In Vitro Fertilisation (IVF)
What is In Vitro Fertilisation?
In Vitro Fertilisation (IVF) is an assisted reproduction treatment where the eggs are fertilized with sperm in the laboratory.
The In Vitro Fertilisation (IVF) consists of three main phases:
- Ovarian stimulation
- Retrieval of the eggs for fertilisation and embryo culture
- Embryo transfer into the uterus
In Vitro Fertilization step by step
Which tests are necessary for an In Vitro Fertilisation (IVF)?
To carry out an In Vitro Fertilization (IVF) a previous study with the following diagnostic tests is necessary:
- Hormonal analysis to analyse the ovarian reserve. The Anti-Müllerian-Hormone (AMH) can be determined at any time of the cycle or the FSH and Estradiol on day three of the cycle
- Spermiogram to evaluate the quality of the sample. If the sperm quality is very low it will be necessary to amplify the andrological studies by additional tests
- Gynecological ultrasound to exclude a pathology in the uterus or ovaries.
- Karyotypes to exclude genetic abnormalities which might affect the embryo
- Serologies to exclude the presence of transmittable infectious diseases.
How are the ovaries stimulated?
To carry out an In Vitro Fertilisation (IVF) with good success rates a sufficient number of eggs need to be retrieved. This will be achieved through a controlled stimulation of the woman’s ovaries by administering subcutaneously hormone injections.
The stimulation protocol will be individually adjusted according to the ovarian reserve of the woman. During the stimulation, the response of the ovaries needs to be monitored through a series of ultrasounds until a correct number of follicles with an adequate size are grown. In this moment, the ovulation will be triggered and 36 hours later the eggs are harvested.
How often do I have to come to the clinic during the ovarian stimulation?
Usually not more than three ultrasound controls are necessary before programming the egg retrieval.
How are the eggs obtained?
The eggs will be retrieved through ovarian puncture guided via ultrasound. It is a simple intervention of only ten minutes and will be carried out under sedation. It is not painful because the woman will be sleeping during the entire procedure. Since it is an ambulatory process, the patient will be able to go home shortly after the egg retrieval.
Type of sperm
For the In Vitro Fertilisation (IVF) a sperm sample from the partner can be used as well as a sperm donor.
In case using donor sperm, it will be chosen according to the established law, preserving maximum phenotypical similarity with the patients.
How is the sperm obtained?
Usually the sperm is obtained through masturbation on the day of egg retrieval. If necessary a frozen sperm sample can be used.
Another way of obtaining sperm is the testicular aspiration (TESA) and the testicular biopsy (TESE). Both techniques shall be used in case no spermatozoon is found in the ejaculate.
In case donor sperm is used the sample will always be a frozen sample.
How does the egg fertilisation take place?
The fertilisation happens in the laboratory after the egg retrieval. The laboratory techniques for egg fertilisation are either a conventional IVF or a microinjection of the sperm (ICSI).
Currently ICSI is the most common technique to fertilise the eggs, especially if there is a history of previous fertilisation failures or bad sperm quality. For the rest of the cases counts, if a solid number of mature quality eggs is available, it is possible to use the conventional IVF technique.
What happens in the laboratory between egg fertilisation and embryo transfer?
Once the eggs are fertilised we have to wait and observe their evolution in the laboratory. After 18-21 hours their correct fertilisation will be controlled and the embryos stay inside an incubator, which provides ideal conditions for their development.
Every day the evolution of each embryo will be analysed until day five when the transfer inside the uterus will occur. This long culture until day five allows us to select those embryos (blastocysts) with the best implantation capacity increasing thereby chances for a pregnancy.
How are the embryos transferred?
The embryo transfer is a simple procedure which neither requires a hospital stay nor anesthesia. The catheter is introduced into the uterine cavity via the cervix in order to place the embryos right inside the uterus. Usually one to two embryos are transferred but currently the trend goes towards transferring only a single embryo to reduce risks of a multiple pregnancy.
What happens to the unused embryos?
If after the embryo transfer more embryos of good quality are left over, they will be frozen.
How long takes the entire process?
The duration of the In Vitro Fertilization (IVF) depends on the elected type of stimulation protocol. For a short stimulation protocol, the duration should be of 15-17 days approx. If a long protocol is to be used we have to consider 10-15 days of previous preparation additionally.
What should be done after the embryo transfer?
After the transfer, the progesterone treatment started after the egg retrieval needs to be continued. If all goes well, the embryo will have implanted a few of hours after the transfer even though we won’t know for sure until the day of the pregnancy test.
Can I live a normal life during the In Vitro fertilization?
During the treatment it is recommended to lead a calm life, avoiding bigger efforts and sports. On the day of egg retrieval, bed rest at home will be necessary. Furthermore, sexual intercourse should be avoided during the entire process.
Can I do something to improve my chances after the embryo transfer?
It is very common to ask oneself what to do after the transfer to increase chances for a pregnancy. There is nothing additional one can do to increase the probabilities for a pregnancy apart from waiting for the embryos to implant correctly and pursue a normal and relaxed lifestyle.
When can I restart another IVF attempt?
Ideally, the woman waits for her ovaries to return to their normal state before restarting another round of stimulation for In Vitro Fertilisation. It is recommended to wait a couple of cycles before commencing a new treatment.
Is there a limit to IVF treatment attempts?
There is no limit to the number of In Vitro Fertilisations (IVF) cycles but usually it is not more than three. It is convenient to re-evaluate the case after each cycle, which did not lead to pregnancy in order to determine if more tests are necessary.
Is it possible to do IVF without stimulation?
An In Vitro Fertilisation within a natural cycle is done in women with previous treatments and a low response to stimulation where the retrieval of only one naturally selected egg is pursued. This option has low success rates and is reserved for couples who do not accept egg donation treatment.
What shall I do to receive transfer of my frozen embryos?
The transfer of frozen embryos only requires a well-developed endometrium. Therefore an oral or transdermal hormone treatment is applied which starts on the first day of the cycle. Some days after, the correct development of the endometrium is confirmed and the transfer organized.
The embryos will be thawed the day of their transfer. If the frozen embryos are of good quality and even more if they are blastocysts, their survival rate is higher than 90%.
Even though good pregnancy rates are achieved with frozen embryos, they still do not accomplish the same numbers as fresh embryos, which are 40% higher.
How long can the embryos stay frozen?
The embryos can stay frozen until their final destination, established by law, is decided. The freezing duration does not affect the results.
In Vitro Fertilisation (IVF) is one of the best available fertility treatments. The success rates depend mainly on the woman’s age, being high until the age of 39 and decreasing gradually from this age on.See results
Risks of IVF
The most important risk of In Vitro Fertilisation (IVF) originates from the ovarian stimulation and the egg retrieval.
Because of the ovarian stimulation, a hyper stimulation syndrome can occur due to an excessive response of the ovaries to the medication. Currently this risk is minimum since individualized protocols are used.
The egg retrieval can lead to small bleedings, which generally disappear on their own. In exceptional cases, an intervention might be necessary.
A multiple pregnancy is another consequence of In Vitro Fertilisation (IVF). The single embryo transfer policy is helping a lot to reduce considerably the number of multiple pregnancy.