IVF treatment in Pakistan (test tube baby)

In vitro means outside the body. In IVF, eggs are fertilised with sperm in a laboratory. A few days later, an embryo (a fertilised egg that has started to divide) is placed in the womb (uterus). If it attaches to the lining of the womb and grows, a pregnancy begins.

Test tube baby is the everyday name for IVF in Pakistan; the baby does not grow in a test tube. Related treatments include ICSI (intracytoplasmic sperm injection), a type of IVF in which a single sperm is injected into the egg, and IUI (intrauterine insemination), when sperm are put into the womb through a thin tube. Your doctor will advise what suits you.

The NHS says a full cycle of IVF takes around 3 to 6 weeks. These are the usual steps, as the NHS and the HFEA describe them; your own treatment may be slightly different.

1. Tests

   Both partners are seen at the first consultation. At MCI, the first consultation, the ultrasound scan (a safe scan that uses sound waves) and the semen analysis (a check for sperm problems) are free. The NHS says you may also need blood tests for infections, such as HIV, hepatitis B and hepatitis C.

2. Medicines to produce eggs

   Hormone medicines, mostly injections, help the ovaries produce several eggs. In one approach, often called a long protocol, a daily injection or nasal spray first suppresses your natural hormones (for 2 to 3 weeks, the NHS says), followed by 2 weeks of daily injections. The HFEA says some clinics may use an antagonist protocol instead, which involves taking a medicine (an antagonist) to suppress your hormones for a few days after you have taken the hormone medicine that boosts the number of eggs. Scans or blood tests check your progress.

3. Egg collection

   A thin needle, guided by ultrasound, collects the eggs through the vagina. The NHS says this takes around 20 minutes and you'll be offered a sedative (medicine that makes you sleepy). You may feel a little sore or bruised afterwards.

4. Fertilisation

   The male partner gives a sperm sample. In the laboratory, the eggs are mixed with the sperm, or a single sperm is injected into an egg (ICSI). The HFEA says the embryos develop for between two and six days.

5. Embryo transfer

   An embryo is put in the womb using a thin tube inserted through the vagina. The HFEA says this happens two to five days after fertilisation, and you won't need any kind of anaesthetic (medicine to stop pain) for it unless you have a condition that would make the procedure painful. Medicine, usually a pessary or gel put into the vagina or rectum, helps prepare the womb lining. Suitable spare embryos may be frozen.

6. Pregnancy test

   The NHS says you'll be given a pregnancy test and a date to use it, around 16 days after the embryo transfer, and that it's important to take your test on the date you're given to get an accurate result. The HFEA also advises against testing early, as you may get a false result.

MedlinePlus says complete bed rest after the transfer is not necessary unless there is an increased risk of ovarian hyperstimulation syndrome (OHSS, see below). NICE (the National Institute for Health and Care Excellence) says bed rest of more than 20 minutes after embryo transfer does not improve the outcome of IVF.

The NHS says IVF is a safe procedure and most people do not have problems with their health or pregnancy. The risks include:

• Side effects of the medicines. The HFEA says many people feel fine, but asks you to tell your clinic about any unexpected reactions, including stomach pains or a bloated stomach, hot flushes, breathing difficulty, mood swings, heavy periods, breast tenderness, insomnia (poor sleep), increased urination, spots, headaches, weight gain, dizziness and vaginal dryness. Some of these, such as breathing difficulty or stomach pains, can also be warning signs that need urgent or emergency help: see the warning signs below.
• OHSS. The NHS says there's a small chance of too many eggs developing in your ovaries, which can become large and painful. The HFEA says severe OHSS can, in very rare cases, be life-threatening, and strong symptoms generally appear the week after egg collection (see the warning signs below).
• Twins or more. The HFEA says a multiple birth is the main risk of fertility treatment and can seriously harm the health of both mother and babies.
• Ectopic pregnancy, when a fertilised egg implants outside the womb, usually in a fallopian tube. The HFEA says women having IVF may be more at risk (see the warning signs below).
• Rarer risks. The HFEA lists infection, bleeding and bowel perforation (damage to the bowel) as rare. It says pregnancy after fertility treatment has a slightly increased risk of pre-eclampsia (a condition causing high blood pressure in pregnancy), gestational diabetes (diabetes during pregnancy) and high blood pressure compared with natural conception, and it lists possible birth defects; these are rare and research is still ongoing. NICE says the absolute risks of long-term problems are low, though a small increased risk of borderline ovarian tumours (a type of growth in the ovary) cannot be excluded.

Your first consultation is free, at the hospital in Mirpur or by video, in Urdu or English. Both partners are seen at the first consultation, and treatment depends on a doctor's assessment. MCI uses only the couple's own eggs and sperm: we do not offer donor treatment or surrogacy.

The hospital has an embryology laboratory on site, and our founder, Dr Ejaz Anjum, leads the fertility team. To book, WhatsApp us on +92 348 335 6595 (9am to 8pm) or contact us.