Iran is now a leading country in the Middle East in terms of offering effective fertility treatments and is among the top countries in the world. IVF and other fertility treatments are offered at more than 70 specialized fertility clinics in Iran, at a price much lower than many countries.
Fertility centers in the capital city Tehran, as well as Esfahan, Shiraz, Yazd, and other cities in Iran have a long history in infertility treatment and research. These centers are well-equipped and ready to offer their services to infertile patients.
In regard to IVF, fertility centers such as Royan Fertility Clinic and Avicenna Fertility Clinic are well-known in the region with enormous research equipment and labs, providing patients with a variety of treatments and options.
What is IVF?
IVF stands for In-Vitro Fertilization and is sometimes called test-tube conception. It is the most effective assisted reproductive technology (ART) and a complex procedure in which mature eggs (ova) are retrieved from a woman’s ovaries and fertilized by male sperms outside of the body in a test tube before being transferred to her uterus, with the purpose of establishing a successful pregnancy. This procedures sometimes involves using donor eggs, sperms, or embryo in couples who can’t produce healthy sperms and eggs on their own.
IVF process: step by step
The timeline of a typical IVF is something like what follows:
You take gonadotropin — a fertility medication that stimulates ovaries to produce multiple mature eggs — 8-14 days before the beginning of your menstrual cycle. You also have to take synthetic hormones such as leuprolide or cetrorelix that prevents too early egg release.
You need to visit your doctor every two or three days while taking these medications in order to have your blood hormone levels checked and get ultrasound measurements of your ovaries done. This is for the purpose of monitoring the development of the ovarian follicles, where eggs mature.
You will get a ‘trigger shot’ when your follicles are ready. The injection helps the eggs to mature fully and ready to be fertilized. Some 36 hours after the trigger shot, you visit the clinic to get your eggs retrieved.
After you receive an anesthetic, your doctor inserts an ultrasound probe to check your ovaries and identify the follicles. Then, a thin needle is also inserted to extract eggs, which are usually 8-15. Some women experience cramping or spotting for a few days after the egg retrieval process, but generally, you will feel better in a day or two.
Egg retrieval process in IVF
Now it’s time for your eggs to be combined with your partner’s sperm for fertilization. Before this, an embryologist, who is a specialist in sperm, eggs, and embryo, will examine your eggs.
If after a few cycles of IVF fertilization doesn’t happen or the sperm quality is low, the specialist may recommend an intracytoplasmic sperm injection (ICSI) procedure. In this technique, sperm is directly injected into the ovum using a microinjection device.
If the eggs aren’t normal and cannot be fertilized, you need to consider egg donation, which involves using donor eggs from a third party (an anonymous or known woman) to produce embryos that are to be implanted into your uterus for pregnancy.
After 3 days, some of the eggs that are successfully fertilized become 6- to 10-celled embryos and by the 5th day some of them become blastocysts containing fluid-filled cavity and tissues that will separate into baby and placenta.
Now the most viable embryo(s) are selected by the embryologist and ready to be implanted into the uterus. If there are any extra embryo, they can be frozen to be used in future IVF cycles.
Using a thin tube called catheter, the doctor inserts one to five embryos into the uterus through the cervix.
If you are lucky enough, the implanted embryo will grow into a baby. If you get more than one embryo, the chance of your pregnancy will be higher, and so is the chance of having multiple pregnancy. That is why some 20% of babies born through in-vitro fertilization are twins, triplets, or more.
Two weeks after embryo transfer, you can take a pregnancy test.
* In some women who are incapable of producing mature eggs on their own, immature eggs are retrieved and matured artificially outside the body through another process called in-vitro maturation (IVM).
Am I a good candidate for IVF?
In-vitro fertilization is usually recommended for these people:
- Women with ovulation problems and low-quality eggs
- Women with blocked fallopian tubes
- Women with endometriosis (a condition in which the tissue that makes up the uterine lining grows outside the uterus)
- Men with low sperm count and/or motility
- Couples suffering from infertility with unknown cause (unexplained infertility), especially if other treatments have been unsuccessful
IVF cost in Iran
IVF is an expensive fertility procedure in general. The price of a cycle of IVF depends on many factors, including the fee of the specialist and clinic, medications needed, and the number of embryos you want to get implanted.
Costs also vary depending on the pre-implantation diagnosis (PGD), and post-op care services. Additionally, some couples need egg donation, which increases the overall cost of treatment.
That said, the cost of an IVF procedure in Iran is much more affordable than many other countries. This is because fertility specialists and clinics in Iran charge much more reasonable fees compared with those in other countries — though the cost of medications is not much different.
Typically, the cost of a cycle of IVF in Iran ranges from $3,000 to $5,000, inclusive of medications and all other related costs. This is while a cycle of IVF in the US, for example, would cost around $15,000, which does not include medications. This decent price of IVF in Iran has encouraged many couples who were looking for IVF abroad to travel to Iran to undergo the treatment.
IVF sex selection
Sex selection, sometimes incorrectly referred to as gender selection, in IVF is a procedure aimed at assigning an embryo’s sex to help couples have a baby of the sex they like. Some fertility clinics offer sex selection option to IVF candidates but as there are some considerations in this treatment, they also give patients a thorough consultation before the procedure.
There are two sex selection techniques in IVF: using pre-implantation genetic diagnoses (PGD) and microsorting.
PGD sex selection
One of the main methods for sex selection in IVF is PGD. In an IVF cycle, several embryos are produced and then those with the highest quality are selected through pre-implantation genetic diagnoses (PGD) to be transferred to the woman’s uterus. PGD is typically aimed at preventing genetic disorders in babies who are going to be born through IVF but it can be also used to identify the baby’s sex thus creating the chance to implement the embryo with the sex the parents wish.
The success rate of PGD is almost 100%; that is to say, if the IVF is successful and a baby is born, he/she will be of the sex that was decided before.
Another sex selection method in IVF (as well as in IUI) is called microsorting or microsort. In this sperm sorting procedure, extracted sperms are sorted out one by one using a laser flow cytometer based on whether they contain X or Y chromosome. Microsorting is said to have a high success rate for girls (around 90%) and a lower rate for boys (75%).
Artificial sex selection is offered by Iranian hospitals and fertility centers through PGD and microboring, but it is mostly recommended to those who already have children and want to have another child for family balancing.
Sex selection cost in Iran
Sex selection cost varies from country to country and clinic to clinic. The average cost of a PGD in Iran is around $1,000 while Microsorting cost is approximately $700. This is an additional fee and is added to the cost of IVF.
In general, the following instructions are advised for the post-IVF period:
- Do not use the bathtub or swim for 48 hours after embryo transfer
- Avoid vaginal shower or tampon
- Avoid sexual intercourse from a few days before to 2 weeks after embryo transfer
- After embryo transfer, the woman can resume her daily activities. However, avoid intense physical activities such as running, aerobics or playing sports such as football and tennis
- Avoid lifting heavy objects
- Take 24 hours of absolute rest in bed (other than getting up for a bath or having meals).
- Two to three days after the operation, the patient would be able to travel. However, depending on the patient’s situation, some doctors prescribe absolute rest following embryo transfer.