In Vitro Fertilization is a one assisted reproductive technology (ART) commonly referred to as IVF. IVF is the process of fertilization by manually combining an egg and sperm in a laboratory dish, and then transferring the embryo to the uterus. Other forms of ART include gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT).
IVF can be used to treat infertility with the following patients:
• Blocked or damaged fallopian tubes
• Male factor infertility including decreased sperm count or sperm motility
• Women with ovulation disorders, premature ovarian failure, uterine fibroids
• Women who have had their fallopian tubes removed
• Individuals with a genetic disorder
• Unexplained infertility
There are five basic steps in the IVF and embryo transfer process:
• Monitor and stimulate the development of healthy egg(s) in the ovaries.
• Collect the eggs.
• Secure the sperm.
• Combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and early embryo growth.
• Transfer embryos into the uterus.
• Step 1: Fertility medications are prescribed to stimulate egg production. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. Transvaginal ultrasound is used to examine the ovaries, and blood test samples are taken to check hormone levels.
• Step 2: Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity to remove the eggs. Medication is provided to reduce and remove potential discomfort.
• Step 3: The male is asked to produce a sample of sperm, which is prepared for combining with the eggs.
• Step 4: In a process called insemination, the sperm and eggs are mixed together and stored in a laboratory to encourage fertilization. In some cases where there is a lower probability of fertilization, intracytoplasmic sperm injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.
• Step 5: The embryos are usually transferred into the woman’s uterus three to five days following egg retrieval and fertilization. A catheter or small tube is inserted into the uterus to transfer the embryos. This procedure is painless for most women, although some may experience mild cramping. If the procedure is successful, implantation typically occurs around six to ten days following egg retrieval.
Although you may need to take it easy after the procedure, most women can resume normal activities the following day.Some side effects after IVF may include:
Passing a small amount of fluid (may be clear or blood-tinged) after the procedure
• Mild cramping
• Mild bloating
• Breast tenderness
If you experience any of the following symptoms, call your doctor immediately:
• Heavy vaginal bleeding
• Pelvic pain
• Blood in the urine
• A fever over 100.5 °F (38 °C)
As with most medical procedures, there are potential risks. Fertility medications can have various side effects including headaches, mood swings, abdominal pain, hot flashes, and bloating, amongst other side effects. Although it is rare, fertility medications may cause ovarian hyper-stimulation syndrome (OHSS). Symptoms of OHSS may include abdominal pain or a feeling of being bloated. More severe symptoms include the following:
• Nausea or vomiting
• Decreased urinary frequency
• Shortness of breath
• Severe stomach pains and bloating
• Ten pound weight gain within three to five days
If you experience any of these symptoms above, contact your doctor right away.
• Egg retrieval carries risks of bleeding, infection, and damage to the bowel or bladder.
• The chance of a multiples pregnancy is increased with the use of fertility treatment. There are additional risks and concerns related to multiples during pregnancy including the increased risk of premature delivery and low birth weight.
• Assisted reproductive technology (ART) involves a significant physical, financial, and emotional commitment on the part of a couple. Psychological stress and emotional problems are common, especially if in vitro fertilization (IVF) is unsuccessful.
The success rate of IVF clinics depends on a number of factors including reproductive history, maternal age, cause of infertility, and lifestyle factors. It is also important to understand that pregnancy rates are not the same as live birth rates.
You may choose to use donor eggs, sperm, or embryos. However, make sure to talk with a counselor experienced with donor issues. You will want to be informed about various legal issues related to gamete donation including the legal rights of the donor.
The number of embryos transferred typically depends on the number of eggs collected and maternal age. As the rate of implantation decreases as women age, more eggs may be implanted depending on age to increase the likelihood of implantation. However, a greater number of eggs transferred increases the chances of having a multiples pregnancy. Make sure to talk with your doctor before the procedure so you both agree on how many embryos to implant.
Step 1: Initial Specialist Appointment
At your initial appointment, your fertility speacialist will review your medical history and all previous investigations and treatments.
You and your partner should both attend your first appointment with your fertility specialist. They will review your medical history, all previous investigations and treatment, and will provide preliminary advice about your treatment options.
Step 2: Pre-treatment consultation
You’ll meet again with your fertility specialist, confirm your treatment plan, have any questions answered and sign the relevant consent forms. Discuss any complementary medicines you are taking now, as these may interfere with your treatment.
Step 3: Treatment begins
Your fertility nurse gives you the medication you need, explains the treatment cycle timeline, and shows you how to self-administer the Follicle Stimulating Hormone (FSH) injections. We recommend both you and your partner attend this appointment.
Step 4: Hormone stimulation
FSH is administered through a diabetic-style pen, stimulating your ovaries to produce more eggs than usual. We have a higher chance of achieving fertilisation and pregnancy when we can collect more eggs.
Step 5: Treatment monitoring
Throughout your cycle, regular blood tests measure your hormone levels and ultrasounds measure the size and number of your ovarian follicles. This also helps us determine the appropriate time for egg collection. All your blood and ultrasound tests are conducted by our nurses within your chosen IVFAustralia clinic, and are included as part of your treatment costs.
Step 6: Trigger injecton
Once you have the optimum number and size of follicles, we plan your egg collection. You’ll have a trigger injection of hCG (human chorionic gonatrophin) in the evening, and the operation for egg collection will occur 36 to 38 hours later. The hCG injection replaces the natural Luteinising Hormone in the body and 'triggers' or instigates ovulation.
Step 7: Egg collection in day surgery
Egg collection is undertaken in day surgery, usually under ultrasound guidance. Most women prefer a light general anaesthetic, but you can have a local anaesthetic with sedation if you prefer. You will be at the hospital for about 4 hours and will need someone to drive you home afterwards. Make sure you can take the rest of the day off work.
On the morning of your egg collection your partner will need to provide a fresh semen (sperm) sample, so we can immediately fertilise your eggs.
Step 8: Egg fertilisation
Collected eggs are taken to the laboratory and placed in culture medium to prepare them for fertilisation later that day. In IVF, prepared sperm and eggs are placed together in a dish where fertilisation occurs. In ICSI, an individual sperm is selected by a highly experienced embryologist, and, under very delicate microscopic control, the egg is injected with this single sperm.
Step 9: Embryo development
The egg and sperm are then placed in individual incubators at 37 degrees to mimic the temperature of the human body. The next day, scientists will examine the eggs to determine if fertilisation has occurred, and will call you to advise you of the development of the embryos.
Step 10: Embryo transfer
Embryo transfer is a simple day surgery procedure and usually takes place five days after the egg collection. The embryos are transferred into the uterus through a very fine catheter passed through the cervix, a procedure similar to a pap smear. In some cases we may recommend transferring embryos earlier.
Step 11: Embryo freezing
Any extra embryos not used during a treatment cycle that are suitable for freezing can be stored for the future.
Step 12: Pregnancy test
Your nurse will organise an appointment for you to have a blood test two weeks after the embryo transfer. Occasionally, women can still have a period despite being pregnant, so this blood test will occur even if your period has commenced. We do not recommend the use of urinary pregnancy test kits, as the hormone medication given throughout treatment could produce an incorrect reading.
Your pregnancy blood test results are usually available by mid afternoon. If the pregnancy test is positive, we will arrange an ultrasound scan approximately three weeks later.