How does IVF work

IVF is a common treatment for people who are unable to conceive naturally

Usually in IVF, the woman has medicines (fertility hormones) to stimulate the ovaries to produce several eggs. The eggs are then collected and mixed with sperm in a laboratory.

IVF is carried out when the sperm quality is considered to be ‘normal’ If there are issues with the sperm quality such as low motility or numbers, a procedure called intracytoplasmic sperm injection (ICSI) may instead be used – this is where a single sperm is injected into the egg by an embryologist

If fertilisation is successful, the embryos are allowed to develop for between two and six days. This helps the embryologist to select the strongest embryo, which is then transferred back to the woman’s womb to hopefully continue to a successful birth.

Often several good quality embryos will be created. In these cases, it's normally best practice to freeze the remaining embryos because putting two embryos back in the womb increases your chance of having twins or triplets, which carries health risks. You can use your frozen embryos later on if your first cycle is unsuccessful or you want to try for another baby.

What does IVF involve?

This process outlines a single cycle of IVF following the most commonly used procedure. You may find that your treatment is slightly different depending on your history and what your clinic thinks is best for you.

• Usually, the first step is to use medication to stimulate the ovaries to produce eggs. There are different ways this can be done. One way is to suppress natural hormones before taking hormone medication to stimulate the ovaries. This treatment, often called a long protocol, involves taking a daily injection or nasal spray to suppress hormone production. A scan checks the woman’s natural cycle is fully suppressed. If it is, hormone treatment (usually gonadotrophin) is started to boost the number of eggs the body produces.
• Some clinics may use the ‘antagonist protocol’. This involves taking medication (an antagonist) to suppress your hormones for a few days after you have taken the hormone medication (usually gonadotrophin) to boost the number of eggs the body produces.
• Whichever way the ovaries are stimulated to produce eggs, you will be closely monitored for a few days by the clinic. This may involve having blood tests or ultrasound scans.
• The eggs will be collected whilst under sedation or general anaesthetic. The procedure takes around half an hour and you may feel a little sore or bruised.
• Whilst the eggs are being collected, the man will be asked to come to the clinic to produce a sperm sample, or your donor sperm will be taken from the freezer, for mixing with your eggs.
• Medication will help to prepare the lining of the womb. This is usually taken as a pessary or gel which you can insert yourself into the vagina / rectum.
• The eggs will be mixed with the sperm in a laboratory. The aim is for the eggs and sperm to fertilise to create an embryo.
• If fertilisation happens, the resulting embryo(s), will be monitored to check how it’s/they’re developing.
• Two to five days after fertilisation, the embryo(s) will be transferred to the womb. You won’t need any kind of anaesthetic for this unless you have a condition that would make the procedure painful. You’ll be given a date to do a pregnancy test. Although you’ll understandably be excited at this stage, try not to do this early as you may get a false result.

How prepare for IVF?

The Centers for Disease Control and Prevention and the Society for Assisted Reproductive Technology provide information online about U.S. clinics' individual pregnancy and live birth rates.

When choosing an in vitro fertilization (IVF) clinic, keep in mind that a clinic's success rate depends on many factors, such as patients' ages and medical issues, as well as the clinic's treatment population and treatment approaches. Ask for detailed information about the costs associated with each step of the procedure.

 

Before beginning a cycle of IVF using your own eggs and sperm, you and your partner will likely need various screenings, including:

• Ovarian reserve testing. To determine the quantity and quality of your eggs, your doctor might test the concentration of follicle-stimulating hormone (FSH), estradiol (estrogen), and anti-mullerian hormone in your blood during the first few days of your menstrual cycle. Test results often used together with an ultrasound of your ovaries, can help predict how your ovaries will respond to fertility medication.
• Semen analysis. If not done as part of your initial fertility evaluation, your doctor will conduct a semen analysis shortly before the start of an IVF treatment cycle.
• Infectious disease screening. You and your partner will both be screened for infectious diseases, including HIV.
• Practice (mock) embryo transfer. Your doctor might conduct a mock embryo transfer to determine the depth of your uterine cavity and the technique most likely to successfully place the embryos into your uterus.
• Uterine exam. Your doctor will examine the inside lining of the uterus before you start IVF. This might involve a sono hysterography — in which fluid is injected through the cervix into your uterus — and an ultrasound to create images of your uterine cavity. Or it might include a hysteroscopy — in which a thin, flexible, lighted telescope (hysteroscope) is inserted through your vagina and cervix into your uterus.

Before beginning a cycle of IVF, consider important questions, including:

• How many embryos will be transferred? The number of embryos transferred is typically based on age and the number of eggs retrieved. Since the rate of implantation is lower for older women, more embryos are usually transferred — except for women using donor eggs or genetically tested embryos. Most doctors follow specific guidelines to prevent higher-order multiple pregnancies — triplets or more — and in some countries, legislation limits the number of embryos that can be transferred. Make sure you and your doctor agree on the number of embryos that will be transferred before the transfer procedure.
• What will you do with any extra embryos? Extra embryos can be frozen and stored for future use for several years. Not all embryos will survive the freezing and thawing process, although most will. Cryopreservation can make future cycles of IVF less expensive and less invasive. Or, you might be able to donate unused frozen embryos to another couple or a research facility. You might also choose to discard unused embryos.
• How will you handle a multiple pregnancies? If more than one embryo is transferred to your uterus, IVF can result in multiple pregnancy — which poses health risks for you and your babies. In some cases, the fetal reduction can be used to help a woman deliver fewer babies with lower health risks. Pursuing fetal reduction, however, is a major decision with ethical, emotional, and psychological consequences.
• Have you considered the potential complications associated with using donor eggs, sperm or embryos, or a gestational carrier? A trained counselor with expertise in donor issues can help you understand the concerns, such as the legal rights of the donor. You may also need an attorney to file court papers to help you become legal parents of an implanted embryo.

 How prepare for IVF?

How is IVF done?

IVF (in Vitro Fertilization) is a common procedure, used to overcome a range of fertility issues. It is a multi-step process involving ovulation induction, egg retrieval, fertilization, culture, and embryo transfer. The IVF process can be explained in these four steps:

 

Ovulation induction

Fertility medications are prescribed to control the timing of the egg ripening and to increase the chance of collecting multiple eggs during one of the woman’s cycles. These drugs are used to stimulate the growth of several eggs in the ovaries. Normally, only one egg grows per month. However, during the IVF treatment process, several eggs are needed. Because, after the fertilization phase, some eggs will not fertilize or they will not grow naturally. Induction ovulation drugs start from 8 to 14 days before the menstruation and you should see your doctor every two or three days to check the ovulation condition.  Depending on the case, normally the ovulation Induction procedure takes 10 to 20 days.

Ovum Pick up:

After the induction ovulation and development of suitable oocytes for fertility, the eggs should be retrieved for in vitro fertilization. Egg retrieval or egg ‘pick up’ is a hospital day procedure where the eggs are collected from your ovaries. An anesthetist will get you ready for a general anesthetic. Your fertility specialist uses the latest ultrasound technology to guide a needle into each ovary and inserts a very thin needle through the upper vaginal wall and removes fluid, which contains eggs, from the follicles of the ovaries. The average number of eggs collected is 8-15. The procedure usually takes less than 30 minutes.

 

Fertilization and embryo culture:

After the ovum picks up, the embryologist examines the obtained egg to select mature eggs that are suitable for fertilization.

The mature eggs are placed in a culture medium and the sperm transferred to an incubator for fertilization. In IVF, high-motility sperms move to the eggs and fertilize them. Once this occurs, the fertilized eggs are considered embryos.

In condition with the low number and low quality of sperm, the specialist uses intracytoplasmic sperm injection (ICSI). It is as an additional part of an IVF treatment cycle which a single sperm is injected into each egg to assist fertilization. If each egg is fertilized, the resulting cell begins to divide and reaches about 10 cells in 3 days. Finally, the embryo is transferred to the uterus within 2 to 5 days after fertilization.

 

 

IVF-fertility-treatment

ICSI-fertility-treatment

 

 

Embryo Transfer

An embryo transfer is the last part of the in vitro fertilization (IVF) process. Around 2 or 3 days before the embryo transfer, the doctor will choose the best eggs to transfer to the uterus. Sometimes, there are “extra” embryos after an IVF cycle, and most people choose to freeze or cryopreserve their extra embryos. Embryo transfer is a simple procedure that does not require any anesthesia. Embryos are loaded in a soft catheter and are placed in the uterine cavity through the cervix. The procedure is usually painless, but some women experience mild cramping.