IVF- comprehensive guide
– Published on 22 Feb 2024
Going through IVF can feel like a journey into the unknown. From the first consultations to determine if you’re a candidate, through months of emotional and physical preparation, to the life-changing days of the actual procedure – it’s a lot to take in all at once.
In this post, I aim to break down the IVF process step-by-step in a clear, easy-to-understand way. My goal is to help give you a sense of what to expect at each phase, ease some of the anxiety that can come from not knowing what’s next, and empower you with information to feel more in control of your treatment.
We’ll discuss each step from start to finish – from screening tests and medication to egg retrieval, fertilization, embryo culture, and transfer – in a scientifically accurate yet patient-centric manner. My hope is that this breakdown provides clarity and reassurance as you embark on your IVF journey. Let’s get started.
Understanding the basics of IVF
In Vitro Fertilisation (IVF) is a form of assisted reproductive technology (ART) that aids individuals or couples in conceiving when other fertility treatments have been unsuccessful. The process involves the fertilisation of an egg outside the body, in a laboratory dish, and then transferring the fertilised egg (now an embryo) into the woman’s womb.
IVF is typically recommended when other less invasive or less expensive fertility techniques have not worked. This may be due to a range of factors such as severe endometriosis, low sperm counts, issues with the uterus or fallopian tubes, ovulation disorders, or unexplained infertility.
IVF can also be used if you or your partner are carriers of a genetic disorder and you wish to avoid passing this onto your child. Speak with your doctor or a fertility specialist to assess if IVF is the most suitable treatment option for your specific circumstances.
How Does IVF Work?
The IVF process involves several stages. The first stage is ovarian stimulation, where fertility drugs are administered to stimulate the ovaries to produce multiple eggs. Regular blood tests and ultrasound scans are conducted to monitor the development of these eggs.
The second stage is egg retrieval, performed under light sedation. A needle is guided through the vagina, into the ovary, and into an egg-containing follicle. The egg is then suctioned out of the follicle.
The third stage is fertilization in the laboratory. The collected eggs are combined with sperm in a petri dish for natural fertilization to occur. In certain cases, a single sperm may be directly injected into an egg, a process known as Intracytoplasmic Sperm Injection (ICSI).
The fourth stage is embryo culture, where the fertilized eggs (now embryos) are grown in the lab for up to six days. The development of these embryos is closely monitored.
The final stage is embryo transfer. A healthy embryo is selected and transferred into the woman’s womb. If the embryo implants in the uterus lining, the procedure is considered successful, resulting in a pregnancy. If multiple embryos are available, the surplus may be frozen for future use.
Remember, the IVF process can be emotionally and physically draining. It’s essential to seek emotional support and understand the process thoroughly before starting the journey.
Who is a good candidate for IVF?
IVF is typically recommended for individuals and couples who have struggled with infertility. This includes women with ovulation disorders, blocked or damaged fallopian tubes, or endometriosis. It’s also an option for men with low sperm count or motility issues. IVF may also be a suitable choice for couples who have unexplained infertility.
Furthermore, IVF can be beneficial for individuals who carry certain genetic disorders they do not wish to pass on to their children, as the procedure allows for genetic testing of embryos prior to implantation. However, every situation is unique, and the suitability of IVF can best be determined through consultation with a fertility specialist.
Preparing for the IVF procedure
Medical and Fertility Tests
Before commencing the IVF procedure, both partners will typically undergo a series of medical and fertility tests. For women, this may involve blood tests to check hormone levels and a pelvic ultrasound to examine the uterus and ovaries. For men, a semen analysis is usually conducted to assess sperm count and quality. These tests help the fertility specialist design an individualised treatment plan.
Medications and Injections
Once tests are complete, the woman may start fertility medications to stimulate the ovaries to produce multiple eggs. This phase often involves daily injections of fertility drugs for about two weeks. The development of the eggs is monitored through ultrasound scans and blood tests.
Lifestyle Changes to Improve Success Rates
Adopting healthy lifestyle habits can significantly enhance IVF success rates. This includes maintaining a balanced diet, regular exercise, abstaining from smoking and limiting alcohol intake. Reducing stress through techniques such as yoga, meditation, or counselling can also be beneficial. It’s essential to remember that both partners play a role in this, and changes should be adopted by both.
Financial and Emotional Preparation
IVF can be a physically, emotionally, and financially demanding process. Before starting the procedure, it’s important to assess your emotional readiness for potential challenges and support each other through the journey. Finances should also be considered carefully, as IVF can be expensive, and insurance coverage may vary.
Step-by-step guide to the IVF procedure
In the this section, we will delve into the methodical details of the IVF procedure. It’s a comprehensive process that unfolds in distinct stages, each requiring specific medical protocols. Understanding the step-by-step procedure can help alleviate anxieties and manage expectations associated with the treatment. Let’s understand each stage of an IVF cycle in detail.
A. Ovulation Induction with Medication
The IVF cycle begins with ovulation induction, where the woman takes fertility drugs to stimulate the ovaries into producing multiple viable eggs. This is crucial because, unlike natural conception where only one egg is typically released, IVF aims to retrieve multiple eggs to increase the chances of a successful pregnancy.
i. Monitoring Hormone Levels and Follicle Growth
Monitoring the response of ovaries to these medications is pivotal. Blood tests are used to check hormone levels, which tell us if the eggs are maturing. In addition, ultrasound scans are done to monitor the growth of the follicles (the sacs where eggs grow). These tests are crucial to determine the optimal time for egg retrieval.
ii. Triggering Ovulation with hCG injection
Once the follicles have reached an appropriate size, indicating that the eggs are mature, ovulation is triggered. This is done using an injection of human chorionic gonadotropin (hCG). The hCG injection initiates the final maturation of the eggs and sets ovulation in motion, which typically occurs about 36 hours later.
iii. Egg Retrieval Process
The egg retrieval process, medically known as ‘follicular aspiration’, is performed 34-36 hours after the hCG injection, just before ovulation starts. This is a minor surgical procedure, done under sedation. Using ultrasound guidance, a thin needle is passed through the vagina into the ovaries.
The needle is used to aspirate the follicles, and the fluid is examined to find and collect the eggs. After egg retrieval, they are immediately passed to an embryology laboratory for the next stage of the IVF process – fertilisation.
B. Fertilisation in the Lab
i. Sperm Preparation and Selection
Once the eggs are retrieved, the next step involves preparing the sperm. This typically involves washing a semen sample to separate the sperm cells from the seminal fluid. The healthiest and most active sperm are then selected for fertilisation.
ii. ICSI vs Traditional Insemination
There are two main methods of fertilising the eggs in the lab: Intracytoplasmic Sperm Injection (ICSI) and traditional insemination. In ICSI, a single healthy sperm is injected directly into each egg, which can increase the chances of successful fertilisation, particularly when there are concerns about the sperm’s quality or quantity. Traditional insemination involves combining the eggs and sperm in a laboratory dish and allowing fertilisation to occur naturally.
iii. Transferring Embryos to Incubator for Development
Following fertilisation, the embryos are transferred to an incubator where they continue to grow and develop. This environment is carefully controlled to mimic the conditions inside the womb. The embryos are usually kept in the incubator for about five days before the most viable one(s) are selected for transfer back into the woman’s uterus.
Next in IVF process- embryo development and implantation
After the fertilisation process, the most viable embryos are selected for further development in the incubator. During this time, embryologists monitor the embryos and keep track of their growth and development. In natural conception, only one embryo usually implants in the uterus, but in IVF multiple embryos may be transferred to improve the chances of pregnancy.
A. Embryo Grading System
The embryo grading system is a key step in the IVF process, providing embryologists with a tool to identify the most viable embryos for transfer. This system evaluates several aspects of the embryos’ development, including their size, shape, and cell division rate.
The embryos are graded on a scale, with higher grades indicating a greater likelihood of successful implantation and pregnancy.
However, it’s important to note that even lower grade embryos can still lead to a successful pregnancy. The grading occurs before the transfer to the uterus, assisting in the selection of the most promising embryos.
B. Embryo Transfer Process
The embryo transfer process is a critical stage in the IVF procedure, where the selected embryos are placed back into the woman’s uterus.
i. Choosing the Number of Embryos to Transfer
This decision is made based on the woman’s age, the quality of the embryos, and her medical history. While transferring multiple embryos may increase the chance of pregnancy, it also raises the risk of multiple pregnancies, which carry higher health risks for the mother and babies.
ii. Guiding Catheter Insertion into Uterus
The embryo transfer procedure is usually painless and does not require anaesthesia. A speculum is inserted into the vagina to expose the cervix. A catheter, preloaded with the chosen embryos, is then guided through the cervix into the uterus. The embryos are gently deposited and the catheter is withdrawn.
iii. Post-Procedure Care Instructions
After the procedure, patients are usually advised to rest for a short while. Normal activities can typically be resumed the following day. Patients are given specific instructions about medications to support the potential pregnancy and when to take a pregnancy test. Attention should also be given to any symptoms such as severe abdominal pain or heavy bleeding and a doctor should be contacted immediately if these occur.
Chances of Success and Potential Risks
The success of an IVF treatment depends on a variety of factors and, as with any medical procedure, there are potential risks involved.
Factors Affecting Success Rates
Several factors can affect the success rates of IVF procedures. These include the age of the woman, the cause of infertility, the quality of the embryos, the health of the uterus, and lifestyle factors such as smoking and weight.
Generally, younger women have higher success rates due to better quality eggs. Chronic health conditions, such as diabetes or hypertension, can also affect the success of the procedure. It’s important to remember that each case is individual and success rates can vary greatly among patients.
Potential Side Effects or Complications
While IVF is generally safe, it does carry some potential side effects and complications. Common side effects include bloating, cramping, breast tenderness, and emotional fluctuations.
More severe complications may include Ovarian Hyperstimulation Syndrome (OHSS), which is characterized by swollen, painful ovaries. There is also a small risk of ectopic pregnancy, where the fertilised egg implants outside the uterus.
Furthermore, as mentioned earlier, transferring multiple embryos increases the risk of a multiple pregnancy, which can lead to complications for both mother and babies. Patients should always consult their IVF specialist to understand the potential risks associated with IVF.
Aftercare and Follow-Up Appointments
It’s essential to take it easy after an embryo transfer. While complete bed rest is not necessary, it’s recommended to avoid strenuous activities and stress. Gentle walks, reading, and other relaxing activities are encouraged.
Pregnancy Test Timing
Typically, a pregnancy test is done about two weeks after the egg transfer. It’s important to wait this period to allow any hCG, the hormone that pregnancy tests measure, to build up in the body. Testing too early could lead to false results.
Next Steps in Case of Successful Pregnancy or Unsuccessful Procedure
If the procedure is successful and a pregnancy is confirmed, patients will usually continue to see their fertility specialist until eight to ten weeks into the pregnancy. They will then be transferred to an obstetrician for the remainder of the pregnancy.
In case the procedure is unsuccessful, it’s important not to lose hope. Many patients need to try more than once before achieving a successful pregnancy. Your fertility expert will review the procedure and make any necessary adjustments for future attempts. Emotional support and counselling are also available to help manage any feelings of disappointment or stress.
In conclusion,
IVF can be an emotional and physically demanding process, but understanding each step can help alleviate any fears or uncertainties you may have about it.
Remember, every journey is unique, so don’t compare your experience to others. Be patient, stay positive, and trust in your IVF expert’s expertise throughout the entire procedure. Please do not hesitate to contact us in case of any help required.
By Dr Samidha Dalvi-Amale
IVF and Fertility specialist Medical Director- Pune IVF