The In Vitro Fertilisation (IVF) process consists of five main steps: Stimulate eggs, collect mature eggs, collect / obtain sperm, fertilize fertilise eggs in the laboratory , and transfer embryos to the uterus.
Prior to any of this starting, however, you need to meet with a local doctor or gynaecologist to have certain fertility tests carried out. It is important at the beginning of the process to rule out any medical issues before attempting any fertility treatment. Some things to look at are the quality of eggs and sperm.
The baseline is the first few days of a woman’s menstrual cycle. It is here, on day 2, 3 or 4 of the cycle, that the doctors will determine if certain parameters are met and if this is the right time to start and IVF cycle.
Some of the things doctors look for in the baseline phase are that neither ovary contain large cysts, that hormone levels of estrogen, progesterone and LH are low, that the uterine lining has shed recently and is ready to start growing again.
If these parameters are not met the chances for a successful IVF treatment are lessened. Given the cost of IVF treatment the doctors want to make sure you have the best chance at success.
If there is a problem with any of these pieces, the couple would need to consider using donor eggs or donor sperm and plan for those added expenses and time.
Once you have completed the fertility tests and are ready to start treatment, the first step in the IVF process is stimulating the eggs. This step involves several processes as well. Initially, the patient may be asked in most cases to take birth control pills in the cycles before starting. This allows regulation of the hormones and planning of the treatment dates in advance.
Once the menstrual cycle begins, it is time to start stimulating the follicles. The idea is to ripen the eggs with fertility medications so that the growth can be controlled. The category of drugs used are called gonadotropin, or FSH.
It is the goal to stimulate multiple follicles, unlike a natural cycle, in order to increase the number that can be collected. The more eggs collected, the better chances of producing a viable embryo for transfer.
During the cycle, your fertility specialist will need to ensure that you do not ovulate. Doctors want to prevent ovulation on your own because once the egg is released from the ovary they can not retrieve it. Some of the common suppression drugs that are used are Antagon, Cetrotide, Lupron, microdose Lupron, and Synarel. At Cyprus IVF Clinic, Cetrotide is normally used because it has the fewest side effects and can be used in the short protocol which gives the best pregnancy results.
The typical duration of the FSH treatment is ten days. One of the monitoring tools is ultrasound. This is used to measure the egg follicles as they enlarge to determine when they are ready to be collected. The doctor is looking for follicles that measure in the 18-22mm range. Another tool is a blood test to monitor the serial blood hormone levels. After reviewing the ultrasound results, and the blood tests,, the doctor will prescribe an injection of hCG to be injected at a precise time to control when the eggs will finish ripening and be ready for collection, approximately 36 hours after the injection.
The timing of the HCG injection ensures that the eggs will be mature at egg collection and prevents premature ovulation. About 36 hours after the injection the woman will ovulate, so it is important to follow the timing instructions precisely.
When it is time to collect the mature eggs, the doctor will do so transvaginally. This procedure is done under sedation and with the use of ultrasound to guide the doctor to the follicles. Then a hollow needle is used to withdraw fluid from the follicles.
At this point, an embryologist would examine the withdrawn liquid and determine if an egg was retrieved. The doctor would repeat this procedure for each mature follicle that was produced. Once the collection process is completed, it is time to fertilise them.
The sperm will at this point have been transferred to the embryologist. Prior to the egg retrieval the partner’s sperm will have been collected typically through masturbation or perhaps through TESA/PESA if the male partner has previously had a vasectomy. It is then sent to the lab to be processed.
Sperm with a good morphology is selected and used for the ICSI procedure by the Cyprus IVF Clinic embryologist to give the eggs the best possible chance. The fertilisation process happens quickly after the eggs are retrieved. The following day after egg retrieval the couple will know how many eggs were successfully fertilised and have entered the embryo stage. Now those embryos will be monitored in special incubators to see if they will divide and grow.
The last stage in IVF is the transfer of the embryos to the uterus. The transfer occurs between three and five days after the egg collection, depending on development. Some transfers occur after five days, and this is called a blastocyst transfer. It is up to the couple and doctor to decide the course of action at this point. Do you do the three days transfer or wait for five days? There are pros and cons to each.
With a three day embryo transfer you have a greater chance at having multiple embryos to transfer increasing your odds, but at the five day blastocyst stage you might have fewer embryos but those that are implanted at this stage have a higher rate of resulting in pregnancy and live birth.
The EmbryoScope time lapse imaging incubator, available exclusively at Cyprus IVF Clinic, can help you make the decision about when to transfer the embryos as the embryologist follows the development and makes annotations at each stage of division. They can then predict whether the embryo will continue to develop or if development will arrest in the near future.
To conduct the transfer, a speculum is inserted in the uterus and embryos suspended in fluid and gently placed into the womb though a catheter. The woman is then encouraged to rest for 2 hours after the transfer, to give the eggs time to settle and implant.
Transferring of the embryos is considered the completion of the IVF procedure. After the transfer a HCG blood test is done twelve days later to test for pregnancy.
From this point, if the pregnancy test is positive you will continue to be monitored having your HGC levels checked for several weeks to ensure the pregnancy is progressing.
It is important to keep all liaise with Cyprus IVF Clinic regularly at this point to monitor the pregnancy till you can be transferred over to your normal prenatal care physician.