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Infertility

IVF: the journey

In vitro fertilization: what to expect?

In vitro fertilization (IVF) is a part of assisted reproductive technology in which your or donor`s eggs are fertilized by sperm in a laboratory dish1,2. The fertilized eggs develop into embryos1,2. One or more of the embryos are transferred into the womb, which may result in pregnancy1,2.

IVF is widely used to treat infertility due to multiple reasons, including endometriosis, male factor and unexplained infertility1. Difficulty in becoming pregnant is a global problem; approximately 10% to 15% of couples experience it1. If this problem affects you, it may be helpful to know more about the steps involved in the IVF procedure.

Steps involved with IVF

The IVF procedure consists of 5 steps2,3. 

Step 1. Ovarian stimulation

The first step involves using fertility medications to increase the number of eggs (follicles) and control the time of ovulation. The stimulation regime is selected individually by your doctor2. 

Generally, you will give yourself an injection of follicle-stimulating hormone once per day2. The main goal of stimulation is to have at least two follicles approximately 15 to 18 mm in size2. 

There are some unpleasant effects during this stage caused by enlargement of the ovaries2. They include abdominal swelling and discomfort and, in more severe cases, nausea or even vomiting2. 

Step 2. Egg retrieval 

Approximately 32 to 36 hours before egg retrieval, you must inject human chorionic gonadotropin2. During this procedure, the physician inserts an ultrasound probe into the vagina and then uses a needle to withdraw the egg from each follicle2. It takes approximately 15 to 30 minutes, depending upon how many follicles are present, and it is performed under light anesthesia2.

Serious complications of egg (oocyte) retrieval are uncommon, but you may experience pelvic cramping, light bleeding, and vaginal discharge2.

Step 3. Fertilization

After the retrieval procedure, the eggs are combined with sperm in a laboratory dish and incubated overnight.2,4. In general, nearly 65 percent of eggs become fertilized2. 

In cases of severe male factor infertility, your doctor may recommend intracytoplasmic sperm injection (ICSI) 2.  During the ICSI process, one sperm is injected into an egg using a micro-needle and a microscope2. 

Step 4. Embryo culture

When the fertilized egg divides, it becomes an embryo3. Laboratory staff will regularly check the embryo to ensure it is growing properly3. Within about five days, a normal embryo has several cells that are actively dividing3.

Couples with a high risk of passing a genetic disorder to a child may consider pre-implantation genetic diagnosis (PGD) 3. The procedure is most often done 3 to 5 days after fertilization3. 

Step 5. Embryo transfer 

One or more embryos are placed in the womb using a thin, flexible catheter inserted through the cervix2. Anaesthesia is not usually needed for this procedure2. Following the transfer procedure, the woman is generally encouraged to rest home for several hours2. 

IVF procedure results

Between 12 and 14 days after embryo transfer, your doctor will test a sample of your blood to check whether you are pregnant4.

If you are pregnant, you will be referred to an obstetrician or other pregnancy specialist for prenatal care4.

If you are not pregnant and your period does not return or you experience unusual bleeding, contact your doctor4. If you are interested in attempting another cycle of IVF, your doctor might suggest steps you can take to improve your chances of getting pregnant through IVF4.

IVF – In vitro fertilization

References

  1. Choe J, Archer JS, Shanks AL. In Vitro Fertilization. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562266/
  2. Patient education: In vitro fertilization (IVF) (Beyond the Basics) https://www.uptodate.com/contents/in-vitro-fertilization-ivf-beyond-the-basics Last access 17.06.2022
  3. In vitro fertilization (IVF) https://medlineplus.gov/ency/article/007279.htm  Last access 17.06.2022
  4. In vitro fertilization (IVF) https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716 Last access 17.06.2022