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IVF, or In Vitro Fertilization (also known as a test tube baby) is a medical treatment that fertilizes the egg cells by the sperm outside the uterus. IVF is currently the most successful treatment option for infertility .

IVF is usually used after other simpler treatments have been unsuccessful. The process requires the woman to begin hormone therapy for superovulation, to help in the production of multiple eggs. These eggs are then removed from the woman’s ovaries , and are combined with sperm in the IVF lab, where the fertilization process occurs. Once the eggs are fertilized, the resulting embryo is transferred to the woman’s uterus , and if it implants, then a pregnancy is established.

When IVF is used for treating male infertility (caused by sperm which are defective and are unable to fertilise the egg, a variant of IVF called intracytoplasmic sperm injection (ICSI) is used. ICSI is the process in which the sperm is inserted directly into the egg cell using a micromanipulator, allowing the sperm to fertilise the egg.

Healthy eggs; sperm ; and a normal uterus are the three key elements that must be present for a successful In Vitro Fertilization. In the past few years, pregnancy rates have greatly improved as a result of IVF treatment; and in good clinics, they are as high as 46% pr cycle. The key is to find a reliable clinic which has a high success rate ; and a dedicated and experienced IVF team.

Want to find out if IVF can help you to have a baby ? Ask for a free second opinion from Dr Malpani, a leading IVF expert, at www.drmalpani.com/malpaniform.htm .Taking treatment at a world-class clinic will maximize your chances of success and give you peace of mind you did your best !

Both IVF ( in vitro fertilisation) and ICSI ( intracytoplasmic sperm injection) are types of assisted reproductive techniques, but patients still get confused between the two. Which do we select and when and why ?

The technique which was first developed was IVF . ICSI is a modification of the basic IVF technique. From the patient's point of view, everything remains the same, as regards superovulation, scans, monitoring, egg collection and embryo transfer. The only difference is what happens in the lab. In IVF, we allow the sperm to fertilise the eggs on their own. In ICSI, we give the sperm a piggy-back ride into the egg with the help of a micromanipulator.

For male factor infertility ( men with very low sperm counts or those with azoospermia) , ICSI is the only option, so there's no question of choosing between the two

However, for men with normal sperm counts, is IVF better ? or is ICSI better ?

The answer is - both are equally good, as long as the sperm fertilise the egg. This is because the embryo implantation rate for both IVF and ICSI is the same. As long as we have an embryo, whether the embryo is formed as a result of IVF or ICSI does not affect success rates at all

Some clinics believe that doing ICSI can harm the egg ( because we are mechanically introducing a sperm in the egg). However, this is not true - and with a skilled embryologist, the egg damage rates after ICSI are less than 2%

What about the risk of injecting an abnormal sperm in ICSI ? Theoretically, some doctors believe that IVF will ensure that only the healthy " best" sperm will fertilise the egg, whereas with ICSI if the embryologist selects an abnormal sperm, the embryo will be abnormal. However, years of experiences with millions of ICSI cycles has proven this is not a valid concern in practise.

It is important to emphasise that the risk of birth defects is not increased after ICSI. It is true that azoospermia men with Y chromosomal microdeletions who do ICSI will have sons who also have the same microdeletion. However, the children of men with normal chromosomes who are born after doing ICSI will also have normal chromosomes . The procedure of ICSI by itself will not cause genetic problems !

Even though the success rates with IVF are as good as with ICSI, we prefer doing ICSI in our clinic, even when the sperm are normal. This is for two reasons.

In ICSI , we need to denude the oocytes before doing the ICSI. This allows us to assess the oocyte quality much more closely - and we think this is important for older women and women with poor ovarian reserve, because this allows us to assess egg quality.

The other reason is that the major disadvantage of IVF over ICSI ( in men with normal sperm) is that in some patients for whom we do IVF, we will have total failure of fertilisation . This can be a big blow, because this is totally unexpected. Even though the sperm count and motility are completely normal, the sperm are not capable of fertilising the eggs, and we only find this out after doing IVF. If there are no embryos, then the chances of achieving a pregnancy are zero - and this means the patient has to start another fresh cycle, in which we have to do ICSI to ensure fertilisation. Doing ICSI for all patients routinely helps to prevent this heart-breaking problem.

Doctors love coining new terms , and this seems to be especially true for IVF specialists. Infertile couples have to learn a whole alphabetic potpourri of medical terms - ranging from IVF to GIFT to ICSI to ZIFT. It's easy to get lost and confused; and most patients can't seem to make sense of any of these !

To add insult to injury, many IVF doctors claim to use "the new and latest" technique to improve pregnancy rates. Obviously, every "new" technique needs a new name - so the confusion gets compounded. It's a competitive business, and IVF doctors always try to keep one step ahead of other doctors ! While this is good because it allows patients access to the newest technology, the downside is that many doctors will then promote a particular technique – not because it is better, but simply because it is new !

It’s easy to get a lot of press coverage for a lot of these “new” advances, because reporters are often not medically sophisticated, and most are quite happy to oblige their doctor friends. Poor patients get even more confused – and will often flock to the doctor featured in the latest article, in the hope that this new technique will give them a baby ! This then sets up a vicious cycle, where doctors compete with each other, in order to be featured in the press. It often becomes a game of one-upmanship, where the doctor with the best PR firm wins !

The newest kid on the block is a term called IMSI ! This stands for Intracytoplasmic Morphology Selected sperm Injection – quite a mouthful ! This is simply a modification of the standard ICSI technique, in which the sperm are magnified even further. The rationale is very logically appealing – let’s use higher powered magnification, so we can select the “best “ sperm for ICSI ! One would therefore expect that this technique would result in higher pregnancy rates after ICSI.

Unfortunately, this is not true in real life. Not only does IMSI not improve pregnancy rates as compared to ICSI, it can actually decrease them. The reason is simple - IMSI takes longer to perform than ICSI because it's much harder to identify sperm when using such high magnification. At such a high power, the field of view is obviously very limited, which means that the embryologist has to scan for much longer to pick up the selected sperm. This means that the embryologist has to keep the fragile eggs ( into which the sperm have to be injected ) on the micromanipulator for longer while doing IMSI, and since eggs are very sensitive, and do not like being kept outside the incubator, this extra exposure can cause them to get damaged.

However, it's very easy to take patients for a ride, and many clinics are now pushing patients who have failed ICSI cycles in other clinics to do IMSI, claiming that the success rates are higher with IMSI.

Caveat emptor - let the patient beware ! More is not always better - and often established techniques are much better than newer ones !