In Vitro Fertilization (IVF)
In Vitro Fertilization (IVF) is a procedure designed to improve fertilization. Eggs are surgically removed from the ovaries, fertilized with sperm in a laboratory, and allowed to grow before being inserted back in the woman’s uterus. IVF techniques are used when medical conditions prevent the sperm from reaching the egg due to blocked or damaged fallopian tubes; or if a man has low sperm quantity or quality which reduces the chance of fertilization.
IVF is appropriate for you if you have a t-shaped uterus, absent or non-surgically repairable fallopian tubes, endometriosis and have not been able to achieve pregnancy after medical or surgical treatment, or dysfunction of the ovaries and have not been able to achieve pregnancy after inducing ovulation regularly. It is also appropriate for couples who are experiencing unexplained infertility or for couples wherein the male partner has severe infertility due to a low sperm count, a congenital absence of the tube that carries sperm from the testicles to outside the penis, a failed vasectomy reversal or a history of anti-sperm antibodies.
In Vitro Fertilization consists of 4 phases:
1. Ovarian stimulation
To increase the possibility of pregnancy, several eggs must be obtained in a single cycle which is achieved by administering hormonal injections to stimulate follicles and to simultaneously produce more than one healthy and mature egg. This procedure generally lasts from 8 to 12 days depending upon the response of the patient and during this time, various ultrasound scans are performed to monitor the growth and development of the eggs.
2. Egg retrieval
The second phase consists of retrieving the eggs from the ovaries. With the use of a transvaginal injection, only the mature eggs are aspirated and their quality is analyzed under a microscope in a laboratory. The intervention, performed under anesthesia, usually lasts for about 15 minutes and after a recuperation period of 30-40 minutes, the patient can leave.
3. Fertilization in the Laboratory
The next step involves preparing an either fresh or frozen semen sample for fertilization to take place. This is done in the laboratory immediately after egg collection where the sperm and egg are placed in a petri dish and are left to unite using a special culture medium. This technique is known as insemination by a conventional IVF method. If there are not enough sperm, or if the sperm is of not so good quality, an ICSI technique is used whereby one sperm is injected directly into the egg to enable fertilization to occur.
Once insemination takes place, the eggs are cultured in an incubator with special environmental controls which are conducive to fertilization and embryo development. The embryos remain in culture for 3 days but if further monitoring is required, this period is extended to the 5th or 6th day, known as the blastocyst stage.
If the embryos have a thick membrane, the doctor may recommend assisted hatching which facilitates the embryos to break through their outer shell and attach to the lining of the uterus for implantation to occur.
4. Embryo transfer
The last phase of an IVF treatment is the transfer of embryos. After fertilization and embryo development, 1 or 2 embryos are placed into the woman’s uterus using a catheter and without anesthesia. The number of embryos that are transferred is determined by the age of the patient, the quality of the embryos and other related factors. Any remaining embryos are frozen for future use.
Two weeks after the transfer, a pregnancy test is performed. If the result is positive, your doctor will continue to monitor you until the presence of a heart beat in the fetus, after which you will be referred to your obstetrician.