IVF is the most advanced procedure in the Assisted reproductive technology(ART), where an egg is combined with sperm outside the body, in vitro (in glass).
It involves monitoring and stimulating a woman’s ovulatory process, removing an ovum (egg ) from the woman’s ovaries and letting the sperm fertilise them in a liquid in a laboratory. The fertilised egg (zygote) undergoes embryo culture for 2–6 days, and is then transferred into the woman’s uterus.
IVF is never the first step in the treatment of infertility except in cases of complete tubal blockage. Instead, it’s reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination haven’t worked.
There are FOUR basic steps in IVF
Step 1: Stimulation – Controlled ovarian hyperstimulation (COH)
Fertility Medicines (fertility drugs), are given to woman to boost egg growth. During this step, patient will undergo transvaginal scan to examine the ovaries and blood tests to check hormone levels.
Step 2: Egg retrieval
A minor surgery, called follicular aspiration, is done to remove the eggs from the patient. The surgery is done as an outpatient procedure. This is performed under sedation or general anaesthesia. Before the egg retrieval, you should comply with the instructions below:
Strictly no food and drink from midnight before egg retrieval. Do not put on contact lens, make up, perfume and nail polish on the day of egg retrieval. Leave valuable things at home. Arrange somebody to take you home after the egg retrieval because you cannot drive within 24 hours after the procedure.
Using ultrasound images as a guide, a thin needle is inserted through the vagina and into the ovary and sacs (follicles) containing the eggs. The needle is connected to a suction device, which pulls the eggs and fluid out of each follicle, one at a time. The procedure is repeated for the other ovary. The procedure will take 15 minutes to half an hour to complete, depending on the number of follicles to be aspirated. There may be some cramping pain after the procedure, but it will go away within a day.
Step 3: Insemination and Fertilization
The man’s sperm is placed together with the best quality eggs. The mixing of the sperm and egg is called insemination. Eggs and sperm are then stored in an environmentally controlled chamber. The sperm most often enters (fertilizes) an egg a few hours after insemination.
If there is low chance of fertilization, the sperm may be directly injected into the egg. This is called intracytoplasmic sperm injection (ICSI).
When the fertilized egg divides, it becomes an embryo. Laboratory staff will regularly monitor the embryo to make sure it is growing properly.
Step 4: Embryo transfer
There are two types of transfers that can occur in an IVF procedure: a standard 2-3 day transfer or a blastocyst transfer day 5.
Embryo transfer (ET) requires no sedation or anaesthesia but requires ultrasound guidance. A speculum is inserted into the vagina to hold it open. Subsequently a thin tube (catheter) containing the embryos is inserted into the woman’s vagina, through the cervix and up into the womb. This is done under Ultrasound guidance which enables to visualise the insertion of ET catheter into the uterus to ensure that the embryos will be placed near the fundus and minimise the trauma to the uterine lining.
The whole procedure just takes 5 to 10 minutes to complete. If an embryo sticks to (implants) in the lining of the womb and grows, pregnancy results. More than one embryo may be placed into the womb at the same time, which can lead to twins, triplets, or more. The exact number of embryos transferred is a complex issue that depends on many factors, especially the woman’s age. The balance embryos may be frozen for future use.
Following the IVF procedure, you would typically stay in bed for several hours and be discharged four to six hours later. Your doctor will probably perform a pregnancy test on you about two weeks after the embryo transfer.