IVF, or In-vitro Fertilization, is a fertility treatment that involves a set of procedures that can help in conception and pregnancy. It is a treatment offered to couples who are unable to conceive even after trying for a year. IVF is also provided as an option for couples who want to prevent genetic problems from getting passed down to their children. There are many stages in the IVF procedure. Here, you can learn when IVF is offered as a treatment and the IVF process step by step.
In-vitro Fertilization, or IVF, is a type of ART (assisted reproductive technology) in which an egg and sperm are fertilised in a lab instead of the human body. It is a complex process that involves retrieving eggs from the ovaries and then manually combining them with sperm in a lab and leaving them for fertilisation. After that, the fertilised egg or embryo is placed in the uterus. When the embryo successfully implants in the uterine wall, pregnancy occurs.
There are many reasons why people choose IVF, including fertility problems or when a partner has some health issues. Some people try IVF when other fertility treatments have failed or if the maternal age is advanced. IVF is considered as:
● Endometriosis
● Damaged or blocked fallopian tubes
● Severe Sperm impairments or very low sperm count
● Polycystic Ovary Syndrome (PCOS)
● Uterine fibroids
● Issues with the uterus
● Genetic disorders
● Unexplained fertility issues
● When using a gestational surrogate or egg donor is required.
The IVF treatment stages can be broken down into the following steps:
Before the IVF treatment starts, your doctor may prescribe estrogen or birth control pills to control your menstrual cycle timing or stop ovarian cyst development. It helps the doctor optimise the mature egg quantity during the egg retrieval process and controls treatment. Some healthcare providers prescribe a combination of progesterone and estrogen pills, while others give only estrogen hormone.
For a healthy woman of reproductive age, many eggs start to grow during a menstrual cycle, but only one is mature enough for ovulation. The remaining eggs disintegrate. During the IVF treatment, you are injected with hormone medications so that all the eggs in that cycle mature simultaneously. That means you have multiple eggs instead of having only one egg. The medication type, frequency and dosage are based on your age, BMI, medical history, Anti-Mullerian Hormone (AMH) egg quality, level and previous IVF cycle history.
Typically, ovarian stimulation occurs for 10-12 days before the eggs are ready to be collected. During this time, blood tests are prescribed to check estrogen levels and a vaginal ultrasound is done to check the ovarian follicles. Once the follicles are of optimal size, the eggs are ready for pick up A trigger shot is injected for the maturation of eggs 36 hours before scheduled egg retrieval.
The egg retrieval procedure is typically performed in the IVF operation threater 36 hours after injecting the trigger shot to mature the eggs. It is critical to follow the proper timing as waiting for more than 36 hours may result in the loss of eggs (some or all) and also risks ovulation. The procedure involves:
● IV sedation, following which a transvaginal ultrasound is used to insert a thin needle to retrieve the eggs from every follicle.
● Multiple eggs are retrieved in about 20-30 minutes, placed in a special solution, and placed in an incubator. Sperm is added later in the day for fertilisation.
● Mild sedation is given to reduce any discomfort during the procedure.
● You may feel cramping after the retrieval and will be given pain relief medication.
There are two ways of fertilisation in an IVF procedure:
● ICSI, Intracytoplasmic sperm injection, is one method where good one sperm is injected into every egg.
● Conventional insemination is another method where eggs and healthy sperm are mixed in a petri dish in a lab and left to incubate for natural fertilisation.
Once the egg and the sperm are combined, they are left for 20 hours, after which it is checked whether fertilisation has happened. Typically, 70% of the mature eggs fertilise and, if successful, become an embryo.
The IVF fertilisation and embryo development are follow up done carefully for six days. The embryo undergoes many hurdles to become viable for transfer to the uterus. On average, half of the fertilised embryos move to the blastocyst stage day 5, which is ideal for uterine transfer. For instance, if seven eggs get fertilised, only three or four of them may develop to the blastocyst .All the embryos suitable for transfer will be frozen for future use.
There are two types of embryo transfers, and the healthcare provider will discuss and choose one based on your situation. Both transfers follow the same procedure, the difference being, as the name suggests, that in a fresh embryo transfer, the embryo is inserted into the uterus three to five days after egg retrieval. In a frozen embryo transfer, the embryos from the previous cycle are thawed and inserted into the uterus with atleast a month gap between the egg and pick up and transfer cycle Frozen embryo transfers can happen many years after the egg retrieval process.
The IVF embryo transfer process is a simple procedure where a flexible soft tube is inserted into the uterus using ultrasound guidance. The embryo is injected carefully into the uterus, which takes about 10 minutes to complete. After the procedure, you can resume normal activities. You may have mild cramping, mild bloating or breast tenderness.
Within two weeks after the entire procedure, you will be prescribed a blood test to check if you are pregnant. If you are, the test is again done in a 48 to check if the hCG (pregnancy hormone) is rising. Two weeks later, a vaginal ultrasound is performed to determine if it is a healthy pregnancy.
You can expect to be pain-free and completely asleep as you will be under anaesthesia.
The embryo transfer process is painless; you can expect mild cramping after completion.
Light bleeding or spotting, mild cramping, nausea, mood swings and breast tenderness are some common symptoms after embryo transfer.
● Fertility assessment and treatment planning take about two weeks
● Ovarian stimulation takes 10 to 12 days
● Egg retrieval takes about 30 minutes
● Fertilisation and embryo development takes about 3 to 6 days
● Embryo transfer about 5 to 6 days after egg retrieval .
● A wait of two weeks for the pregnancy test
