In Vitro Fertilization (IVF)
About IVF
IVF involves taking eggs and sperm from the intended parent(s) or donor eggs and/or sperm.
The egg and sperm are combined in a lab and incubated to produce an embryo.
Once the embryo has been created, it is transferred to the uterus of the intended mother, or a surrogate or gestational carrier. IVF offers the ability to become a parent when other infertility treatments have failed.
Generally, an IVF cycle begins 2-3 days after a woman’s period. You may start medications at that time or be scheduled for a baseline ultrasound and blood test for hormone levels. It takes about 6-7 weeks on average to complete an IVF cycle. There are many different protocols and options that may be available to you. Your doctor will review the best options for you.
Invitro Fertilization Process
Ovarian Stimulation
This step requires three protocols.
- First, oral contraceptives are used to suppress ovulation and prevent premature ovulation for 2-4 weeks.
- Second, fertility medications are used to stimulate the ovaries to produce multiple eggs for fertilization. During this period the patient will receive regular transvaginal ultrasounds and hormone blood tests to monitor egg development.
- Final maturation of the eggs is accomplished with an injection of Human Chorionic Gonadotropin (HCG). This is called the trigger shot because it causes the eggs to fully mature and be ready for fertilization. About 36 hours after the HCG shot, the eggs are ready for retrieval.
Egg Retrieval
- Egg retrieval is a minor surgical procedure done as an outpatient procedure in the doctor’s office, under sedation. Guided by transvaginal ultrasound the fertility expert will insert a very thin needle into the ovaries and sacs (Follicles) containing the eggs. Usually, about 8-15 eggs are retrieved. There may be some mild cramping and spotting after the procedure, which usually resolves with 24 hours. The embryologist will examine the eggs before combining them with the partner’s or donor’s sperm. The retrieved eggs are placed in a special medium and cultured in an incubator.
- On the day of egg retrieval, the male partner will provide a sperm sample, which will be washed and then placed with the eggs for fertilization. Most often fertilization occurs naturally. Under certain conditions, Intra-cytoplasmic sperm injection (ICSI) will be used. ICSI is injection of a single sperm directly into the egg. ICSI is commonly used when the male partner has low sperm concentrations, low sperm mobility and or abnormally shaped sperm. ICSI increases the chance of fertilization in these situations. ICSI is also frequently used with frozen eggs.
Insemination and Fertilization
The sperm is mixed with the eggs (insemination), and incubated overnight. A few hours after insemination, the sperm will fertilize the eggs, and create embryos.
- Embryo Cultures: The fertilized eggs continue their development, and will be monitored to be sure they are growing properly. About 3-4 days after fertilization, couples at high risk of passing a hereditary disorder to the child, or couples seeking gender balancing, can choose Preimplantation Genetic Diagnosis (PGD).
- Embryo Selection: The embryologist selects the most viable embryo(s) for implantation
Embryo Transfer
Embryo transfer is the last step of an IVF procedure. This is when the doctor places the embryo into the uterus for implantation.
The embryo transfer is painless. It feels similar to having an insemination or a pap smear performed. We often use ultrasound to assist and guide in correct placement and we need a full bladder to see well.
After embryo transfer, the intended mother will rest and may return to normal activity the next day. Generally, the intended mother must use daily shots or pills of the hormone progesterone to help thicken the uterine lining. This facilitates embryo implantation.
These next two weeks are described by women undergoing IVF, as the most difficult time. This is the wait time until a pregnancy test can be done.