IVF is one of the high-tech methods to help women with reproductive challenges to conceive a healthy baby. It has been around since 1978 when the first test-tube baby was born and has had a long story of success ever since. There are a lot of reasons and indications for IVF. It might be a good option for women who are diagnosed with endometriosis, blocked fallopian tubes, have problems with ovulation or egg quality, or have unexplained fertility; or the partner has low sperm count or motility. If you need an egg donor, you can have an in vitro fertilization. If conservative treatments didn’t work, this is a more aggressive way to conceive a child. No matter what the reason might be, IVF is sometimes the best way to solve the problem.
The IVF cycle includes the following steps:
Prescreening for both partners.
For males, it consists of semen analysis and infectious disease testing according to the state law of California.
For females, it includes a mandatory infectious disease testing along with ovarian reserve testing: the concentration of FSH and Estradiol (estrogen). The FSH is released by the brain to stimulate ovaries to grow eggs.
Antral Follicle Count is performed during an ultrasound to look at the ovaries and count a number of small follicles that contain an egg. The higher the number, the better is the response to the stimulation.
Trial transfer – a test transfer by placing the catheter through the cervix into the uterus to make sure there will be no difficulties when embryos are transferred.
Uterine Cavity Evaluation – to make sure the uterus has a normal cavity for implantation.
Throughout the IVF cycle, ultrasounds are done every other day to help monitor.
Then it’s time for the hormone therapy to stimulate ovaries. The goal is to have as many mature eggs as possible, as it increases the chances of the successful IVF treatment. Here is a typical order of the medications given.
1) Oral contraceptives to help “synchronize” the follicles in the ovaries so they can be at the same growth stage to maximize the number of mature eggs during the IVF cycle. They are usually started on the 3rd day of period for 10-21 days.
2) GnRH analogs or antagonists are given to prevent premature ovulation.
3) Gonadotropins – hormone are injected up to 8-10 days to stimulate the follicles to grow. The response to the gonadotropin therapy is monitored by the Serum Estradiol level, i.e., estrogen produced by the developing follicles, as well as the ultrasound. The lab results are compared to the ultrasound outcomes to help control the dose of medications given.
HCG injection is administered when the eggs are mature for retrieval. The trigger shot to mature the egg and set off the ovulation.
The retrieval occurs 35.5 or 36 hours later after the HCG shot is administered. The patient will be given a specific time of the egg retrieval procedure. During the retrieval, the patient is under anesthesia. The doctor will insert a needle into an ovary and withdraw the oocytes.
Estrogen and progesterone are initiated after the egg retrieval to help support a future pregnancy.
After the retrieval, the oocytes will be placed in a dish together with the sperm, where they will meet and grow into embryos. If fertilization doesn’t happen in a conventional way, an alternative way might be through the intracytoplasmic sperm injection (ICSI).
The morning after the retrieval, the embryologist will check for fertilization. After the successful fertilization, the embryologist will evaluate the embryos for quantity and quality on the 3rd day after fertilization. Then the embryos will go through the preimplantation genetic diagnosis when they are screened for genetic disease.
The transfer of embryo back into the uterus will occur on days 3-5 after fertilization. It’s a painless procedure that takes a few minutes.
Possible IVF complications happen at a low rate from 1% to 4% the most. They include:
1) IVF cancellation due to the non-response to the hormone therapy.
2) Intraoperative injury/infection.
3) Ectopic pregnancy.
4) Ovarian hyperstimulation syndrome.
5) Psychological feeling of “failure.”
The whole treatment takes up 4 - 6 weeks to complete from the moment you start a hormone therapy to implanting the embryos in your uterus. The success rate of IVF relies on the infertility factor as well as the age of the patient. The outcomes also depend on the clinic and the birth ratio; that’s why it’s important to find the clinic with a high rate of IVF pregnancy as well as live birth success rates.