How is IVF Done—Step by Step
In vitro fertilization (IVF) is the most successful, commonly performed infertility treatment in the world. Still, unless you have gone all through it, most people don’t know what’s with the steps involved with this assisted reproductive technology (ART). You can consider this your introduction to IVF.
First, IVF is a series of procedures that involve fertilization of an egg out of a woman’s body in a specialized lab.
Before IVF, you’ll have an assessment of your uterus and fallopian tubes to be sure there are no problems. The pre-cycle examination includes a hormonal evaluation to evaluate thyroid function and ovarian reserve, testing both partners for HIV and semen analysis of the male counterpart.
Most women take fertility drugs for ovarian stimulation for 8-14 days; the norm is 10-11 days. Ovarian stimulation is done to mature multiple eggs for egg retrieval. Even if ovulation is normal, fertility drugs are used to create more than a single egg because pregnancy rates are higher with more eggs. An average of 10 – 20 eggs are usually extracted for IVF. However, not all of them are viable to utilize as on average only about two-thirds have a suitable maturity.
Fertility drugs for IVF are usually injected, and you’ll be regularly monitored using hormonal testing and vaginal ultrasounds for the result. Once an ultrasound determines you have a big enough follicle and your estrogen level is right, you’ll be given a trigger shot of hCG or other medication.
Egg Retrieval
Thirty-four to thirty-six hours after getting the trigger shot – before the eggs ovulate –a small surgical procedure is performed to remove the eggs from follicles in the ovaries. For this egg retrieval procedure, an ultrasound is used to visually guide a small needle through the top of the vagina into one ovary and then the other. One is under sedation during this process being monitored by an anesthesiologist
Follicles are entered in with the needle and the follicular fluid is removed using gentle suction that brings the egg along with the fluid; the entire process takes less than 30 minutes. The fluid from the follicles that contain the egg is placed into a test tube. The test tube is then handed to an embryologist who with the help of a microscope finds the egg in each test tube of follicular fluid. All the minute details of the eggs are carefully recorded. The number of eggs produced and removed is dependent on the patient’s age, ovarian reserve, reaction to ovarian stimulation and, rarely, the ability to access the ovaries with the needle.
Once eggs arrive at the lab, experts analyze them to determine maturity and quality. Mature eggs are moved into a special culture medium, kept in an incubator and within a few hours of egg retrieval are fertilized with sperm.
In the conventional method, sperm is put in the culture medium in a small petri dish containing an egg; the sperm and eggs are incubated together in the dish in the lab, letting the sperm to enter the egg on its own. For ICSI, one sperm is injected into the cytoplasm of the egg with the help of a needle and microscope. The fertilization is checked the next morning for both the processes.
After fertilization, the IVF specialist and the couple determine when embryo transfer will take place usually 3-5 days after egg retrieval.
To maximize the chance for success, the healthiest embryo is selected by the embryologist based on a grading system used to evaluate each embryo.
A soft, flexible, and thin catheter is used to transfer the embryo into the uterus. An ultrasound is used to make sure that the tip of the catheter places the embryo at the safest location for the embryo to implant. Pain and discomfort are rare. Good embryos not used for transfer are usually frozen in case the cycle is not successful or a couple wants more children after a successful first cycle.
The development of the embryo continues in the uterus and the embryo implants in the uterine lining within 1-2 days following embryo transfer.
About 14 days after the embryo transfer, a blood pregnancy Beta HCG test is done. If a pregnancy is confirmed, a follow-up blood test and ultrasounds are done to confirm viability and whether there are multiple pregnancies or not. If the pregnancy looks normal at 9-10 weeks, you’ll be referred back to your obstetrician!
