In vitro fertilization or IVF is the most preferred and effective infertility treatment in the world, it can cure almost all the problems in both men and women related to fertility. It is a procedure involving fertilization of an egg outside the women’s body and is often used after the failure of other methods of pregnancy.
IVF is one of the major processes involved in A.R.T (Assisted Reproductive Technologies). It is a generic term encompassing all medical procedures that help a woman have a baby. It involves removing the egg from the woman’s body and treatment of the egg in the embryology laboratory.
In vitro fertilization is a long process and includes major steps. The steps involved in IVF are-
Before going for any treatment under IVF it is necessary to have pre-cycle testing. Pre-testing is the process including hormonal evaluation to access thyroid function and ovarian reserve, screening both partners for sexually transmitted infection and semen analysis of the male partner.
The basic and the foremost step involved in IVF is the ovarian stimulation. Most women are advised to take fertility drugs for 10-14 days before undergoing the process of ovarian stimulation. It is the process that assures the maturity of multiple eggs for egg retrieval. An average of 10-14 eggs are retrieved for IVF process, however not all the eggs are viable to use. The basic use of fertility drugs is to increase the pregnancy rate, even if the oavulation is normal these drugs are used for producing more eggs as more eggs are better for higher pregnancy rate. After the fertility drugs are injected you will be monitored continuously using hormonal testing and vaginal ultrasounds unless you have sufficient eggs and right estrogen level. The doctors and physicians frequently check for chance of ovarian stimulation syndrome(OHSS) and determines if everything for a better ovulation is fulfilled. After a certain time you will receive hCG (Human chorionic gonadotropin) and other medications ensuring the final stage of ovulation.
The process of egg retrieval is carried out with an ultrasound to visually guide a small needle through the vagina’s top into one ovary and then another. With the help of needles follicles are injected into the vagina and the follicular fluid contents are removed using gentle suction that brings the egg along in the fluid. After that the fluid from the follicles that contains eggs are suctioned by IVF physicians through small tubing into a test tube that is handed to an embryologist who finds the egg in each test tube using a microscope. According to the experts the number of eggs produced is influenced by patient’s age, response to ovarian stimulation and sometimes the ability to access the ovaries with needle. You may feel cramping and some dizziness during the day or week but it gradually decreases.
The process of fertilization can be done in two ways conventional insemination or infra-cytoplasmic injection (ICSI). It actually depends on your IVF team to determine which process will be suitable for you and it also varies on the couple going through IVF. Both the fertilization methods delivers same success rate but ICSI is mostly used in case of poor semen quality and previous IVF failures.
Once the egg has reached lab, they are examined by the experts for determining maturity and quality. The sperm is placed in the culture medium in a small petri dish which also contains the egg, then the egg and sperm are incubated together in a dish allowing the sperm to enter the egg on its own. For ICSI, one sperm is injected into the cytoplasm of the egg using a needle and a sophisticated operative microscope. Leaving for the rest of the night, the fertilization process is checked the other morning.
After the completion of fertilization process couple and the IVF decides at what day embryo transfer will take place. It usually takes 3-5 days after egg retrieval, sometimes they go for genetic testing. In this first of all a biopsy is taken from the embryo on regular days interval of 5 to 6 days when the eggs are sent to testing at the lab while embryos are frozen and remain in IVF laboratory. After the genetic test results the embryo which was selected is transferred into the uterus within 1 or 2 months after the egg retrieval.
The embryologists select the fittest embryo according to some grading system used to evaluate each embryo and single embryo transfer is advised at a time. A soft, flexible and thin catheter is used to transplant and place the embryo at the best location allowing its safety. Good embryos not used for transfer are usually frozen in case the cycle is not successful or a couple wants more children following a successful first cycle. You can feel a bit pain and uneasiness but it’s quite fine.
The embryo development continues in the uterus and the embryo implants in the uterine lining within 2 days after the embryo transfer.
An additional process known as assisted hatching is also used sometimes to provide help to couples who are too old or had unsuccessful IVF treatments or with frozen embryos. It is the process of fertilization where a hole is made in the flexible shell surrounding the cell of early embryo. People generally do not go for assisted hatching because it does not assure about increased pregnancy rates and development of embryo.
After each and every above mentioned step, pregnancy test is carried out for checking either the couple is pregnant or have chances multiple births. If everything goes fine, doctors prescribe ultrasounds and other medical treatments for better pregnancy and a normal child.