An Overview of the IVF Process

Beginning IVF (in vitro fertilization) can often seem overwhelming and the process filled with uncertainty. Remembering your goal of a healthy baby can help you to understand that though complicated the process does have purpose.
It is important for both parents and surrogates to have a clear understanding of how the IVF process works before entering into it. We have given a basic overview of both the process and the risks involved to help you along your way.

The term IVF stands for in vitro fertilization which is actually Latin meaning ‘in glass’; IVF is an assisted reproductive technology (ART) that is done through the process of extracting eggs, retrieving sperm and them combining both in a laboratory dish to create an embryo which is then transferred to the Uterus. IVF is often the last hope for individuals and couples who are not able to conceive through conventional ways or are unable to carry a child. It has given new hope to the birth of families over the last few decades.

Once combined the egg and sperm are then monitored through the fertilization process where successfully fertilized eggs will become embryos. These embryos are then examined, tested and often frozen to prepare for transfer.

An IVF ‘cycle’ is how we describe one round of IVF treatment, which begins on the first day of your menstrual cycle and lasts on an average of 6-8 weeks. It is important to remember that IVF is not a treatment but a series of procedures that the woman must go through both before and after transfer.

In some case during the cycle before transfer the woman may be put on birth control pills, this has been shown to help improve the odds of success and it may help decrease the risk of such things as ovarian cysts. Birth control is just one of many options available, a woman may also be asked to track her ovulation through such things as ovulation kits and basal body temperature charting; In this situation the fertility clinic will want to be notified once ovulation is detected and the woman may be put on a GNHR antagonist or agonist depending on the specific case. These are usually in the form of an injectable substance, but other forms may be given such as nasal spray or implant. The purpose of these medications is to allow the doctor control over the woman’s ovulation in order to increase the IVF success rate.

The first day of your IVF cycle is the first day of your menstrual cycle. Woman going through IVF will be on medication before the beginning of their cycle so this can be confusing.

If egg retrieval is being done then fertility medications are prescribed to help stimulate egg production. A transvaginal ultrasound will be given to look at your ovaries along with blood tests to check hormone levels. Ovaries typically only produce one egg; the medication is given to help boost the natural levels of hormones in your body to encourage the follicles in your ovaries to produce more eggs. In most cases the medications used is either follicle-stimulating hormone (FSH) or luteinizing hormone (LH) but other medication may be given more specific to your body and treatment plan.

Eggs are retrieved through a surgical procedure where a needle is guided by ultrasound through the cervic to remove the eggs. Medication is often given to help with the discomfort, and you may be put to sleep. The procedure takes about 20 minutes, resulting in an average of 8-15 eggs. Some cramping and spotting are common following the procedure.

In this step the male is asked to produce a sample of his sperm which is them prepared for combining with the eggs.

In this process the eggs and sperm are mixed together in a laboratory dish to help encourage fertilization. In cases where there is a less likely chance of natural fertilization a procedure called intracytoplasmic sperm injection (ISCI) may be used where a single sperm is injected directly into the egg in order to increase the chance of fertilization. Once mixed the eggs are monitored to confirm fertilization and once fertilized they become embryos.

Once fertilized the embryos are put into an incubator where the conditions for growth and development are perfect. The embryos are then monitored over the course of the next 3-5 days to look at cell development.
A healthy embryo has a two- to four-cell embryo on day 2 and a six- to eight-cell embryo on day 3. Unfortunately, not all fertilized eggs will reach the ideal stage for transfer, some may not mature and in other cases the sperm may not be strong enough.

Embryos are usually transferred to the woman’s uterus three to five days following egg retrieval and fertilization, however in some cases the embryo may be frozen to wait for the woman’s body to be in the optimal position for transfer which is usually the case when the embryos are PGS/PGD tested to check the health of the embryos.

In the transfer procedure a small catheter is inserted into the uterus to transfer the embryo(s). this procedure is painless for most women although it may be followed by some minor cramping. Successful transfer results in implantation.

Around two weeks after your embryo transfer you will have a blood test to check your HCG levels in the hopes of confirming pregnancy. The clinic will let you know when this needs to be done.

If you find yourself pregnant after the pregnancy test, depending on the clinic you may be monitored by the clinic itself or be transferred to a doctor closer to home for monitoring. Many clinics will monitor you through the first trimester to ensure success.

If the IVF cycle was unsuccessful the clinic will work with you to make a schedule to begin a new cycle.