How Does IVF Work? Step-by-Step Procedure

Why Is IVF Performed?

An IVF procedure is performed for multiple reasons; infertility being one of the most significant reasons. Couples also opt for this procedure when one of them has an existing underlying health condition. It is also an option for same-sex couples or single people who would wish to have a baby without a partner.

IVF is an option if you or your partner has:

• A major health condition like epilepsy, cerebral palsy, cancer, etc.

• If the maternal age is advanced

• Blocked or damaged fallopian tubes

• Endometriosis

• Low sperm count

• Sperm impairment

• Polycystic ovary syndrome (PCOS)

• Ovary impairment

• Uterine fibroids

• Problems with uterus

• Risk of passing on a genetic disorder to the foetus

How Long Is the IVF Procedure From Beginning to End?

IVF is a complex process consisting of numerous steps that can take around four to six weeks to complete. This includes the time before egg retrieval during which a person takes fertility medication until they are tested for pregnancy. The procedure starts with various tests that comprehensively evaluate your fertility and overall health. Fertility treatment can only begin after completing the initial fertility testing, which involves a detailed medical examination checking for any potential genetic problems to high thyroid or blood sugar levels. Certain medical conditions may require lifestyle modifications to make it easier for you to conceive, which can add to the timeline. However, such changes can make all the difference in the end.

• Comprehensive blood work

• Genetic carrier screening

• Trans-vaginal ultrasound to assess ovarian reserve

• Evaluations of the uterine cavity (SHG) and fallopian tubes (HSG)

• Semen analysis and blood work for the male partner, if applicable

What Are the Steps of IVF Treatment?

Once the diagnostic testing is done, the IVF treatment begins. The steps of IVF treatment can be divided into four stages.

Stage 1: Oral Contraceptives

Before starting the treatment, your doctor may prescribe birth control pills or estrogen to stop the development of ovarian cysts and control the timing of your menstrual cycle. By doing so, it will allow your healthcare provider to control the treatment and maximize the number of mature eggs during the egg retrieval procedure. Some people may be prescribed a combination of birth control pills that contain both oestrogen and progesterone, while others may be given oestrogen alone. Research has shown that taking oral contraceptives before ovarian stimulation can increase the number of eggs available for retrieval, promote the growth of follicles as a cohesive group, and improve ovarian health throughout the IVF process.

Stage 2: Ovarian Stimulation

In a typical natural cycle for a healthy person of reproductive age, a group of eggs begins to mature every month, but only one egg is usually mature enough to ovulate. The rest of the immature eggs in that group disintegrate. During an IVF cycle, you will take injectable hormone medications to encourage all the eggs in that cycle to mature simultaneously and fully. This means you may have multiple eggs instead of just one, like in a natural cycle. The type, dosage, and frequency of medications prescribed will be personalised based on your medical history, age, AMH (anti-Mullerian hormone) level, and your response to ovarian stimulation during previous IVF cycles. The other steps in the ovarian stimulation process include:

• Monitoring: Your ovaries’ response to the medications is monitored daily or every few days over 2 weeks by ultrasounds and blood hormone levels. Most stimulations last between eight and 14 days. At monitoring appointments, healthcare providers use ultrasound to look at your uterus and ovaries. The eggs themselves are too small to be visible with ultrasound. But, your healthcare providers will measure the size and number of growing ovarian follicles. Follicles are little sacks within your ovaries that should each contain a single egg. The size of each follicle indicates the maturity of the egg it contains. Most follicles greater than 14 mm contain a mature egg and those less than 14 mm are more likely be immature and won’t fertilize.

• Trigger shot: When your eggs are ready for final maturation (determined by your ultrasound and hormone levels), a “trigger shot” is given to finalize the maturation of eggs in preparation for egg retrieval. You’ll be instructed to administer the trigger shot exactly 36 hours before your scheduled egg retrieval time.

Stage 3: Egg Retrieval

At this stage, the eggs are removed from the ovarian follicles. Your doctor will use an ultrasound to guide a thin needle into each of your ovaries through your vagina. The needle is connected to a suction device used to pull your eggs out of each follicle. The eggs once removed are placed in a dish containing a special solution, and the dish is then placed in a controlled environment or an incubator. To minimise discomfort during the procedure, medication and mild sedation are used. Egg retrieval is scheduled 36 hours after the last hormone injection, the "trigger shot."

Stage 4: Embryo Transfer

The following afternoon after your egg retrieval procedure is completed, the embryologist will try to fertilise all mature eggs using intracytoplasmic sperm injection, or ICSI. This means that sperms will be injected into each mature egg. On average, around 70% of mature eggs will fertilise. For instance, if 10 mature eggs are retrieved, about seven will fertilise. If fertilisation is successful, the fertilised egg will develop into an embryo. If there are an exceedingly large number of eggs or you don’t want all eggs fertilized, some eggs may be frozen before fertilization for future use.

Embryo Development

After being carefully monitored in the IVF lab, the embryo will be transferred back to the uterus on Day 5, which is considered Day 0, the day of egg retrieval. The embryo transfer is a painless procedure and you will remain awake throughout the procedure without requiring any anaesthesia. A speculum is placed within the vagina, and a thin catheter is inserted through the cervix into the uterus. A syringe attached to the other end of the catheter contains one or more embryos. The embryos are injected it the uterus through the catheter. The procedure typically takes less than 10 minutes.

Pregnancy

Pregnancy occurs when the embryo implants itself into the lining of your uterus. Following the transfer, there will be a waiting period of 9-10 days to check if the embryo has successfully implanted in the uterus. Your healthcare provider will use a blood test to determine if you’re pregnant. The duration of the waiting period may vary depending on the maturity of the embryo at the time of the transfer.