In Vitro Fertilization (IVF) comes from the words “in vitro” (which means “in glass”) and “fertilization“. IVF is a process of fertilization by extracting eggs, retrieving a sperm sample, and then combining an egg with sperm in a laboratory dish (“glass”), outside of the female body. After embryo culture process, the embryo(s) is then transferred to the uterus.
Before attempting IVF treatment, there are less invasive treatments that you and your partner might be able to try to treat infertility such as:
- fertility drugs in order to increase the number of eggs produced.
- IUI (Intrauterine Insemination): a fertility treatment that involves placing sperm inside a woman’s uterus near the time of ovulation to facilitate fertilization. IUI increases the chance of fertilization by providing sperm a head start. Although, the sperm still needs to reach and fertilize the egg on its own.
IVF is offered if you or your partner has the following condition(s):
- Damage or blockage in the Fallopian tube.
- Ovulation is infrequent or absent, fewer eggs.
- Endometriosis; when tissue normally found inside the uterus grows in other parts of the body (ovaries, fallopian tubes, bowel, or other internal parts).
- Uterine fibroids: Fibroids in the wall of the uterus.
- Previous tubal removal or sterilization.
- Premature ovarian failure.
- Problems with sperm production / function: low sperm count, poor mobility sperm, or abnormalities in sperm size and shape.
- Genetic disorder. IVF consists a preimplantation genetic diagnosis which can identify certain genetic disorders from the fertilized eggs.
- Cancer or other health conditions that need fertility preservation. Radiation or chemotherapy can harm your fertility. IVF may be an option to preserve women’s eggs and freeze them in an unfertilized state (or even fertilized state as embryos) for future use.
There are 8 basic steps that are involved in the IVF process:
- Fertility drugs / medications.
At birth, normal female ovary contains about 1-2 million eggs. Women cannot produce new eggs. Around puberty, only around 300,000 eggs remain. These egg supplies in each ovary are immature and must undergo growth and maturation each month. Every month, one or more eggs are released from one of your ovaries. There are between 15-20 eggs mature inside your ovaries. The ripest egg is released into one of your fallopian tubes. These fertility medications are prescribed in order to stimulate your ovaries to produce multiple eggs. This process is called controlled ovarian hyperstimulation (super ovulation).Why do we want to get multiple eggs? Because some eggs will not develop or fertilize after retrieval process. Multiple eggs will increase the success rate of producing more fertilized egg(s).
In this process, the fertility specialist will check the condition of both of the ovaries via transvaginal ultrasound. Blood test will also be required in order to check hormone levels.
- Egg retrieval.
The mature eggs are retrieved through a minor surgical procedure. A small hollow needle is passed through the top of vagina under ultrasound guidance to get to the ovary and follicles. The fluid in the follicles is aspirated through the needle and the eggs detach from the follicle wall and are sucked out of the ovary. This procedure usually takes about 10-15 minutes. Medication is given after the procedure to reduce and remove potential discomfort.
- Sperm sample.
The male will be asked to produce a sample of sperm. When semen is received, it will go through a process called sperm washing; process in which individual sperms are separated from the semen, removing inactive cells and seminal fluid. If the semen is provided by a sperm donor, then it usually have been prepared for treatment before being frozen, and it will be thawed ready for use.
In this process, the sperm and eggs are incubated together and stored in a laboratory dish at a ratio of about 75,000:1 in order for fertilization to take place. In some cases, such as low sperm count or motility, a single sperm may be injected directly into the egg using a procedure called ICSI (intracytoplasmic sperm injection). In most cases, the egg will be fertilized during the co-incubation period. Once the eggs are confirmed to be fertilized and cell division are taking place, the fertilized eggs are considered embryos.
- Embryo culture.
In this process, the embryos will be passed to a special growth medium. The main durations of embryo culture can be differentiate into two stages:
- Cleavage stage (day 2 to day 4 after co-incubation).
- Blastocyst stage (day 4 to day 6 after co-incubation).
The blastocyst stage confers a significant increase in live birth rate per embryo transfer because it allows selection of the best quality for embryo transfer but also confers a decreased number of embryos available for embryo transfer and embryo cryopreservation. Transfer day 2 instead of day 3 after fertilization has no differences in live birth rate. There are higher odds of preterm birth and congenital anomalies among births having from the blastocyst stage compared with the cleavage stage.
- Embryo transfer.
Embryos are graded based on the amount of cells, evenness of growth, and degree of fragmentation. The number of embryos to be transferred depends on the number of embryos available, the age of the woman, and other health and diagnostic factors. Certain countries have different regulations on the maximum number of embryos can be transferred. The embryos are transferred to the woman’s uterus using a thin plastic catheter (small tube) via the vagina and cervix. More embryos may be transferred into the uterus to increase the chances of implantation and pregnancy. This procedure is usually painless but some may experience mild cramping. If the procedure is successful, implantation typically occurs around 6 to 10 days after the egg retrieval day.
- Additional medication.
Generally, medication such as progesterone, progestins or GnRH agonists are administered in luteal phase in order to increase the success rate of implantation and early cell division (embryogenesis).
- Pregnancy Test.
This is your final step. After about 2 weeks or less, your doctor should schedule you for a blood test to test for pregnancy. Do not feel discouraged if you do not succeed in your first round of IVF cycle. Normally, by the third round of IVF, 9 out of 10 women should become pregnant.