In Vitro Fertilisation (IVF) literally means that fertilisation of the egg by the sperm takes place in an incubator outside the body.
The female IVF treatment cycle generally follows these stages:
- IVF Treatment Information and discussion
- Pre treatment tests and preparation
- Preparation of ovaries and uterus by intranasal spray
- Follicle growth treatment (stimulation by injection)
- Ovulation timing (based on blood tests and ultrasound scans)
- Egg collection using ultrasound scan
- Insemination treatment of eggs with sperm
- Assessment of fertilisation
- Embryo transfer to the uterus
- Pregnancy test (blood test)
- Ultrasound if pregnant
In vitro fertilisation (IVF), which literally means "fertilisation in glass", is a treatment for infertility that has failed to respond to other medical and surgical interventions. The world's first IVF baby, Louise Brown, was born in 1978 in England. Since then, approximately 1,000,000 babies have been born as a result of IVF.
An IVF cycle has 6 phases. Below is information about each step in the IVF process
IVF Process Step 1: Pituitary Suppression
In a natural menstrual cycle, hormones from the pituitary gland, LH and FSH, cause the growth of an egg within a fluid-filled space, or follicle, within the ovary. Although several follicles start to grow each month, in a natural cycle only one will become mature enough to ovulate following a surge of the hormone LH at mid cycle. Release of the egg (ovulation) is triggered by a sudden surge of hormone LH at mid-cycle.
In contrast, during an IVF cycle it is desirable for several eggs to mature simultaneously. At the same time we do not want an LH surge to trigger early release of these eggs. We therefore use a medication known as a GnRH agonist to temporarily turn off your own LH and FSH secretion. This medication is usually started around day 21 of the menstrual cycle and continues through the stimulation phase. It is given daily, usually by nasal spray or occasionally by injection. Other GnRH agonist regimens or protocols may also be used in specific cases.
IVF Process Step 2:Ovarian Stimulation
Your partner's role: Your partner will be asked to produce his semen sample on the day of your procedure. You may accompany him if you wish. It is understandable for some men to have concerns about this part of the process. If you would prefer to collect the sample at home on the day of egg retrieval, please inform the staff. If you have any concerns about collecting the sample, please discuss this with the staff prior to the cycle as we may be able to arrange to freeze one of your partner's semen samples as a backup.
IVF Process Step 3: Egg Retrieval
Once ultrasounds indicate a reasonable size and number of follicles, the stimulation phase ends. The FSH injections and the GnRH agonist are stopped. That evening, an injection of hCG is given. This hormone causes the final maturation of the egg and loosening of the egg from the wall of the follicle. The egg retrieval occurs on the second morning after this final injection (34-36 hours later).
The egg retrieval is performed by an ultrasound guided needle puncture through the top of the vagina. The needle is passed into each follicle in the ovary and fluid is withdrawn into a test tube. The fluid from each follicle is examined under a microscope. Not every follicle contains an egg, but at least half of the large follicles will usually yield eggs.
The procedure itself will only take 10 to 15 minutes, but you will be asked to rest in the recovery room for about one hour afterwards. It is common to experience some cramping and discomfort after egg retrieval as well as some vaginal spotting or bleeding. A heating pad, hot water bottle or analgesic may be helpful. If the pain becomes severe or the bleeding is heavy, please contact the clinic.
Your partner’s role: Your partner will be asked to produce his semen sample on the day of your procedure. You may accompany him if you wish. It is understandable for some men to have concerns about this part of the process. If you would prefer to collect the sample at home on the day of egg retrieval, please inform the staff. If you have any concerns about collecting the sample, please discuss this with the staff prior to the cycle as we may be able to arrange to freeze one of your partners semen samples as a backup.
IVF Process Step 4: Fertilisation (Insemination)
The sperm sample is washed and concentrated, then added to the eggs (in a 4-well Petri dish) a few hours after retrieval. The dishes are placed in an incubator eggs are examined the next day for signs of fertilization. Not all of the eggs will fertilize. We expect about 60 to 70% of the eggs to fertilize if the sperm sample looks normal. The fertilised eggs are kept in the incubator for an additional 48 hours. Not every follicle will contain an egg, not every egg will fertilize, and not every egg that fertilizes will go on to form a good quality embryo.
This procedure takes only a few minutes and is usually not uncomfortable. We will confirm the number and quality of embryos with you just prior to the transfer. Generally, we select the best two embryos for transfer. Some, but likely not all, of the remaining embryos may be suitable for freezing.
You will be prescribed Progesterone (pessaries or crinone) or hCG injections to help keep the endometrium (the lining of the uterus) in optimal condition for implantation. The dosages and timings will be outlined to you by both your IVF doctor and nurse coordinator.
IVF Process Step 5: Embryo Transfer
Two to Three days following egg retrieval, the fertilized eggs (embryos) are transferred to the uterus using a fine plastic tube (transfer catheter). The exact number transferred will depend on a woman's age and embryo quality. Generally one or two embryos (maximum 3 in exceptional circumstances) will be transferred to the uterus. It is important to note that the risk of multiple pregnancy increases with the number of good quality embryos transferred. Please ensure that you and your partner thoroughly discuss the options available as you will be asked at the beginning of the cycle to sign a consent form that specifies the maximum number of embryos you wish to transfer.
This procedure takes only a few minutes and is usually not uncomfortable. We will confirm the number and quality of embryos with you just prior to the transfer. Generally, we select the best two embryos for transfer . Some, but likely not all, of the remaining embryos may be suitable for freezing.
The embryos will be placed in the transfer catheter which is passed through the cervix into the uterus where the embryos are released. The catheter is then slowly removed and checked under the microscope to ensure that the there are no embryos remaining.
Everyone involved with IVF treatment will be offered the option of cryopreservation. Many couples, however, will not have enough extra embryos suitable for freezing. To be selected for freezing, embryos must not show any signs of fragmentation (cell breakdown) or abnormal development. Obviously, not all embryos will meet these criteria.
You will be prescribed Progesterone (pessaries or crinone) or hCG injections to help keep the endometrium (the lining of the uterus) in optimal condition for implantation. The dosages and timings will be outlined to you by both your IVF doctor and Nurse coordinator.
After embryo transfer, it is important that women maintain good health and wellbeing. If you are taking folic acid tablets, we recommend that you continue to do so. Smoking and alcohol should be avoided, while spas and saunas, jogging and aerobics are not advisable during this period. . Sexual intercourse should be avoided for about one week. Some medication may make you feel bloated or possibly nauseous. Drinking a lot of fluid and resting should ease these symptoms within 24 hours. A mild analgesia such as Panadol or Panadeine may be taken if necessary.
IVF Process Step 6: Luteal Phase and Pregnancy
The Luteal Phase is the 2 week period between the embryo transfer and the pregnancy test. You will be encouraged to limit your activity for 24 hours after the embryo transfer. Your activity can be gradually increased over the next few days to non-strenuous, non-aerobic activity. Many women return to work after a few days if their jobs are not strenuous. Sexual intercourse should be avoided for about one week.
If you experience bloating, breast tenderness and lower abdominal cramping, an analgesic may be taken to relieve the discomfort. If you are concerned that the symptoms are getting progressively worse, call the centre and ask to speak to a nurse.
Vaginal bleeding may occur before you are due for your pregnancy test. Although this is very disappointing, it does not always mean that treatment was unsuccessful. You should continue using the progesterone until there is a full period and/or the blood test results are known. At the same time, the progesterone itself may delay your period, and this does not necessarily mean that you are pregnant.
After 16-days, a blood test will determine whether a pregnancy occurred.
The luteal phase can be an exciting and optimistic time of the IVF treatment cycle. However, waiting for results can feel like months rather than weeks. This time is often emotionally charged with expectation and anxiety. We understand this will be a difficult period for couples. We encourage you to call our centre for support if you are finding it especially hard to deal with the stress of waiting.
Assistance from professional counsellors is also available as part of your IVF treatment cycle.