A Comprehensive Guide to IVF Treatment: From Start to Finish

In vitro fertilization (IVF) stands as the world’s most effective and widely performed infertility treatment. Despite its prevalence, many individuals are unfamiliar with the intricacies of IVF. The following information serves as your introductory guide, shedding light on the steps involved in this assisted reproductive technology (ART).

Understanding the IVF Process and Timeline

IVF is a meticulously planned sequence of procedures designed to fertilize an egg outside a woman’s body, typically undertaken when conventional methods of conceiving have proven unsuccessful. The journey begins after comprehensive fertility tests and diagnosis. During a consultation with your healthcare provider, you’ll outline your IVF protocol, including ovarian stimulation, fertilization methods, embryo testing, fresh or frozen embryo replacement, and hormonal support for the luteal phase. The cycle’s start date and any necessary medications will be discussed and finalized, typically taking between 2 to 6 weeks, depending on your menstrual cycles and clinic scheduling.

Before commencing ovarian stimulation, some protocols involve taking oral contraceptives or other medications for 2 to 4 weeks. Ovarian stimulation typically spans 10-11 days. Once your follicles and hormone levels are deemed suitable, a “trigger” injection is administered, followed by egg retrieval 34-36 hours later. Embryos are nurtured in the laboratory for around 5 to 6 days before embryo replacement or cryopreservation. Subsequently, the luteal phase spans approximately two weeks, concluding with a pregnancy test.

The duration of an IVF cycle can range from as little as 4 weeks (for cases where embryos are frozen) to approximately 14 weeks, contingent upon your specific circumstances, menstrual cycle, and clinic scheduling.

Preparation for an IVF Cycle – Testing and Ovarian Stimulation

Before embarking on IVF, an evaluation of the uterus and fallopian tubes is essential to identify any issues necessitating surgical correction. Pre-cycle testing encompasses hormonal assessments for thyroid function and ovarian reserve, screening both partners for sexually transmitted infections, and a semen analysis for the male partner.

Most women receive fertility medications for ovarian stimulation over 8-14 days, with an average of 10-11 days. Ovarian stimulation encourages the maturation of multiple eggs for retrieval. Even in cases of normal ovulation, fertility drugs are administered to increase the egg count, as higher egg numbers improve the chances of successful fertilization. Typically, 10-20 eggs are retrieved for IVF, but not all are viable due to maturity concerns.

Your healthcare provider tailors the protocol to maximize egg production while safeguarding against ovarian hyper-stimulation syndrome (OHSS). Fertility drugs for IVF are typically administered through injections, and your progress is closely monitored through hormonal tests and vaginal ultrasounds.

Once an ultrasound confirms an adequate number of mature follicles and the right estrogen level, a trigger shot of hCG or other medication is given to initiate egg maturation, ensuring their readiness for fertilization.

Egg Retrieval

Egg retrieval takes place 34-36 hours after the trigger shot, before the eggs naturally ovulate. This surgical procedure involves guiding a small needle through the vagina, using ultrasound for precise navigation. Sedation via intravenous administration ensures your comfort and safety throughout the procedure, supervised by an anesthesiologist.

During egg retrieval, the follicular fluid is gently suctioned to extract the eggs. This process typically lasts less than 30 minutes and may result in minor cramping, which typically subsides within a day. You may experience a sense of fullness or pressure due to enlarged ovaries, a condition resulting from ovarian stimulation, which may persist for a few weeks.

The retrieved follicular fluid, containing the eggs, is collected in test tubes and delivered to an embryologist who identifies and records details of each egg. The number of eggs retrieved depends on factors such as age, ovarian reserve, response to stimulation, and accessibility of the ovaries.

Fertilization

Upon reaching the laboratory, eggs undergo assessment to determine their maturity and quality. Mature eggs are placed in a specialized culture medium, incubated, and fertilized with sperm within hours of retrieval. Fertilization can occur through conventional insemination or intra-cytoplasmic sperm injection (ICSI), chosen by the IVF team based on various factors. Both methods yield similar success rates, with ICSI employed when factors like poor semen quality or prior IVF failures are present.

For conventional insemination, sperm and eggs are placed together in a petri dish, allowing sperm to penetrate the egg naturally. In contrast, ICSI involves injecting a single sperm directly into the egg using a fine needle and precise microscope guidance. Regardless of the method, fertilization is assessed the following day.

Embryo Transfer

Following fertilization, you, along with the IVF team, decide on the timing of embryo transfer, typically occurring 3-5 days after egg retrieval for fresh embryo transfer. If preimplantation genetic testing (PGT) is planned, a biopsy is conducted on day 5 or 6, with embryos frozen for future transfer. Once genetic test results are received, a healthy embryo is selected, thawed, and transferred into the uterus, generally within 1 to 2 months after egg retrieval.

The number of embryos produced varies, often influenced by the woman’s age. To enhance success rates while minimizing risks, single embryo transfer is recommended, especially if PGT confirms normalcy.

A soft, flexible catheter is employed to transfer the embryo into the uterus under abdominal ultrasound guidance. The process is typically painless, likened to a pap smear, with any discomfort being rare. Remaining good embryos are frozen for potential use in subsequent cycles or additional family planning.

Assisted Hatching

Assisted hatching is occasionally employed for older women, couples with prior IVF failures, or frozen/thawed embryos. This micromanipulation procedure involves creating a small hole in the embryo’s flexible outer shell, aiding implantation. While it’s not definitively proven to enhance live birth rates, it may carry minimal risks. If used, assisted hatching is performed just before embryo transfer.

Pregnancy Test

Around 12 days post-embryo transfer, a blood pregnancy test is conducted to confirm pregnancy. Subsequent blood tests and ultrasounds monitor viability and, if applicable, the possibility of a multiple pregnancy. Assuming a normal progression at 9-10 weeks, you’ll be referred to your obstetrician, entering the next phase of your journey towards parenthood.