In Vitro Fertilization (IVF) is a widely used assisted reproductive technology (ART) that helps couples struggling with infertility to conceive. The IVF process involves several steps, from stimulating the ovaries to fertilizing the eggs outside the body and transferring the resulting embryos back into the uterus. This guide explains each stage of the IVF program in detail, making it easier for you to understand what to expect during your fertility journey.
Stimulation of Ovaries
Normally, a woman produces one egg per month after reaching menarche, typically around the 14th day of her menstrual cycle. However, for IVF, a single egg may not be sufficient to achieve a successful pregnancy. The success of the IVF program depends on obtaining multiple high-quality eggs. To achieve this, we use a method called Controlled Ovarian Hyperstimulation (COH).
COH involves stimulating the ovaries to produce more eggs using hormone injections. This process is carefully monitored and tailored to each woman’s unique needs, considering factors like age, weight, basal hormone levels, and ovarian reserve. Two main protocols are used:
- Long Protocol: This involves “downregulating” the body’s natural hormone production before stimulating the ovaries. It helps in better synchronization and control over the stimulation process.
- Antagonist Protocol: This approach allows for shorter treatment cycles and involves the use of medications that prevent premature ovulation during ovarian stimulation.
Hormones such as Recombinant FSH, LH, HCG, Pure FSH, and HMG are administered to encourage the ovaries to produce multiple eggs. The dosage and duration of these injections depend on individual factors. For convenience, many of these medications come in self-injectable syringes, and we provide training to spouses on how to administer them.
Once the follicles (which contain the eggs) reach the desired size, we plan the egg retrieval (or “egg pick up”) procedure. We discuss the anesthesia options with the couple, ensuring it doesn’t affect egg quality. Typically, we use intravenous (IV) analgesia, which is effective and minimally invasive.
Egg Pick Up (Egg Retrieval)
Egg retrieval is usually scheduled during regular working hours and is performed under IV sedation, which ensures comfort without compromising the eggs’ quality. The procedure involves using an ultrasound machine to guide a specialized instrument called a Transvaginal Probe through the vaginal vault. This probe is equipped with a guide for the egg retrieval needle, which punctures the follicles to retrieve the eggs.
The needle system used in this procedure has two ports: one for aspirating the follicular fluid and another for flushing the follicle with a specific medium. This system is connected to a low-power suction motor, which gently aspirates the fluid without damaging the eggs. The aspirated fluid, containing the eggs, is collected in sterile test tubes and immediately sent to the IVF lab.
In the lab, an embryologist examines the aspirate under a stereo zoom microscope to identify and separate the eggs. The eggs are then placed in a nutritious culture medium inside an incubator, where they are kept until fertilization.
How IVF Works
In the IVF lab, the identified eggs are carefully handled in a controlled environment. The lab is equipped with an Integrated Laminar Flow Workstation, which maintains a sterile zone with the ideal gas mixture (N2, CO2, O2) and a warm (37°C) environment necessary for the eggs’ survival. The entire procedure, from egg retrieval to handling in the lab, takes about 30 minutes. Pain and bleeding during this process are minimal.
Sperm Collection and Preparation
The success of IVF also depends on the quality of the sperm. Sperm collection and preparation are carried out with great care to avoid contamination. Before the IVF program begins, a trial sperm preparation may be conducted to assess the sperm’s quality, integrity, and viability over time.
On the day of egg retrieval, the male partner is asked to provide a semen sample within two hours. If this is stressful or if the partner is unavailable on the day of retrieval (e.g., working abroad or undergoing medical treatment), a semen sample can be provided earlier and cryopreserved for later use.
For men who find it difficult to produce a sample through masturbation, alternative methods are available. Non-toxic condoms can be provided to collect the sample during intercourse, or a vibrator may be used to assist with ejaculation.
Practical Tips for IVF Success
- Follow Your Treatment Plan Closely: Adhere strictly to your doctor’s instructions regarding medications, appointments, and lifestyle modifications.
- Prepare for Emotional Challenges: IVF can be an emotional rollercoaster. Consider counseling or joining a support group to navigate the stress.
- Focus on Health: Maintain a balanced diet, exercise regularly, and avoid harmful substances to enhance your fertility.
- Stay Informed: Educate yourself about each step of the process so you know what to expect.
- Consider Support from Loved Ones: Lean on family and friends for emotional support throughout your IVF journey.
Conclusion
In Vitro Fertilization is a powerful option for couples struggling with infertility. By understanding each step of the process, from ovarian stimulation to embryo transfer, and following your doctor’s guidance, you can improve your chances of success. If you have any concerns or questions, don’t hesitate to discuss them with your fertility specialist.
FAQs About In Vitro Fertilization (IVF)
What is IVF, and how does it work?
IVF is a process where eggs are fertilized outside the body and then transferred to the uterus. It involves stimulating the ovaries, retrieving eggs, fertilizing them in the lab, and implanting the embryos into the uterus.
Who is a good candidate for IVF?
Couples with infertility issues such as blocked fallopian tubes, low sperm count, ovulation disorders, or unexplained infertility are often good candidates for IVF.
How long does the IVF process take?
The IVF process typically takes about 4-6 weeks from the start of ovarian stimulation to the embryo transfer.
Is IVF painful?
While some discomfort may occur during egg retrieval and hormone injections, most women find the procedures manageable, especially with sedation and pain management options.
What are the success rates of IVF?
Success rates vary based on age, fertility issues, and other factors, but generally range from 40-60% per cycle.
Can IVF be used for gender selection?
IVF can be used for gender selection through preimplantation genetic testing (PGT), although this is often limited to specific medical reasons.
What are the risks associated with IVF?
Risks include ovarian hyperstimulation syndrome (OHSS), multiple pregnancies, and, in rare cases, complications from egg retrieval.
How many embryos are usually transferred during IVF?
The number of embryos transferred depends on the patient’s age and medical history. Typically, 1-2 embryos are transferred to reduce the risk of multiple pregnancies.
Can lifestyle changes improve IVF success?
Yes, maintaining a healthy diet, managing stress, avoiding smoking and alcohol, and taking prescribed supplements can improve IVF outcomes.
What happens if IVF fails?
If IVF fails, your doctor may suggest additional testing, alternative treatments, or trying another cycle. It’s important to discuss all available options with your fertility specialist.