Ivf And Icsi
In Vitro Fertilisation
Understanding IVF – What It Actually Is
In Vitro Fertilisation – IVF – Is A Process By Which Eggs Are Retrieved From A Woman’s Ovaries, Fertilised With Sperm In A Laboratory, And The Resulting Embryos Are Cultured And Then Transferred To The Uterus. ‘In Vitro’ Means ‘In Glass’ In Latin – Fertilisation Occurs Not Inside The Body But In The Controlled Environment Of A Specialist Laboratory. IVF Was First Successfully Performed In The United Kingdom In 1978, And Since Then It Has Become One Of The Most Transformative Medical Developments Of The Twentieth Century, Enabling Millions Of Families To Have Children Who Would Otherwise Have Been Unable To Do So.
Dr. S. Krishnakumar Has Overseen More Than 75,000 IVF Births Over His Forty-Year Career. This Is Not A Clinic That Recently Added IVF To Its Service Menu – This Is A Clinic That Has Been Performing IVF Since Its Early Years In India, That Has Refined Its Protocols Through Tens Of Thousands Of Cycles, And Whose Laboratory Has Been Continuously Updated With The Latest Technology And Technique. When Dr. Krishnakumar Says That IVF Is Something He Has Been Doing For Decades And Doing Well, The Numbers Support That Claim Entirely.
Step-By-Step: What Happens In An IVF Cycle
Ovarian Stimulation
In a natural cycle, the ovaries produce a single egg each month. IVF requires multiple eggs to maximise the chance of obtaining at least one viable embryo. Ovarian stimulation — using injectable gonadotropin medications — encourages the ovaries to develop multiple follicles simultaneously. The stimulation protocol — the type of medication, the starting dose, the duration, and the monitoring schedule — is personalised for every patient based on her age, AMH level, antral follicle count, body weight, and any response history from previous cycles. Monitoring during stimulation involves regular transvaginal ultrasound scans and blood hormone measurements to track follicle growth and adjust the medication dose as needed. This monitoring phase typically lasts 10 to 14 days. Dr. Krishnakumar reviews every monitoring result personally and adjusts each patient’s protocol in real time to optimise the response while minimising the risk of ovarian hyperstimulation syndrome (OHSS).
Trigger Injection and Egg Retrieval
When follicles have reached the appropriate size (typically 18 to 20mm in diameter), a trigger injection — either hCG or a GnRH agonist — is given to complete the final maturation of the eggs. Egg retrieval is performed 34 to 36 hours after the trigger, under intravenous sedation (not general anaesthesia) in the operating suite. Using transvaginal ultrasound guidance, a fine needle is passed through the vaginal wall into each follicle, and the follicular fluid — containing the egg — is aspirated. The procedure takes 15 to 30 minutes. Patients rest for a few hours afterwards and can return home on the same day. Mild cramping is normal; the majority of patients describe the recovery as straightforward.
Fertilisation in the Laboratory
The retrieved eggs are immediately transferred to the embryology laboratory, where they are examined under a high-powered microscope. Mature eggs are separated from immature ones and prepared for fertilisation. In standard IVF, the eggs are incubated together with a prepared sperm sample, and fertilisation occurs naturally over the course of 16 to 18 hours. In ICSI, a single sperm is selected by the embryologist and injected directly into each mature egg using a micromanipulator. The fertilised eggs are then placed in a specialised culture medium and observed over the next five to six days.
Embryo Culture and Assessment
The fertilised eggs — now embryos — are cultured in the laboratory under carefully controlled conditions of temperature, atmosphere, humidity, and culture medium composition. The embryologist observes their development daily. By day 3, the embryo typically consists of six to eight cells. By day 5 or 6, the most advanced embryos have developed into blastocysts — a more complex structure with an inner cell mass that will become the fetus, and an outer cell layer (trophectoderm) that will become the placenta. Blastocyst transfer has become the standard in contemporary IVF practice because it allows the best embryos to be selected at the most informative developmental stage, improving implantation rates per transfer.
Embryo Transfer
Embryo transfer is a simple, painless procedure performed without sedation or anaesthesia. A thin, flexible catheter is passed through the cervix into the uterine cavity under ultrasound guidance, and one (or occasionally two) embryo(s) are gently deposited at the optimal position in the uterus. The procedure takes a few minutes. A small amount of spotting or cramping is normal. Patients are advised to resume normal light activity after transfer, as bed rest has not been shown to improve outcomes.
Waiting and the Pregnancy Test
The period between embryo transfer and the pregnancy test is fourteen days. This waiting period is widely recognised as one of the most emotionally challenging aspects of IVF. Dr. Krishnakumar’s team is available during this period for questions, reassurance, and support. On day 14 after transfer, a blood hCG test is performed. This is a quantitative test that measures the actual level of pregnancy hormone — more informative than a urine home test. A positive result with a rising hCG level in a repeat test two days later is confirmation of a continuing pregnancy.
ICSI – Intracytoplasmic Sperm Injection
ICSI was developed in the 1990s as a solution for severe male factor infertility. In conventional IVF, fertilisation requires sperm to swim to and penetrate the egg independently. In ICSI, this step is bypassed entirely: the embryologist selects a single sperm and injects it directly into the egg using a micromanipulator. It is used for low count, motility, morphology, or when sperm have been surgically retrieved.
Frozen Embryo Transfer (FET)
Vitrification has transformed cryopreservation: survival rates after thawing now exceed 95 percent. Frozen embryo transfer (FET) cycles are simpler and less physically demanding than full stimulation cycles, allowing a couple to use their remaining embryos in subsequent attempts without undergoing another full egg retrieval.
The Honest Truth About IVF Success Rates
Every fertility specialist who offers to discuss IVF success rates owes their patients an honest and nuanced explanation, not a headline figure. Published IVF success rates vary enormously depending on patient age, diagnosis, and the definition of ‘success’ being used (positive pregnancy test versus clinical pregnancy versus live birth rate).
Dr. Krishnakumar does not give a single success rate figure on a website. He gives each patient their own honest probability estimate at the first consultation — based on their individual circumstances. After 75,000 IVF births, the overall record speaks for itself. But for the individual couple, what matters is their plan.
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