmed with BHCG levels in the blood.
A woman who has conceived naturally would most probably start taking her folic acid and multivitamin tablets only after realising that she is pregnant while all women who have undergone IVF take these as well as progesterone and HCG hormone injections even before their pregnancy is detected. A woman with IVF pregnancy is under a lot of stress during the first few days of conception after taking hormonal injections and hoping desperately for a positive result. Early visits to the doctor and more number of sonographies are a norm in all IVF pregnancies.
The incidence of miscarriages is slightly higher in women with IVF pregnancies despite being under strict supervision and receiving more medications than those with a natural pregnancy. The reasons for this are most likely attributed to the higher incidence of elderly women with some medical conditions like diabetes or hypertension, presence of fibroids and higher incidence of aneuploid embryos (embryos with abnormal number of chromosomes).
Need for bed-rest
The commonest myth that prevails about IVF pregnancy is that a strict bed-rest would be required for all nine months. There is no added advantage of taking strict bed-rest after conceiving by IVF and the fertility specialist would only advise the women to avoid strenuous activities.
Risk factors in IVF pregnancy
The presence of high-risk factors in an IVF pregnancy is closely related to the factors that led the couple to undergo IVF in order to conceive. Presence of fibroids, endocrine disorders, diabetes, high blood pressure and increased age of the women all contribute to higher risk in an IVF pregnancy. The biggest risk due to IVF is the higher incidence of multiple (twins or triplets) pregnancy. This is due to the placement of two or three embryos and all two or three embryos getting implanted. The incidence of twins in IVF pregnancy is about 20 per cent. Preterm delivery can result due to the presence of multiple pregnancy. The best IVF centres will transfer only one or maximum two high quality blastocysts (Day 5) embryos in order to prevent multiple pregnancy.
Incidence of caeserian section
Women with IVF pregnancies have a higher incidence of caesarian section and it is once again due to the associated high risk factors like diabetes, high blood pressure, fibroids, multiple pregnancy and sometimes preterm delivery.
Abnormalities in IVF babies
The biggest doubt in the minds of women with IVF pregnancies is about whether the babies of IVF would be normal as they are artificially created in the lab. Women with IVF pregnancies are continually under strict supervision to confirm the normalcy of babies by various tests, which are very reassuring. The rates of anomalies were not different within the infertile population whether conceived by IVF or spontaneously. These data suggest that the diagnosis of infertility in itself is the common denominator for the increase in the rates of anomalies seen in both IVF and natural conceptions. The congenital abnormalities could be due to the higher aneuploidy in higher age group of the women and not due to the procedure of IVF.
The babies of women who had frozen embryo transfers after IVF were found to have relatively higher birth weights.
Tips to follow when you are carrying an IVF pregnancy
· All expecting mothers who have conceived by IVF should stay positive and enjoy the journey of motherhood because of the extra efforts that have been invested for conception.
· Apart from medical care, personal care should also be taken. Having a nutritious diet full of vitamins, minerals, calcium, and iron is more advisable to both the mother and the baby.
· Refraining from unhealthy habits like smoking, alcohol or caffeinated products is advised.
· Expecting mothers need to pay special attention to their body. If you feel weak, tired or lethargic, take a nap as and when required to refresh yourself during the exhausting weeks of pregnancy.
· Any small episodes of bleeding along with spotting, cramps or lower abdomen pain should be noted and reported to the obstetrician immediately. However, if mild spotting (implantation bleeding) is observed in the first few weeks of pregnancy, it should be watched carefully and if it’s repeated, then follow-up with the doctor needs to be done.
· It is recommended that couples should avoid having intercourse, especially in early pregnancy weeks.
· It is important to do all investigations and sonographies as advised by the obstetrician.
· An antenatal scan helps in examining your baby’s heartbeat rate, detection of chromosomal abnormalities (Down syndrome), development of the baby, images of the gestational sac, ovaries, and possibility of miscarriage.
· Yoga and Meditation exercises should be followed by patients during pregnancy.
Ultimately, the joy of seeing and holding the baby makes all the immense efforts worthwhile and takes away all the stress.
(The writer is Chief IVF Consultant, Cloudnine Group of Hospitals, Pune.)