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In Vitro Fertilization Guide
The Female Body
|What Is The Process For IVF?
IVF is a complicated technical process that takes several weeks and many sleepless nights to complete. You will start by injecting yourself with powerful infertility drugs to stimulate your ovaries to produce more eggs. You will need to take lots of time out of your regular routine to have regular ultrasound scans, blood tests and to undergo minor surgery to have your eggs retrieved. And that's only the beginning! After this your partner will have to provide a sperm sample. His sperm is mixed with your eggs in the lab and incubated for a few days. Another minor surgery is performed to place the embryos in your womb, and then there is a two week waiting period before you can test for pregnancy. This is referred to as one complete IVF cycle. If it fails, you need to repeat the cycle all over again (although you might be able to skip the egg retrieval part if your surgeon extracted extra eggs on the first cycle). Even then, there are variations in the IVF process. Extra assisted reproduction technology (ART) may be combined with IVF to increase the chance of conception. This includes ICSI procedure, egg donation or sperm donation. Obviously the more procedures used, the higher the cost of an IVF cycle. Before starting your procedure, be sure to read about IVF preparation as well as IVF costs.
6 Steps: IVF Process
The following are the six basic steps in the IVF process:
1. Fertility Medications
Ovulation Induction: Infertility drugs are prescribed to boost your egg production levels. Normally a woman produces one egg a month during her menstrual cycle. By boosting production levels so that many eggs are produced at once, it increases your IVF success rates. This is because not all eggs will fertilize or grow after retrieval. Which type of medications you are prescribed depends on which IVF protocol you are following. IVF protocols are just a fancy title for treatment plans, and they can vary according to the cause of infertility. Most drugs have to be taken by injection every day for about 10 days. You will be trained by your fertility clinic how to self-inject. You will be monitored by the clinic every few days with blood tests and ultrasound scans to see how you are reacting to the medications. At any point your dosage can be increased or decreased. At the end of the 10 or so days you will be told to take a HCG (human chorionic gonadotropin) injection. This injection 'tells' the eggs when to mature and release. The timing of this single injection is very important, it is given 32 to 36 hours before egg retrieval. Giving a HCG injection allows clinics to plan surgeries in their own time rather than waiting for the woman's body to release the eggs naturally. This means you could be injecting yourself at 2am in the morning or 3pm in the afternoon, depending on your scheduled surgery time.
2. Egg Retrieval
Egg retrieval is a minor surgery (also called follicular aspiration) that is carried out under anesthesia. The surgeon inserts a vaginal ultrasound probe into your vagina (picture). It has a long hollow needle on top which the doctor guides, using the ultrasound, to your ovaries. Once in place it sucks the eggs out, one at a time. The process takes about 30 to 40 minutes and you may experience some light cramping when you wake up. Some women also complain of a feeling of 'fullness' for several weeks. You may also develop bright red vaginal spotting caused by puncture wounds in the vagina. If this lasts longer than 48 hours or develops into bleeding, contact your clinic straight away.
3. Sperm Collection
While you are recovering from your surgery your partner will be asked to provide a semen sample. The sperm are 'washed' and counted, ready for fertilizing the eggs.
The sperm and eggs are placed in a petri dish (small shallow plastic dish) and combined in a culture medium. They are placed in an incubator to allow fertilization to occur. If there is a low probability that the sperm will fertilize the eggs (perhaps due to male infertility issues) then intracytoplasmic sperm injection (ICSI) may be used. This is where a single sperm is injected directly into the egg, saving it the hassle of trying to force its own way in! The eggs are checked after 18 hours for signs of fertilization and after 48 hours they should have started growing into an embryo and be ready for transfer. If fertilization fails at this stage, the couple may need to consider an egg donor, sperm donor or even embryo donation for future cycles.
4a. Pre-implantation Genetic Diagnosis (PGD)
If the parents are worried about passing on a genetic disorder to their children, they can ask for a pre-implantation genetic diagnosis (PGD). This involves extracting a cell from the developing embryos and testing them for signs of the disorder. It can test for 20 diseases including cystic fibrosis, Huntington's disease, Tay-Sachs disease, Duchenne muscular dystrophy and hemophilia A. It can reveal chromosome abnormalities indicating Down syndrome, but it doesn't eliminate the need for Down syndrome testing when the mother is pregnant. See also, how important is genetic screening for IVF babies?
5. Embryo Transfer
The embryos can be transferred anytime between 1 and 6 days after insemination, but normally they are transferred at 3 days (read more about day 5 embryo transfer). The remainder can be frozen for up to 5 years to use in other IVF cycles. During the embryo transfer process the embryos are loaded into a long thin tube called a catheter, which is inserted through the vagina into the uterus. When the catheter is as close as possible to the womb, the embryos are expelled and hopefully will start to stick to the womb (implant, picture). Assisted hatching is an optional extra treatment (which you need to pay for) that may help increase the chance of implantation.
6. Waiting Game Begins
Next, the waiting game begins. You will need to wait 12 to 14 days before performing a pregnancy test. In this time you will no doubt watching for early pregnancy symptoms. You must avoid sexual intercourse, hot baths, sunbathing, swimming, strenuous exercise, caffeine, alcohol and smoking to give implantation the best chance. If your test is positive, congratulations, exciting times ahead! If it negative, try not to despair. It takes 3 IVF cycles on average to fall pregnant. Ideally you should take 1 to 3 months off before trying again, in order to allow your body time to recover.
Questions and answers you may find useful at this point:
What are the early signs of pregnancy before a missed period?
Is it possible to be a little bit pregnant?
What are the signs of a miscarriage?
How many IVF cycles are average before becoming pregnant?
If your eggs fail to fertilize: What is egg donation?
How Many Embryos Can Be Transferred?
The more embryos that are transferred the higher the risk of multiple pregnancy and miscarriage. For this reason most clinics do not allow women under 30 to transfer more than 2 embryos. Between 30 and 35 they allow 3 embryos, and 4 embryos after 35 and up to 6 or more if you are aged over 40. In England you are only allowed to transfer 2 embryos if you are under the age of 40.