In vitro fertilization (IVF) is an assisted reproductive technology in which eggs are retrieved from a woman and inseminated with sperm from a man in a laboratory to create embryos. After closely monitoring embryo development, one or multiple embryos are transferred to the uterus of a woman. If any resulting embryos remain, they are frozen through a process known as vitrification.
Since the first successful in vitro fertilization procedure in 1978, over five million babies have been born worldwide through IVF treatments. In vitro fertilization is the most common fertility treatment utilized by patients today.
The In Vitro Fertilization Process
There are several steps in an IVF cycle, which typically requires two to three months to complete. The below process briefly summarizes what to expect. It is written with the assumption that a patient has already undergone testing and medical evaluation.
Step 1: Preparation for Ovarian Stimulation
In order to control the timing of the cycle, decrease the chances of cyst production, and synchronize follicle production (fluid-filled sacs that contain immature eggs), a patient may be placed on a birth control pill for one month.
Step 2: Ovarian Stimulation and Monitoring
In a natural monthly cycle, the body usually releases one egg from the ovaries into the fallopian tubes. In an in vitro fertilization cycle, we aim to increase the number of eggs produced in order to create multiple embryos for treatment. Ovarian stimulation increases follicle production, which in turn increases the number of mature eggs within the ovaries for an egg retrieval. To stimulate the ovaries, medication administered through a tiny needle injection is taken daily for 8-14 days.
While on stimulation medication, regular monitoring via ultrasound and blood test is required. Ultrasound monitoring measures egg follicle growth as well as the increasing thickness of the uterine lining. Blood work monitors estrogen levels, which rise as follicles develop. Once follicle development and estrogen levels reach optimal numbers, the final medication step is a trigger shot. The shot allows the eggs to develop to the final stage of maturation and begins the process of ovulation.
Step 3: Egg Retrieval Procedure
The egg retrieval will take place approximately 36 hours after the trigger shot. During the 15-minute procedure, a patient is placed under sedation for comfort. Using ultrasound guidance, a needle is guided into each follicle and aspirated or “sucked through” for collection.
The amount of eggs obtained during a retrieval will vary based on a patient’s response to stimulation, ovarian reserve, age, and multiple other factors. Some patients experience spotting, bloating, and mild discomfort after a retrieval. Most patients are fully recovered within one or two days.
Fresh or frozen sperm can be used to inseminate the eggs. If a fresh sample is being used, on the same day of the egg retrieval, a sperm sample must also be collected. It is best to abstain from ejaculation for two or more days prior to sample collection.
Step 5: Egg Fertilization Through Sperm Injection
Eggs and sperm are then taken to an embryology lab where they are placed in optimal conditions to foster growth. The eggs can be inseminated via two methods — conventional insemination where hundreds of thousands of sperm are placed in the same dish as the egg, allowing fertilization to occur or via Intracytoplasmic Sperm Injection or ICSI (pronounced: ick-c), where embryologists inject each egg with an individual sperm. The eggs and sperm are then placed in an incubator to allow fertilization and further development of the embryos.
Step 6: Monitoring of Embryo Development
Embryologists will closely monitor growth and development of the embryos, starting the observation of fertilization. For various reasons such as the failure of an egg to fertilize, genetic abnormality, or inadequate embryo development, not all fertilized eggs will develop into healthy embryos.
If you elect to do preimplantation genetic screening (PGS) or preimplantation genetic diagnosis (PGD) your embryos will be biopsied and frozen while testing is complete. A transfer will be performed on a subsequent cycle.
Step 7: Embryo Transfer Procedure
Dependent upon embryo development, embryos are typically transferred anywhere from three to six days after fertilization. An embryologist will evaluate each embryo and select the most viable embryos for transfer. To improve the chances of a healthy singleton baby, it is usually recommended to transfer one embryo, depending on age of the patient and quality of embryos to select from.
Using a soft, ultra-thin catheter, under ultrasound guidance, an embryo is transferred into the uterus. The procedure takes two minutes and can be compared to a pap smear in terms of discomfort. No anesthesia is required.
Step 8: Freezing of Remaining Embryos
Embryos are cryopreserved, or vitrified, using a fast-freezing process called vitrification. This is a critical procedure in the IVF cycle that we entrust to the most skilled and experienced embryologists in the region.
Should the fresh cycle not result in a pregnancy, the remaining frozen embryos can allow for additional pregnancy opportunities. Expert cryopreservation techniques allow for a higher embryo survival rate during the thawing process prior to an embryo transfer. Scientific techniques have advanced greatly over the years, allowing the success rates of a frozen embryo transfer to be comparable to that of a fresh embryo transfer.
Step 9: Pregnancy Test
Known as the “two week wait,” patients undergo a blood pregnancy test approximately two weeks after an embryo transfer.
In Vitro Fertilization Cycle Alternatives
Fertility treatment is a personal decision, and each couple may have their own approach. For any couples not comfortable with standard IVF protocol, we offer alternatives.
To learn more about fertility treatment options specific to your diagnoses, schedule a consultation today.