In vitro fertilization (IVF) and a journey of hope towards parenting
What is meant by IVF treatment
In vitro fertilization or IVF is a type of Assisted Reproductive Technology (ART) where sperm and egg are fertilized outside the body and is a complex process that involves retrieving eggs from the ovaries and manually combining them with sperm in the laboratory for fertilization.
Several days after fertilization, the fertilized egg (now called the embryo) is placed inside the uterus. Pregnancy occurs when this embryo implants itself in the wall of the uterus.
Why is IVF treatment performed
People choose IVF treatment for many reasons, including infertility problems or when one of the spouses has a health condition. Some people will try IVF after other fertility methods have failed or if they are at an advanced maternal age.
IVF is an option if one of the spouses has:
- Blockage or damage to the fallopian tubes.
- Endometriosis of the uterus.
- Low sperm count or weakness of other spermatozoa.
- Polycystic ovary syndrome (PCOS) or other ovarian conditions.
- Uterine fibroids.
- Problems with the uterus.
- The risk of transmission of a disease or genetic disorder.
- Unexplained infertility.
How long is the IVF process from beginning to end
IVF is a complex process with many steps. On average, you can expect the process to last four to six weeks. This includes the time before the egg is retrieved, when a person takes fertility medication so that he can be tested for pregnancy.
How common is IVF treatment
Approximately 5% of infertile couples will try artificial insemination. More than 8 million IVF babies have been born since 1978. It is one of the most effective assisted reproductive technologies.
What is the difference between IVF and intrauterine insemination (ICSI)
Intrauterine insemination differs from in vitro fertilization because in the procedure of intrauterine insemination, fertilization occurs in the wife’s body.
A sperm sample is collected and only high-quality sperm is left. This sample is inserted into the uterus using a catheter (thin tube) during ovulation.
This method helps the sperm to reach the egg more easily in the hope that fertilization will occur.
In IVF, the sperm and egg are fertilized outside the uterus (in vitro) and then placed in the uterus as an embryo.
Intrauterine insemination is less expensive and less invasive than IVF but intrauterine insemination has a lower success rate per period.
What are the steps of IVF treatment
IVF can be divided into the following steps:
Pills or estrogen
Before starting IVF treatment, a specialist doctor may prescribe pills or oestrogen. This is used to stop the development of ovarian cysts and control the timing of the menstrual cycle.
Allows your doctor to control your treatment and increase the number of mature eggs during the egg recovery procedure.
Some are prescribed compound pills (estrogen and progesterone), while others are only given estrogen.
Ovarian stimulation
During each normal cycle in a healthy person of childbearing age, a group of eggs begin to mature every month. Usually, only one egg becomes mature enough to ovulate. Immature eggs left in that group disintegrate.
During the IVF treatment cycle, you will take injectable hormonal drugs to encourage the whole range of eggs of that cycle to mature simultaneously and fully. This means that instead of having only one egg (as in the natural cycle), you may have many eggs.
The type, dosage and frequency of prescription drugs will be designed for you as an individual based on your medical history, age, level of Müller hormone and your response to ovarian stimulation during previous IVF treatment.
Egg retrieval
The specialist uses ultrasound to guide a thin needle to each of the ovaries through the vagina. The needle is connected to a suction device that is used to pull your eggs out of each follicle.
The eggs are placed in a dish containing a special solution. Then the dish is placed in an incubator (controlled environment).
Medications and light anesthesia are used to reduce discomfort during this procedure.
Oocytes are retrieved 36 hours after the last hormonal injection.
Fertilization
The afternoon after the egg recovery procedure, the embryologist will try to fertilize all mature eggs using intrauterine sperm injection or ICSI.
This means that sperm will be injected into each mature egg. An immature egg cannot have ICSI performed on it. Immature eggs will be placed in a plate with sperm and nutrients. Unripe eggs rarely finish the process of their maturation in the dish. If the immature egg has matured, then the sperm in the dish can try to fertilize the egg.
On average, 70% of mature eggs will be fertilized. For example, if 10 mature eggs are retrieved, then about seven will be fertilized. If successful, the fertilized egg will become an embryo.
If there are too many eggs or you don’t want to fertilize all the eggs, some eggs may be frozen before fertilization for future use.
Embryo development
Over the next five to six days, the development of your embryos will be carefully monitored.
Your fetus must overcome significant obstacles to become a suitable embryo for transfer to your uterus. On average, 50% of fertilized embryos progress to the blastocyst stage.
This is the most favorable stage for transfer to your uterus. For example, if seven eggs are fertilized, then three or four of them may develop to the blastocyst stage.
The remaining 50% usually fail to progress and are eliminated.
All embryos suitable for transfer will be frozen on the fifth or sixth day of fertilization for use in future embryo transfers.
Embryo transfer
There are two types of embryo transfers: transfer of new embryos and transfer of frozen embryos. Your doctor may discuss the use of new or frozen embryos with you and determine which is best based on your situation. Frozen and fresh embryo transfers follow the same transfer process. The main difference is implied by the name.
A new embryo transfer means that your embryo is inserted into your uterus between three and seven days after the egg recovery procedure as this embryo has not been frozen
Frozen embryo transfer means that frozen embryos (from a previous IVF cycle ) are thawed and inserted into your uterus. This is a more common practice for logistical reasons and because this method is more likely to lead to a live birth. Frozen embryo transfers can occur years after egg recovery and fertilization.
As part of the first step in transferring frozen embryos, you will take hormones by mouth, injection, vaginally, or through the skin to prepare the uterus to accept the embryo. Usually, this is 14 to 21 days of oral medication followed by six days of injections.
You usually have two or three appointments during this time to monitor the readiness of your uterus with ultrasound and measure your hormone levels through a blood test. When the uterus is ready, an embryo transfer procedure will be scheduled.
The process is similar if you use new embryos, except that embryo transfer occurs within three to five days of their recovery.
Embryo transfer is a simple procedure that does not require anesthesia. It looks similar to a pelvic examination or Pap smear.
The speculum is placed inside the vagina, and a thin catheter is inserted through the cervix into the uterus. The syringe attached to the other end of the catheter contains one or more embryos.
Embryos are injected into the uterus through a catheter. The procedure usually takes less than 10 minutes.
Pregnancy
Pregnancy occurs when the embryo implants itself in the lining of your uterus. Your doctor will use a blood test to determine if you are pregnant approximately nine to 14 days after the embryo transfer.
There are many factors that need to be considered before starting IVF treatment. To get the best understanding of the IVF process and what to expect.
What to do to prepare for IVF treatment
Before starting IVF treatment, you will need a thorough medical examination and fertility tests. Your husband will also be examined and tested. Some of the preparations you will go through include:
- IVF consultation
- Uterine test, updated Pap test and mammography (if over 40).
- Semen analysis.
- Screening for sexually transmitted diseases and other infectious diseases.
- Ovarian reserve test, blood and urine tests.
- Instructions on how to give fertility drugs.
- Genetic carrier screening.
- Sign the consent forms.
- (Evaluation of the uterine cavity) hysteroscopy or salt-filled Sonography (SIS.(
Your doctor will ask you to start supplementing folic acid at least three months before the embryo transfer.
How is IVF treatment started
During IVF treatment, you will take injectable hormonal drugs to encourage the entire group of eggs of that cycle to mature simultaneously and fully. Your doctor will determine the type of medication, frequency and doses you need for your treatment.
This depends on your age, medical history, hormone levels, and your response to previous IVF cycles if possible. You can expect to inject fertility medication for eight to 14 days.
What drugs are used in IVF
Many drugs can be used during IVF treatment. Some of them are taken orally, while others are injected or placed in the vagina. Your doctor will determine the exact dosage and timing depending on your treatment plan.
During the ovarian stimulation phase, you can expect to receive injectable hormones:
- Follicle stimulating hormone (FSH): these hormones stimulate the ovaries to produce eggs. You may get one or a combination of both during treatment. This is done for about 14 days.
- Human chorionic gonadotropin (HCG): it is usually given as the last dose to stimulate the eggs to mature and impart movement to ovulation.
You may be prescribed birth control pills or injections before starting IVF treatment. This provides a level of control over your cycle and allows all eggs to start simultaneously.
Most cases are given estrogen supplements to take before and after embryo transfer. This hormone helps to thicken the lining of their uterus.
Progesterone is also added to improve the chances of embryo implantation and growth to a successful pregnancy.
Most of them continue this throughout the first trimester of pregnancy. These drugs are either oral, injectable, through the skin or vaginally.
What are the risks of IVF treatment
There are several risks associated with IVF treatment:
- Multiple births: pregnancy with many children has a higher risk of premature birth.
- Premature birth: you may have a slightly higher risk of having your baby born early or with a lower birth weight.
- Abortion: the abortion rate is the same as the pregnancy rate of a normal pregnancy.
- Ectopic pregnancy: this is a condition in which a fertilized egg implants outside the uterus.
- Complications during egg restoration: bleeding, infection, damage to the bladder, intestines or genitals during the egg restoration process.
- Ovarian hyperstimulation syndrome (OHSS): a rare condition that causes abdominal pain, nausea, vomiting, diarrhea, rapid weight gain, bloating, shortness of breath and inability to urinate.
What are the most common side effects of IVF operations
Some wives experience side effects from fertility drugs used during the ovulation stimulation phase of IVF.
They include the following:
- Nausea and vomiting.
- Hot flashes.
- Headaches.
- Ovarian enlargement.
- Abdominal pain.
- Bruises from IVF injections.
After the transfer of your fetus, you should be able to resume normal activities.
Your ovaries will be enlarged, and some discomfort may occur. Common side effects after embryo transfer are:
- Constipation.
- Bulge.
- Spasm.
How effective is IVF treatment in pregnancy
Your age is one of the strongest factors in the success of IVF treatment.
Your chance of getting pregnant through IVF is much higher if you are under 35, and lower if you are over 40. The live birth rate also varies and is closely related to age.
How long does it take to find out that you are pregnant after IVF
The pregnancy test takes about nine to 14 days after the embryo transfer and the attending physician is likely to use a blood test to check for pregnancy. Blood tests measure HCG (chorionic gonadotropin), the hormone produced by the placenta during pregnancy.
When can you try again after an unsuccessful IVF procedure
Most treatment centers recommend that you have one full menstrual cycle between cycles after the IVF procedure.
The length of your menstrual cycle varies, but you can expect to wait four to six weeks after a negative test to start another cycle. A small break between courses is usually recommended for health and emotional reasons.
Is there anything I can do to increase my chances of getting pregnant with IVF
Several factors can determine the success of IVF – some are under your control, others are not. Such factors include the following:
- Age.
- Height and weight.
- The number of previous births.
- The total number of pregnancies.
- The number of times of IVF.
- Health conditions.
- The cause of your infertility.
Your doctor will work with you to determine how you can increase your chances of getting pregnant with IVF based on your situation and medical history.
Why IVF treatments fail
IVF treatments can fail for many reasons and at any step in the IVF process. Some of the reasons for processing failure are:
- Premature ovulation.
- No oocyte develops.
- The egg is not fertilized with sperm.
- Sperm quality.
- The embryo stops developing or does not implant.
- Problems with egg retrieval or embryo transfer.
Your doctor will be able to examine each step of the process with you and determine how best to proceed with future treatments.
What is the best age to get IVF
Research shows that your chances of getting pregnant or having a live birth after IVF treatment decrease starting at the age of 35. The success rate drops significantly after the age of 40.
Should embryos be frozen during IVF treatment.
Cryopreservation of the fetus is carried out as part of the IVF process.
Some people choose to freeze and store embryos so that they can have another chance to get pregnant.
Additional embryos can be frozen and stored for several years, although not all of them will survive the freezing-thawing process.
