In Vitro Fertilization (IVF)

In vitro fertilization is one of the most popular fertility treatment methods. The words “in vitro” refer to processes or reactions that occur in the laboratory. Therefore, in vitro fertilization means laboratory fertilization. During IVF, the male sperm cell fertilizes the female egg cell in a laboratory dish. Then, one or more fertilized eggs will be transferred to the female’s uterus. These transferred eggs will eventually develop to become an embryo.

IVF increases the chances of a successful pregnancy but it comes with a few disadvantages. Some of these disadvantages include side effects that occur due to fertility medication and invasive procedures. The chance of having twins and triplets is also higher than with a normal pregnancy. Ectopic pregnancies (pregnancies where the embryo develops outside the uterus) and premature birth can also occur, but the risk is lower than with other fertility treatment options.

Treatment duration

IVF has several steps that occur within the span of a few weeks. If the treatment progresses smoothly, it should take around 3 weeks.

Paraclinical tests required for in vitro fertilization

Before your doctor recommends IVF as a fertility treatment option, they will prescribe a few blood and imaging tests to figure out what the cause of infertility is.

Preoperative care, the procedure, and postoperative care

Before the procedure

The most important thing that you must take care of is you and your significant other’s mental well-being. This treatment has many complicated, long, and costly steps and it does not always result in pregnancy. You must not let that demotivate you.

Stay away from cigarettes as much as possible. If you are overweight, losing some weight can have a positive effect on the results.

The in vitro fertilization procedure

Educating the patient

First, your doctor will familiarize you with the procedure, its benefits and potential risks. If needed, you will also be educated on how to inject medication at home.

Stimulating the ovaries

This involves the use of fertility medication to control ovulation and increase egg production. The type of medication used depends on the cause of infertility and the doctor’s recommendation. First, you are prescribed a drug that stops your body’s natural ovulation cycle. Then, you must start injecting a drug that contains the “FSH” hormone. This hormone stimulates the maturation of egg cells in your ovaries. After a few days, your doctor will use ultrasound to find developing eggs in your ovaries. A blood test can also help us analyze your hormone levels. Your doctor might increase or decrease your dose of FSH depending on the results.

The goal of this step is to get at least two mature eggs, although it usually results in more than two. When the blood tests and ultrasound show that you are ready, you will be injected with the “hCG” hormone which will make you start ovulating. The eggs will be free from their follicles around 36 hours later. Your doctor may prescribe other drugs such as leuprolide to stimulate the ovulation.

Retrieving the eggs from the female and sperm from the male

The egg retrieval process begins 36-38 hours after the hCG injection. The doctor inserts an ultrasound probe into the vagina and uses a needle to take the eggs. This takes around 15-30 minutes. Afterwards, you will be under supervision for a while and then you can return home. The male will provide the sperm and it will be sent to the laboratory.

Fertilization and primitive embryo development in the lab

The eggs and sperm are combined in a lab dish so that the sperm could fertilize the egg, approximately 50% will be fertilized. If the sperms’ shape and movement are extremely unnatural, another method where the sperm is directly injected into the egg will be used.

Transferring the embryo

Approximately 2-5 days after fertilization, the doctor will use a thin flexible tube to transfer one or more fertilized eggs to the uterus. The doctor will do this gently to avoid uterus cramping because an aggressive transfer could decrease the chance of success. Progesterone can help the embryo implant in the uterus, this is why most doctors prescribe it to patients after the transfer. The remaining eggs will be frozen in case the procedure will not be a success.

After the procedure

You might experience bloating, nausea, vomiting, and swelling in the stomach after taking the hormones that stimulate ovulation. This is completely normal. It happens because the ovaries become larger. However, if you experience severe stomachache and a lot of vomiting, do not hesitate to inform your doctor. This could be due to a condition called “ovarian hyperstimulation syndrome” in which there is an overproduction of eggs in the ovaries. Don’t underestimate these symptoms as they might cause dehydration, a deficiency in electrolytes,  and the formation of blood clots. After the retrieval of the eggs, you may experience bleeding and stomach pain. Immediately go to the hospital if these symptoms exacerbate.

Around 2 weeks after the embryo transfer, you will have to get a blood test to measure blood hCG levels. If the results of this test are positive and your blood hCG levels are on the rise, you’ll need to get a sonogram (ultrasound). The sonogram will will be done 4 weeks after the transfer and the doctor will be looking for signs of pregnancy.

Important notes regarding in vitro fertilization

IVF is an invasive and expensive procedure and in most cases is not the doctors first choice of fertility treatment. However, it is useful in the following cases:

• Women who lack a fallopian tube or whose fallopian tube was closed due to infection or other reasons. The fallopian tube plays an important role in moving the the egg from the ovaries to the uterus.
• Sterile men such as those who have a low sperm count or whose sperm does not move very well. Another cause of sterility could be sperm that does not leave the testicles and therefore cannot make contact with an egg.
• Old age and failure of fertility induction therapies
• Endometriosis and ovulation disorders that did not respond to primary therapies.
• Women who suffer from ovarian failure that cannot produce eggs at all. These cases would require a donor egg from another woman.