When a patient first learns that they need help in creating the pregnancy they so much desire, they may find the process of IVF daunting and confusing. Fertility forums are a great source for finding support and answers to your questions and also the internet has its uses, however in some cases they can also cause further confusion and more unanswered questions!
However as you will see in the following information the process of IVF can be explained in six easy steps:
Hormonal treatment (ovarian stimulation)Unlike in a natural cycle hormone stimulation allows for several oocytes (eggs) to mature. The matured oocytes are retrieved from the ovary ready to be fertilised. Having several oocytes is vital since not every oocyte may fertilise, as well as not all the embryos have equal chances for implantation this is normal in all IVF cycles.
Hormone therapy for stimulation of your ovaries is based upon your own personal and medical history. Your individual plan will be designed to ensure that a sufficient quantity of the oocytes mature and the most successful outcome can be achieved and your risks are low. The medicines used for this preparation are available as daily injections, nasal spray or depot injections.
At AVA-Peter we offer both long (3 weeks) and short (11-14days) protocols and also other variations of these time frames. Through discussion with your AVA-Peter doctor and your past medical history your Doctor will decide which protocol will be most suitable in meeting your needs.
Stimulation is performed under regular ultrasound monitoring, which helps to control the quantity and size of follicles, and endometrial thickness. This is vital for selecting the optimal time for HCG administration (your final Injection) and the oocyte retrieval (egg collection). Furthermore, the monitoring helps to reduce the risk of hyperstimulation.
Egg CollectionYour stimulation is continued until the follicles reach their mature size. After this, HCG is used to stimulate ovulation. The effects of HCG are almost identical to those of LH in the natural cycle. About 36 hours after HCG injection the oocytes are retrieved from the follicles (follicular puncture) just before ovulation (Fig. 1). On the same day a partner delivers sperm for fertilization. There is also the option for your partner to freeze sperm in advance of your egg collection, this will be discussed in advance.
Egg Collection can be carried out under local or general anaesthesia, but in our clinic we prefer general anaesthesia. The procedure is performed in outpatient conditions. After the procedure you may experience minor pains and small amount of vaginal bleeding this is perfectly normal. After you are awake your personal doctor will discuss your collection results with you and answer any questions you may have, you are then free to return to your hotel and relax.
For fertilization the fresh husband's sperm or donor sperm is required on the day of the egg retrieval. If you are using the sperm of your partner or husband they will be required to provide their sample by means of masturbation. This can be carried out at the clinic or we can always provide you with a sterile test tube in advance if you prefer to bring sperm ready from your hotel on the day of the egg collection. Just let us know your preference in advance so that we note this in the treatment plan.
FertilisationThe sperm will be prepared in the laboratory ready for fertilisation of the collected eggs. Once prepared the sperm and eggs are placed in a dish for natural fertilisation to occur. In some cases ICSI may be required and will be carried out if necessary.
The morning after the oocytes have been collected our specialists in the IVF laboratory check to see if fertilization has occurred. There are two pronuclei in a fertilized ovum, one is from the sperm and one is from the oocyte. Within a few hours, the pronuclei join together and form the nucleus of the cell.
The fertilized oocytes continue to be cultivated in an incubator where the temperature and amount of carbon dioxide are carefully regulated. By the following morning the oocytes have divided and they are now referred to as embryos. The embryos are classified based on the amount of cells they have and the quality of their structure. The best embryos are chosen to be transfered in the uterus and the rest of the good embryos may be frozen at a very low temperature by vitrification for the next possible attempts or pregnancies (embryo cryopreservation).
Embryo TransferEmbryo transfer is a simple and painless procedure and can be carried out on day 2, 3, 4 or 5 (Blastocyst stage) after egg collection. Each patient and cycle is different therefore the day of transfer will be dictated by each individual case and in discussion with your personal doctor. The aim as always is to transfer embryo/s on the day that will give the patient the best possible chances of success.
The embryo is transferred using a very thin soft plastic catheter, which is introduced into the uterus via the vagina and cervical canal and there is no need for medication or sedation.
If fresh embryo transfer does not work we usually transfer two frozen embryos. Still the final decision on whether one or two embryos should be transferred is taken by the patients on the basis of our recommendation. Our recommendation is based on the patient’s medical situation and embryo quality.
After embryo transferAfter the embryo is transferred into the uterus, progesterone and estrogens are used to support the implantation, this is also called luteal phase support. Your pregnancy test is made two weeks after the transfer and as per the date in your treatment plan.