- IVF is a multistep process that will take some time and patience.
- If you are getting an IVF, in-clinic testing will usually confirm your pregnancy in seven to nine days (sometimes after two weeks) after embryo transfer.
Some closely monitor their symptoms in the hope that their bodies will tell them when they are pregnant before pregnancy is confirmed. However, the symptoms of an IVF pregnancy may be complicated and sometimes misleading (as they are with other types of pregnancies).
A single IVF cycle can last between four and six weeks. Occasionally, the IVF procedure is divided into stages, lengthening the process. However, this is dependent on the success rates of the specific treatment.
Some people are lucky enough to get pregnant after only one round of treatment, whereas others require more cycles. Typically, one to two weeks following the egg retrieval process, you will be requested to perform blood tests to determine pregnancy.
What is IVF?
The process of collecting eggs and fertilizing them in a laboratory is called in vitro fertilization (IVF). The resulting embryos are cultured for three to five days before being implanted or frozen for future use.
Because of the high number of eggs produced in one cycle and the low number of sperm required to fertilize them, IVF is far more successful than natural fertility.
IVF treatment necessitates the administration of medications (gonadotropins or FSH, LH, or progesterone), which are typically administered via subcutaneous or intramuscular injections. A person may receive up to 90 shots per cycle, with a frequency of one to two injections per day depending on the course of specific treatment and cycle. In some cases of IVF, insufficient progesterone levels are observed and thus, supplementation is prescribed. The supplementation begins around the time of egg retrieval or ovulation and lasts until the pregnancy-produced progesterone levels are maintained.
8 basic steps in IVF
- Ovarian stimulation:
- In a natural cycle, a woman can produce 10 to 20 eggs per cycle, but only one of them is allowed to grow and ovulate. To increase the chances of in vitro fertilization (IVF) success, medications are used to directly stimulate the ovaries to override this selective tendency and allow more eggs to mature.
- These stimulating medications contain follicle-stimulating hormone (FSH), which stimulates the growth of multiple follicles. The body has a defense to stop multiple pregnancies.
- When confronted with multiple growing follicles, the brain and pituitary gland can stimulate the ovulation of the largest follicle by secreting the luteinizing hormone (LH). Once the first egg is released, all remaining follicles stop growing.
- To prevent interference, doctors must use another type of medication. These medications (Lupron or a GnRH antagonist) act on the brain and pituitary to prevent the release of LH, which causes premature ovulation.
- Once the risk of premature ovulation is eliminated, ovarian stimulation can continue until the follicles mature and are ready for egg retrieval.
- When the pituitary no longer interferes with follicle growth, stimulation of the ovaries can begin, with close monitoring of the ovaries via ultrasound and hormone levels.
- One of the most important decisions in IVF planning is selecting the appropriate stimulation protocol. People with normal egg reserves can use standard IVF protocols, whereas those with low egg reserves can benefit from one of the aggressive protocols.
- Egg retrieval:
- Most of the follicles should mature to an acceptable size after about 10 days of ovarian stimulation with injectable medications. To induce the final maturation of the eggs, a human chorionic gonadotropin (HCG) injection is administered.
- The eggs are then aspirated through the vagina under ultrasound guidance in the office about 36 hours after administering HCG. An anesthesiologist administers intravenous sedation to the person for approximately 20 minutes.
- When the retrieval is finished, the person awakens almost immediately after the IV medications are stopped. Most experience mild pelvic soreness and cramping after the procedure, but this is self-limiting and resolves within a couple of hours.
- The eggs are ready for fertilization in the lab once they have been collected, identified, and prepared.
- The eggs are isolated under a microscope after aspiration and fertilized on the same day.
- Each egg is incubated overnight in a droplet of special media containing 70,000 motile sperm in conventional IVF. A sperm will fertilize the egg.
- Intracytoplasmic sperm injection (ICSI) is required to ensure fertilization in cases of low sperm concentration or motility. One normal-looking sperm is selected under the microscope and injected directly into the egg.
- The day after the eggs or sperm are inseminated or injected, they are examined for signs of fertilization. When two pronuclei (one from each parent) are seen in an egg, it is considered to have normal fertilization.
- The average rate of normal IVF or ICSI fertilization is 70 percent. Doctors check for fertilization the day after the retrieval. Approximately 70 percent of mature eggs are fertilized.
- Embryo culture:
- The fertilized eggs are cultured for five days. The embryos are cultured in extremely controlled conditions, including temperature, gases, and pH.
- Doctors check the embryos on days one, three, and five to minimize fluctuations in the air and temperature of the incubator, counting day one as the day after retrieval. After each check, people are informed of the status of their embryos.
- The person takes progesterone during this time to prepare the uterine lining for embryo transfer.
- Embryo transfer:
- One of the most important factors influencing the cycle's outcome is the ability to transfer. Most embryo transfers are performed on day five of culture. The transfer procedure is painless and does not require sedation or anesthesia.
- One or two embryos with the highest grading scores are loaded into a soft catheter and delivered into the uterus at a depth determined during the trial transfer visit.
- In difficult cases, ultrasound guidance is used to aid the transfer. If the remaining embryos meet freezing criteria, they are frozen for future use.
- Freezing of embryos:
- Optimal embryos are then frozen before being transferred back into the person’s womb one to two months later.
- Before the transfer, the person will need to take hormone pills daily.
- Transfer of embryos:
- In a simple procedure performed at the IVF clinic, the embryo will be transferred back into the person’s womb. This transfer will take about 20 to 30 minutes and will not require anesthesia.
- Check if IVF is successful:
- A pregnancy test (blood test) will be performed two weeks after the embryo transfer into the person’s womb to determine if the woman has successfully conceived.
Who should undergo IVF?
In vitro fertilization (IVF) is an assisted reproductive technique (ART) that is frequently the last ray of hope for people attempting to conceive. Though it may appear complicated and intimidating to some, it is generally a safe procedure. It is only advised after a proper fertility assessment by a fertility specialist.
Common reasons to undergo IVF
- Age-related infertility: The quality of a person’s eggs deteriorates with age. IVF can improve an older person’s chances of conceiving by increasing the number of eggs they produce, improving egg selection, or allowing them to use donor eggs to create embryos.
- Recurrent pregnancy loss or miscarriage: Depending on the underlying cause of recurrent pregnancy loss, IVF could be a useful treatment to assist with the start of a successful pregnancy by increasing the number of potential embryos to increase successful implantation.
- Unexplained infertility: One-fifth of infertile couples have unexplained infertility, and these couples frequently conceive with IVF.
- If a person is not ovulating (anovulation), ovulation-inducing drugs can help them get pregnant.
- If they are unable to conceive using these cautious techniques, IVF, which has a very high success rate, can be employed.
- Damaged fallopian tubes: If there is significant tubal damage, the only fertility treatment options are surgical repair, which has a low success rate. IVF is another option, which can bypass the fallopian tubes.
- Male infertility factors: Male infertility factors are typically associated with a lack of sperm quantity or quality. In these cases, doctors advise IVF with intracytoplasmic sperm injection (ICSI).
- Endometriosis: Endometriosis can lead to infertility, but it is treatable with a combination of surgery and medication. If the first round of surgical or medical treatment is unsuccessful, IVF is a viable option.
- Low ovarian reserve:
- If a person’s ovaries contain a low number of eggs, IVF can be used to stimulate the development of healthy eggs, allowing the reproductive endocrinologist to collect mature eggs directly from the ovaries.
- Younger people with low ovarian reserve, who generally have good egg quality, would have higher success rates with IVF treatment.
IVF is mostly recommended for people who have nonfunctional or missing fallopian tubes, as well as men who have very poor sperm quality. Before IVF, a doctor may recommend alternative infertility treatments, such as intrauterine insemination (IUI). If these do not work, IVF is frequently the next step.
What’s the success rate of IVF?
Based on these criteria, the global average success rate for in vitro fertilization (IVF) therapy is between 30 to 50 percent.
In recent years, it has been discovered that freezing the embryos before implanting them into the woman's body increases IVF success rates. The underlying theory is that embryos that have survived freezing are more resilient, and thus have a better chance of resulting in pregnancy.
Many IVF clinicians now transfer frozen embryos regularly.
IVF is a therapy that is dependent on several aspects, including the:
- Couple's general health
- Women's reproductive health
- Sperm and the quality of the embryo (whether fresh or frozen)
- The facility doing the procedure
- The embryologist and the person performing the retrieval and transfer
What is IVF? https://www.plannedparenthood.org/learn/pregnancy/fertility-treatments/what-ivf
Infertility and In Vitro Fertilization. https://www.webmd.com/infertility-and-reproduction/guide/in-vitro-fertilization
IVF – In Vitro Fertilization. https://americanpregnancy.org/getting-pregnant/infertility/in-vitro-fertilization/
In Vitro Fertilization. https://www.ncbi.nlm.nih.gov/books/NBK562266/
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