Overview - IVF (In Vitro Fertilization)

Overview

In vitro fertilization (IVF) is a complicated chain of procedures to help with the fertility problems and conception of a baby. Also, it helps to prevent genetic problems that may occur in the future. During IVF, a gynecologist doctor will retrieve mature eggs from your ovaries and fertilize them with sperm in a lab. Then, the process continues as your doctor transfers the fertilized egg (embryo) or eggs (embryos) to your uterus. Usually, one full cycle of IVF takes about three weeks. However, your doctor may split the stages into different parts and the treatment may take longer. IVF currently is the most effective assisted reproductive technology in the world. Doctors perform IVF by using a couple’s eggs and sperm. Also, they may use eggs, sperm, or embryos from a known or anonymous donor. IVF’s success depends on many factors, such as age and the reason for infertility. Of course, your doctor will help you understand IVF, the potential risks, and whether IVF is right for you.

Why IVF is Done?

IVF can treat infertility and genetic problems. However, before having an IVF for infertility, you should consider less-invasive options. For example, fertility drugs that increase the production of eggs or intrauterine insemination. Doctors may offer IVF as a primary treatment for infertility in women over age 40. Also, certain health conditions make IVF a necessity to have a baby.

Fallopian tube damage or blockage

This condition makes fertilization difficult or prevents the embryo from traveling to your uterus.

Ovulation disorders

If you ovulate rarely or not at all, there are fewer eggs for fertilization.

Endometriosis

It occurs if tissue similar to the lining of the uterus implants and grows outside. This condition often affects the function of the ovaries, uterus, and fallopian tubes.

Uterine fibroids

It is common in women in their 30s and 40s. Fibroids are benign tumors in the uterus but they can disrupt the implantation of the fertilized egg.

Previous tubal sterilization or removal

Doctors can cut or block your fallopian tubes to permanently prevent pregnancy. If you want to have a baby after this procedure, IVF may be a good alternative to reversal surgery.

Low sperm production or function

Certain conditions may make it difficult for sperm to fertilize an egg. If the sperms have poor concentration, mobility, or abnormalities in size and shape, fertilization may be difficult.

Unexplained infertility

Sometimes, doctors may not find the reason for infertility although they perform evaluations for common causes.

A genetic disorder

If one of the partners is at risk of passing on a genetic disorder to the child, they may be candidates for IVF.

Fertility solution for cancer or other health problems

Cancer treatment such as radiation therapy or chemotherapy-can harm fertility. In this case, IVF becomes a viable option.

How You Prepare for IVF

Before starting a cycle of IVF with your eggs and sperm, you and your partner need various tests.

Ovarian reserve testing

Your doctor determines the quality and quantity of your eggs by testing the concentration of the hormones in your blood during the menstrual cycle. Test results and an ultrasound of your ovaries can help the doctor to predict how your ovaries will react to fertility medication.

Semen analysis

Doctors conduct a semen analysis as a part of a fertility evaluation. In some cases, they perform this test just before starting an IVF treatment cycle.

Infectious disease screening

Your doctor screen you and your partner both for infectious diseases such as HIV.

Practice (mock) embryo transfer

This test aims to determine the depth of your uterine cavity and the technique to place the embryos successfully.

Uterine exam

There are some important questions to consider before starting an IVF cycle:

How many embryos?

Your doctor decides the number of embryos to transfer based on your age and the number of eggs. More likely, you will need more embryos if you are older. The rate of successful implantation lowers in later stages. However, most doctors follow specific guidelines to prevent multiple pregnancies. You should talk to your doctor about the number of embryos before the transfer procedure.

What will you do with extra embryos?

Your doctor can freeze and store the extra embryos for several years. Also, most embryos survive the freezing and thawing process. If you have frozen embryos, a future attempt at IVF may be less expensive or invasive. Or, you can donate them to a couple or a research facility. You can also choose to discard them.

Multiple pregnancies?

If more than one embryo enters a uterus, IVF may result in multiple pregnancies. This condition may be risky for you and your babies. Sometimes, doctors perform fetal reduction to help deliver fewer babies with lower health risks. However, fetal reduction is a very invasive procedure. It is a major decision with ethical and emotional consequences.

What Can You Expect?

IVF procedure has several steps and one cycle may take 2 to 3 weeks. Also, you may need more than one cycle.

Ovulation induction

Your doctor starts the cycle by stimulating your ovaries with synthetic hormones to produce multiple eggs. Normally, you have a single egg that develops each month. You need multiple eggs because some of them will not develop after fertilization. Your doctor may use several different medications: Medications for ovarian stimulation. Stimulation of your ovaries by injecting medication that contains hormones. As a result, medication stimulates more than one egg at a time. Medication for oocyte maturation. When your eggs are ready (after 8 to 14 days), this medication helps the eggs mature. Medication to prevent premature ovulation. It prevents your body from releasing eggs too soon. Medications to prepare the lining of your uterus. Your doctor may recommend they make the lining of your uterus more receptive to IVF. Your gynecologist decides the type and timeline of medications. Normally, you need one or two weeks of stimulation before your eggs are ready. Also, your doctor may order blood tests or perform a vaginal ultrasound to find if the eggs are ready to collect.

Egg Retrieval

Your doctor retrieves your eggs 34 to 36 hours after the final injection and before ovulation. Firstly, you take sedation and pain medication for the procedure. Then, your doctor uses transvaginal ultrasound to retrieve the eggs. For this, your gynecologist inserts an ultrasound probe into the vagina and takes the eggs with a thin needle. They can remove multiple eggs in 20 minutes. You may experience cramps or pressure after the procedure. After retrieving the eggs, your doctor places them in a nutritive liquid. Finally, the mixing process with sperm begins to create embryos.

Sperm Retrieval

You will need a semen sample on the morning of the egg retrieval. Masturbation is the common way to collect semen. However, there are other methods such as testicular aspiration. Or, you can use donor sperm as well. Then, your doctor separates sperm from its fluid in the lab.

Fertilization

There are two methods of fertilization.

Conventional insemination

During this procedure, your doctor mixes and incubates healthy sperm and mature eggs overnight.

ICSI

In ICSI, your doctor injects a single healthy sperm into each egg. ICSI is useful when semen quality and quantity are not enough or if fertilization is failed in prior IVF cycles.

Embryo Transfer

Your doctor performs embryo transfers 2 to 5 days after egg retrieval. You take a mild sedative. Also, this procedure is mostly painless but you might experience mild cramping. Then, your doctor reaches the uterus through the cervix with the help of a catheter. Lastly, places the embryos into your uterus with a syringe attached to the catheter. An embryo implants in the lining of your uterus 6 to 10 days after egg retrieval.

After the IVF

You can resume your regular life but you should avoid vigorous activities because your ovaries will be enlarged. Possible side effects:

• A small passing of clear or bloody fluid shortly after the procedure
• Breast tenderness
• Mild bloating
• Mild cramping
• Constipation

If you begin to feel moderate or severe pain, contact your doctor.

Results

After 12 days to two weeks, your doctor orders a pregnancy test. If the result is;

• positive, your doctor refers you to a pregnancy specialist.
• negative, you stop taking progesterone and get your period within a week. If you don’t get your period or see unusual bleeding, contact your gynecologist. If you want to try another cycle of IVF, your doctor can help you to take the steps to improve your chances of having a baby through IVF.

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