In Vitro Fertilisation: 9 steps that lead to pregnancy
Multiple biological factors associated with the potential of oocytes and/or spermatozoa may make natural fertilization very difficult. If you have already tried to conceive with other, milder assisted reproduction methods such as ovulation induction or insemination and did not succeed, you can resort to In Vitro Fertilisation to have a healthy child.
IVF is a process used to fertilise the egg with the sperm outside the uterus which then is transferred back into the uterus as an embryo with the intention of establishing a successful pregnancy. An IVF procedure takes 9 to 30 days depending on the stimulation protocol that we will choose and the steps are as follows:
1. Ovarian stimulation
Our goal in the first step is to stimulate the ovaries with safe and mild medication so that they will produce more than one egg since a woman produces one egg naturally every month. We aim to produce 12 to 15 eggs if possible. Of course, even with a less amount of eggs, we can have very good results. In order to achieve ovarian stimulation, a tailor made ovarian stimulation hormonal protocol of medication is administered for 9 to 12 days. The kind of treatment depends on the age and medical history of the woman.
2. Monitoring the effects of medication
The ovaries are continuously monitored by ultra sounds and blood tests so that the doctor can determine how their stimulation is developing and be able, on the one hand, to alter the medication if necessary and, on the other, arrange for the retrieval of the oocytes at the appropriate time.
3. Oocyte Development
Two days prior to the eggs retrieval, the patient is injected with a hormone known as chorionic gonadotropin which helps the developed eggs to mature and reach the final stage they need to be at in order to be fertilised.
4. Oocyte collection
At this stage of the procedure, when the eggs have reached the required maturity, the doctor collects the eggs from the follicles using a puncture needle. Oocyte collection is a short uncomplicated procedure involving light anesthesia to bring the patient to a state of sedation for a painless procedure.
5. Sperm collection
The husband provides the sperm on the same day of the egg collection via masturbation. Given the fact that there is some good quality sperm as indicated from the sperm analysis, the sperm can then be collected from the ejaculation. Even the least of sperm is enough to obtain positive results with intracytoplasmic sperm injection (ICSI). Even if there are no spermatozoa in the ejaculation quality of the sperm from ejaculation, there is still hope by performing a biopsy to collect sperm either directly from the testicles or from the epidymidis using anesthesia for a painless extraction.
6. Fertilisation/ ICSI
The spermatozoa, after having been processed and cleaned from the seminal fluid, are placed with the oocytes in a petri dish in order for fertilisation to take place. If the sperm is too weak, then some of the most perfect morphologically spermatozoa are injected cautiously by an embryologist in every egg with a micro-needle (this actually is ICSI).
7. Embryo transfer
The embryo transfer into the woman's uterus is performed with the use of a catheter 2 to 5 days following the egg collection and is usually painless. The final number of embryos transferred depends on their quality, the woman's age and the number of IVF attempts that have already been performed so far. To reduce the chance of a multiple pregnancy and raise the possibility of a successful IVF, it is more appropriate for the embryo transfer to take place 4 to 6 days post the egg harvesting, when the embryo is in the state of blastocyst, in other words, a more developed embryo state. Each blastocyst has a better chance to be implanted. However, a blastocyst transfer cannot be performed on all patients.
8. Egg/Embryo freezing
In Vitro Fertilisation may produce a greater number of embryos than the ones needed for the embryo transfer. This means that you can freeze any extra embryos which can be used in the future if you potentially want another baby, without the trouble of stimulating your ovaries and retracting the new eggs all over again. Preserving these frozen embryos saves you the trouble not only from repeating the procedure but from the extra costs as well.
9. Pregnancy test
Two weeks following the embryo transfer, you need to take a blood test (chorionic gonadotropin) in order to find out if your IVF was a success: In case the blood pregnancy test is positive, you will then be scheduled for your first ultra sound after a fortnight. This is when you get to see your baby for the first time.
If your test is negative, then you will need to discuss your options with your doctor and decide whether you should proceed with another IVF treatment and if yes, then discuss what should be done differently to achieve a positive result. Nowadays, there are so many options even for the most challenging cases and for this reason we shouldn't feel hopeless.
At EmBIO clinic we cover a wide range of services that include medical diagnosis and infertility treatment, IVF, egg donation program, sperm bank storing and preimplantation genetic diagnosis (PGD) for genetic disorders. This means that you not only ensure the maximum fertilisation possibilities but you also secure the health of your baby.
