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.

Egg Quality in Women

The peak fertility for women is reached around age 25 and remains about the same until approximately age 32, when it begins to decline. At age forty, the rate of decline accelerates and by age 42 a woman has lost almost 70% of her fertility potential. This trend continues until menopause, which occurs around age 51 on average in the U.S.

 

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At birth there are approximately 1-2 million eggs in the ovaries. This number falls to about 500,000 at the time of puberty and results in approximately 400 ovulations during the reproductive years. The development of eggs is controlled by the pituitary gland which releases a hormone called Follicle Stimulating Hormone (FSH) that stimulates follicular growth. Inside of each follicle is an egg, surrounded by granulosa cells and follicular fluid. The follicle produces estrogen, which signals the brain as a feed back. At the beginning of a woman’s reproductive life span, the ovary responses readily to stimulation from the brain to produce a mature egg. However, over time the number of eggs decreases in the ovary. These remaining eggs do not respond as easily to the FSH signal from the brain, which makes more FSH in an attempt to stimulate the ovary to produce an egg. We measure the FSH and estradiol (E2) on the third day of the menstrual cycle to determine ovarian reserve. Since E2 can falsely suppress FSH, the interpretation of FSH requires that the E2 concentration be less than 40 pg/ml on same day.

An elevated FSH level does not necessarily mean that the woman is about to enter menopause. Rather, it suggests that she has entered the transitional period, which is the period that precedes the onset of menopause. Most women with increased FSH levels continue to have regular periods and ovulate. Women with markedly elevated FSH levels (greater than 20) usually do not respond adequately to stimulation with fertility medications and are best treated using donor eggs. This is even more indicated when raised FSH levels are detected in a woman over 40, whose egg quality is likely to be reduced as well.

It is important to realize that while FSH levels are relatively reliable indicators of ovarian strength and sensitivity to fertility hormones, it is largely the woman’s age that determines her inherent egg quality. While a woman in her 30s with a raised FSH is likely to have ovarian resistance to fertility drugs, the outcome may be better than someone in her 40s with normal FSH.

Women in the late reproductive years not only have significantly lower pregnancy chances, but also a high miscarriage rate due to chromosomal abnormalities in their embryos. IVF through facilitating the delivery of multiple embryos to the uterus can enhance the birthrate in such women. IVF is accordingly the treatment of choice for infertile women in their early forties, who simply do not have the time to waste on relatively non-efficacious alternatives. If conventional IVF fails using one’s own eggs, ovum donation promises outstanding success rates regardless of the woman’s age or FSH level. The live birth rate of ovum donations (regardless of the woman’s age) ranges from 50-55% per fresh cycle, not including the additional frozen cycle pregnancies.

What to eat during IVF

 

During an IVF cycle, focus on eating healthy, balanced meals. Don’t make any major or significant changes during this time, like going gluten-free if you weren’t already.

 

Doctors recommend a Mediterranean-style diet. Its plant-based, colorful foundation should provide the positive nutrition your body needs.

 

In fact, research shows that a Mediterranean diet may improve the IVF success rate among women who are under 35 years old and who don’t have overweight or obesity.

 

While the study was small, eating a healthy diet during the weeks leading up to the cycle certainly doesn’t hurt.

Since diet also affects sperm health, encourage your partner to stick to the Mediterranean diet with you.

Here are easy ways to revamp your nutrition with the Mediterranean diet:

 

• Fill up on fresh fruits and vegetables.
• Choose lean proteins, like fish and poultry.
• Eat whole grains, like quinoa, farro, and whole grain pasta.
• Add in legumes, including beans, chickpeas, and lentils.
• Switch to low-fat dairy products.
• Eat healthy fats, such as avocado, extra-virgin olive oil, nuts, and seeds.
• Avoid red meat, sugar, refined grains, and other highly processed foods.
• Cut out salt. Flavor food with herbs and spices instead.

What to eat during IVF