In vitro fertilisation, popularly called IVF, is effective and carried out as the last infertility treatment. This procedure has become one of the most common infertility treatments, but most people do not know the steps it involves, especially those that haven’t gone through it.
IVF is an assisted reproductive technology (ART) that involves several procedures to fertilise the woman’s egg outside the body, usually in a specialised lab. IVF is usually an option when other methods to aid conception fails.
Below is a step-by-step guide for IVF:
Preparation for the IVF (testing and ovarian stimulation)
Prior to the IVF procedure, the woman will undergo fallopian tubes and uterus evaluation to ensure no present issue needs surgery. The pre-cycle tests will involve evaluation to check the ovarian reserve and thyroid function. Both partners will also have sexually transmitted infection (STI) testing, and the doctor will analyse the male partner’s semen.
Most female partners will be on fertility drugs to stimulate the ovaries for about 8 – 14 days, with the average period being 10 to 11 days. The ovarian stimulation helps to make multiple eggs mature for retrieval.
Even with normal ovulation, fertility medications are still necessary to make more than one egg because the rate of getting pregnant is higher with several eggs. Usually, the medical expert will retrieve about 10 to 20 eggs for IVF, but some are not viable. On average, around two-thirds of the retrieved eggs reach full maturity.
The physician carrying out the procedure will design a suitable protocol to get the highest number of eggs possible without ovarian hyper-stimulation syndrome (OHSS) occurring. Drugs used for fertility during IVF are mostly administered via injection, and you will undergo frequent monitoring with vaginal ultrasound and hormonal testing.
The physician will administer HCG trigger shots or another suitable medication when the ultrasound identifies sufficient follicles and the right oestrogen level. This serves as a replacement for the natural luteinising hormone surge that a woman experienced at the last egg maturation stage to fertilise the eggs.
About 34 – 36 hours following injection of the trigger short, which is before ovulation, surgery will be necessary to remove the eggs present in the follicles of the ovaries. During the procedure to retrieve the egg, the medical expert will use an ultrasound which serves as a visual guide for a tiny needle inserted through the vagina into the ovaries.
The procedure is under sedation administered intravenously, monitored by the anesthesiologist, so you won’t feel discomfort or pain.
The small needle enters into the follicles, and then they will remove the content of the fluid present in the follicle with gentle suction to make the egg come out along with the fluid. This procedure usually takes less than thirty minutes.
After the procedure, you may experience minor cramping, but it will subside by the following day. You may also experience pressure or feel full due to the expansion of the ovaries resulting from their stimulation. This feeling may remain for some weeks.
The physician will suction the extracted follicular fluid containing the egg through a small tubing into test tubes. They will send the test tubes to the embryologist, who will check for the eggs in the test tubes containing follicular fluid using a microscope.
The number of eggs that will be produced from stimulating the ovaries and removed with the follicular fluid will depend on the ovarian reserve, patient’s age, response to the ovarian stimulation and in some cases, the needle’s ability to reach the ovaries.
When the eggs get to the lab, the specialists will examine them for their quality and maturity. They will transfer the mature eggs into a specialised culture medium and place the culture in an incubator. Within a couple of hours following egg retrieval, fertilisation of the eggs with the sperm will occur.
Two ways for egg fertilisation are available. They include:
- Intracytoplasmic injection (ICSI)
- Convention insemination
The IVF team comprising the embryologist and physicians will determine the type of fertilisation to use depending on several factors that affect the couple carrying out the procedure.
The two fertilisation methods have the same rate of success. However, ICSI is suitable in about 70% of cases when factors such as previous IVF failure and poor semen quality make fertilisation less likely to occur.
In the conventional fertilisation method, the medical expert will place the sperm in a culture medium present in a petri dish that contains an egg. They will incubate the egg and sperm in the petri dish to allow the sperm to fertilise the egg without external aid.
In ICSI, the specialist will inject the sperm into the egg’s cytoplasm with an advanced operative microscope and a needle. Regardless of the fertilisation procedure employed, the specialist will check if fertilisation occurred the following morning.
After fertilisation, the couple and the IVF team will determine when they will transfer the embryo. This is usually between 1 – 6 days and within 3 – 5 days following retrieving the egg.
However, if genetic testing is required, the specialist will take the first biopsy from the embryo, usually on the 5 – 6th day of culture. They will likely send 3 – 8 cells to another lab for testing and then freeze the embryos in the laboratory.
When the genetic testing results are available, the couple can choose an embryo, which the specialist will thaw and transfer into the woman’s uterus. This is usually 1 – 2 months following retrieval of the eggs.
Several factors, such as the couple’s age, will determine the number of embryos gotten. Previously, specialists transferred multiple embryos to help maximise the success rate, but this resulted in twins and triplets in a few cases. This resulted in pre-term birth issues and other life-threatening complications for the mother and babies.
The safest option of to limit embryo transfer to one as this increases the likelihood of success. The embryologist will select the healthiest-looking embryos by evaluating them with a grading technique.
The specialist will use a soft, thin and flexible catheter to transfer the selected embryo into the uterus, then carry out an ultrasound of the abdomen to ensure that the catheter’s tip places the selected embryo at a suitable location to allow implantation of the embryo.
Most people do not feel discomfort and pain, and they report that the procedure feels like getting the pap smear test. The IVF team will still freeze the good embryos if the current cycle is unsuccessful or the couple wants to have more children after a successful cycle.
Normally, the embryo will continue to develop in the woman’s uterus, hatch and implant in the lining of the uterus in 1 – 2 days after the transfer of the embryo.
In some cases, an extra process is necessary to help older women or couples who had unsuccessful IVF or have thawed or frozen embryos. This procedure is known as assisted hatching. It is a micromanipulation procedure involving making a hole in a flexible shell surrounding the early cells of the embryo.
This additional process has no definitive proof of improving the rate of live birth, and it may involve minor risks. No evidence is also available to show that assisted hatching improves the live birth or pregnancy rate for other IVF patients. If assisted hatching is necessary, it will be before transferring the embryo.
After the embryo transfer, you will need a pregnancy test. The pregnancy test should be about 12 days following the embryo transfer, then other blood testing and ultrasound to confirm the pregnancy’s viability and if multiple pregnancies are present. The specialist will refer you to your obstetrician if your pregnancy is normal at weeks 9 – 10.
If you’ve been trying to conceive and considering different options, then undergo well woman exam from a nearby clinic followed by advice. You can call our specialist at Gynae Clinic on 020 7183 1049 to discuss your fertility treatment options.
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