Do the words “in vitro fertilisation” (IVF) make you shudder? Well, there’s nothing to fear as IVF has been around for 40 years and is now commonly used around the world to help bring healthy babies into the world.
Medical interventions and technologies are now frequently used in all types of medical procedures and IVF is just one of them that can contribute to a happy outcome.
IVF literally means “fertilisation in glass”, except that today it is no longer in glass, but in plastic. The process involves fertilising the egg with sperm in an incubator outside the body, then transferring the best embryo into the woman’s womb. The whole process, up to the embryo transfer stage, generally takes three to four weeks.
If, after an initial consultation (test and diagnosis), your specialist determines that IVF is the best solution for you, then you will find below the 8 stages of IVF treatment:
- Stage 1: Start of treatment
- Step 2: Ovarian stimulation
- Step 3: Starting the injection
- Stage 4: Egg retrieval and sperm collection
- Stage 5: Fertilisation (insemination) and embryo development
- Stage 6: Embryo transfer
- Stage 7: Luteal phase
- Stage 8: Pregnancy test
Here are the step-by-step details:
Stage 1: Start of treatment
During a regular menstrual cycle, pituitary hormones – luteinising hormone (LH) and follicle-stimulating hormone (FSH) – work together to grow and release an egg from a fluid-filled follicle in the ovary. While many follicles begin to grow each month, only one will become mature enough to ovulate. Ovulation (the release of the egg from the ovary) is triggered by an increase in LH about two weeks before the start of menstruation.
On the other hand, during an IVF cycle in Spain, it is desirable for several eggs to mature at the same time thanks to injections of FSH, with a trigger injection, given to mature the developing eggs before retrieval. Hence the need for “pituitary suppression”.
There are different forms of IVF treatment: with pituitary suppression before the start of stimulation (sometimes called “long down regulation”), and with pituitary suppression after the start of stimulation (sometimes called “antagonist cycle”).
Your treating specialist will have selected the type of cycle best suited to your individual needs.
Your fertility co-ordinator will provide you with detailed information about your specific treatment cycle, including timing and medication. He or she will also show you how to administer your daily FSH injections and give you instructions for any other medication you may need during your treatment cycle.
Step 2: Ovarian stimulation
This stage involves stimulating the ovaries with medication to encourage the growth of follicles containing eggs. This stimulation is achieved by daily injections of FSH for 9 to 14 days. The dose of FSH used is slightly higher than that produced naturally by the woman – in the hope of stimulating the growth of several follicles.
The response of the ovaries is monitored by ultrasound scans and regular blood tests. Most women learn to administer their own injections, or their partner can help them, reducing the number of visits to the clinic.
Stage 3: Triggering the injection
The ovarian stimulation phase ends when ultrasound scans show that the number and size of follicles are adequate. The injections of FSH and GnRH agonist/antagonist (pituitary suppressor) are then stopped. Once your fertility co-ordinator has confirmed the timing of the theatre procedure, he or she will tell you the exact time to give your induction injection. This is an injection of human chorionic gonadotropin (hCG) to promote final maturation of the egg and detach it from the follicular wall.
The egg is retrieved on the second morning after the final injection (34-36 hours later). The time of the trigger injection is crucial, so make sure you note it carefully with your instructions.
Stage 4: Egg retrieval and sperm collection
Your specialist will then proceed to retrieve or ‘collect’ the eggs under light sedation. This involves passing an ultrasound-guided probe, to which a fine needle is attached, through the vaginal canal and into each follicle of the ovary. The liquid contained in the follicle is then extracted into a test tube and studied under a microscope for eggs.
This procedure takes between 20 and 30 minutes, depending on the number of follicles that have developed. After the eggs have been retrieved, you will rest for an hour before going home. The city’s fertility centre recommends that patients take a day off work and avoid strenuous exercise.
On the day of the egg collection, your partner will be asked to produce his sperm sample. Men’s toilets are available at each City Fertility Centre clinic. If you and your partner have any concerns about the collection of the sample, please discuss them with the staff before starting your cycle. It is possible to produce the sample at home and bring it to the clinic, or to freeze one of your partner’s sperm samples as a reserve.
Step 5: Fertilisation (insemination) and embryo development
The sperm sample is washed and concentrated, then added to the eggs approximately four hours after collection. The sperm and eggs are placed in an incubator overnight and the eggs are examined the next day for signs of fertilisation. In general, 60-70% of eggs are fertilised if the sperm sample appears normal.
An embryologist will contact you to discuss the results of the fertilisation and any questions you may have. The fertilised eggs are then kept in the incubator for a further 48 hours.
Your treating specialist may suggest intracytoplasmic sperm injection (ICSI) as part of your treatment if sperm quality is poor (sperm count, morphology or motility). ICSI is a specialised form of male infertility treatment and involves injecting a single sperm directly into a single mature egg.
Stage 6: Embryo transfer
Embryo transfer takes place two to five days after egg retrieval. The embryo chosen for transfer is inserted into a thin plastic catheter (a flexible tube), which is passed through the cervix into the uterus and gently released. The process itself takes just a few minutes and is generally painless.
Generally, only one embryo is transferred, or two in exceptional cases – this depends on your personal situation and the quality of the embryo.
After transfer, some of the remaining embryos may be suitable for vitrification (quick freezing), and this option is available to all patients undergoing IVF treatment in Turkey or Spain, or even in Cyprus for PGD IVF.
Frozen embryos can be used in subsequent cycles if the first was unsuccessful. In order to be frozen, the embryos must not show any signs of abnormal/slow development or fragmentation (cellular decomposition).
Stage 7: Luteal phase
The luteal phase is the two-week period between the embryo transfer and the pregnancy test. During this time, it is important that you take care of yourself and maintain your health and well-being. You will be encouraged to limit any strenuous activity for 24 hours after the transfer.
The progesterone medication you start taking after egg retrieval can sometimes cause fatigue, nausea, cramps and bloating. You may choose to take a painkiller if you feel any discomfort. If you are concerned about any symptoms, contact your fertility centre and speak to a fertility co-ordinator.
Vaginal bleeding may occur before the pregnancy test, but this does not always mean that the treatment has failed. You should continue to use the treatment medication until your full period begins and/or you and your specialist have received the results of your blood test.
Step 8: Pregnancy test
Your pregnancy blood test should be taken approximately 14 days after the embryo transfer. Your nurse will telephone you with the results and advise you on the next steps on your journey to delivery.
We recognise that the period between your embryo transfer and your pregnancy test can be emotional and anxious. We understand that this can be a difficult time and encourage you to call your clinic for help if you are struggling to cope with the stress of waiting. Access to professional counselling is also available as part of your IVF treatment.
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