- IVF Process
- Invitro fertilization
- Illustration of Egg Retrieval
- Egg Retrieval Technique
- Intracytoplasmic Sperm Injection (ICSI)
- Illustration of a Blastocyst
In vitro fertilization (IVF) involves several steps — ovulation induction, egg retrieval, sperm retrieval, fertilization and embryo transfer. One cycle of IVF can take about two weeks, and more than one cycle may be required.
If a woman is using her own eggs during IVF, at the start of a cycle she will begin treatment with synthetic hormones to stimulate the ovaries to produce multiple eggs rather than a single egg that normally develops each month. Multiple eggs are needed because some eggs won’t fertilize or develop normally after fertilization. The woman may need several different medications, such as:
Medications for Ovarian Stimulation
To stimulate the ovaries, a woman might receive an injectable medication containing a Follicle-Stimulating Hormone (FSH), a Luteinizing Hormone (LH) or a combination of both. These medications stimulate the production of more than a single egg to develop at a time.
Medications for Oocyte Maturation
When the follicles are ready for egg retrieval (generally after eight to 14 days) she will take Human Chorionic Gonadotropin (HCG) or other medications to help the eggs mature.
Medications to Prevent Premature Ovulation – These medications prevent the body from releasing the developing eggs too soon.
Medications to Prepare the lining of the Uterus
On the day of egg retrieval or at the time of embryo transfer, the doctor may recommend progesterone supplements be taken to make the lining of the uterus more receptive to implantation.
The doctor works with the woman to determine which medications to use and when to use them.
Typically, one to two weeks of ovarian stimulation are required before eggs are ready for retrieval. To determine when the eggs are ready for collection, the doctor is likely to perform:
This is an imaging examination of the ovaries to monitor the development of follicles (fluid-filled ovarian sacs) where eggs mature.
to measure her response to ovarian stimulation medications because estrogen levels typically increase as follicles develop while progesterone levels remain low until after ovulation.
Sometimes IVF cycles are canceled before egg retrieval for one of the following reasons:
- Inadequate number of follicles developing
- Premature ovulation
- Too many follicles developing, creating a risk of Ovarian
- Hyperstimulation Syndrome
- Other medical issues.
If a woman’s cycle is canceled, her doctor might recommend a change of medications or their doses to promote a better response during future IVF cycles. Or she may be advised to use a donated egg.
Egg retrieval can be done in the doctor’s office or a clinic 34 to 36 hours after the final injection and before ovulation. During egg retrieval, a woman is sedated and given pain medication.
Transvaginal Ultrasound Aspiration is the usual retrieval method. An ultrasound probe is inserted into the vagina to identify follicles. Then a thin needle is inserted into an ultrasound guide which goes through the vagina, into the follicles to retrieve the eggs.
If the ovaries are not accessible through Transvaginal Ultrasound, an abdominal surgery or Laparoscopy (a procedure in which a tiny incision is made near the navel and a slender viewing instrument laparoscope is inserted) may be performed.
The eggs are removed from the follicles through a needle connected to a suction device. Multiple eggs can be removed in about 20 minutes.
After egg retrieval, cramping and feelings of fullness or pressure may be experienced.
Mature eggs are placed in a nutritive liquid (culture medium) and incubated. Eggs that appear healthy and mature will be mixed with sperm to attempt to create embryos. However, not all eggs may be successfully fertilized.
If a woman using her partner’s sperm, he will provide a semen sample at the doctor’s office or a clinic through masturbation the morning of egg retrieval. Other methods, such as Testicular Aspiration (the use of a needle or surgical procedure to extract sperm directly from the testicle) are sometimes required. Donor sperms also can be used. Sperms are separated from the semen fluid in the lab.
Fertilization can be attempted using two common methods:
Insemination – During insemination, healthy sperms and mature eggs are mixed and incubated overnight.
Intracytoplasmic Sperm Injection (ICSI)
In ICSI, a single healthy sperm is injected directly into each mature egg. ICSI is often used when semen quality or number is a problem or if fertilization attempts during prior IVF cycles failed.
In certain situations, the doctor may recommend other procedures before embryo transfer.
About five to six days after fertilization, an embryo “hatches” from its surrounding membrane (zonapellucida), allowing it to implant into the lining of the uterus. If the procedure is for an older woman, or if the woman has had multiple failed IVF attempts, the doctor might recommend assisted hatching — a technique in which a hole is made in the zonapellucida just before transfer to help the embryo hatch and implant.
Preimplantation Genetic Testing
Embryos are allowed to develop in the incubator until they reach a stage where a small sample can be removed and tested for specific genetic diseases or the correct number of chromosomes, typically after five to six days of development. Embryos that don’t contain affected genes or chromosomes can be transferred to your uterus. While Preimplantation Genetic Testing can reduce the likelihood that a parent will pass on a genetic defect, it cannot totally eliminate the risk. Prenatal testing may still be recommended.
Embryo transfer is done at the doctor’s office or a clinic and usually takes place two to six days after egg retrieval.
A mild sedative may be administered. The procedure is usually painless, although mild cramping may be experienced.
The doctor or nurse inserts a long, thin, flexible tube called a catheter into the vagina, through the cervix and into the uterus.
A syringe containing one or more embryos suspended in a small amount of fluid is attached to the end of the catheter. Using the syringe, the doctor or nurse places the embryo or embryos into your uterus. If successful, an embryo will implant in the lining of the uterus about six to 10 days after egg retrieval.
AFTER THE PROCEDURE
After the embryo transfer, the woman is free to resume normal daily activities. However, the ovaries may still be enlarged. Consider avoiding vigorous activity, which could cause discomfort.
TYPICAL SIDE EFFECTS INCLUDE:
Passing a small amount of clear or bloody fluid shortly after the procedure – due to the swabbing of the cervix before the embryo transfer. Other side effects include – breast tenderness due to high estrogen levels as well as mild bloating, mild cramping and constipation.
In the event the woman develops moderate or severe pain after the embryo transfer, the doctor should be contacted. He or she will evaluate for complications such as infection, twisting of an ovary (Ovarian Torsion) and severe Ovarian Hyperstimulation Syndrome.
About 12 days to two weeks after egg retrieval, the doctor tests a sample of the woman’s blood sample to detect whether pregnancy has occured.
If she is pregnant, the doctor refers her to an obstetrician or other pregnancy specialist for prenatal care.
If she is not pregnant, the woman is taken off progesterone and will likely menstruate within a week. The doctor should be contacted if menstruation is delayed or in the event of unusual bleeding.
If the woman is interested in attempting another cycle of In vitro Fertilization (IVF), the doctor may suggest steps to improve chances of getting pregnant through IVF.
The chances of giving birth to a healthy baby through IVF depend on various factors including.
The younger a woman is, the more likely she is to get pregnant and give birth to a healthy baby using your own eggs during IVF. Women aged 41 and older are often counseled to consider using donor eggs during IVF to increase the chances of success.
Transfer of embryos that are more developed is associated with higher pregnancy rates compared with less developed embryos (day two or three). However, not all embryos survive the development process. Talk with your doctor or other care provider about your specific situation.
Women who have given birth previously are more likely to get pregnant using IVF than are women who have never given birth. Success rates are lower for women who have previously used IVF multiple times but did not get pregnant.