Fertility treatment – Steps in the IVF process

Fertility treatment – Steps in the IVF process

There are a number of steps in the IVF process:

Initial consultation

In your first consultation with a physician, which is the first step in the IVF process, the doctor has the opportunity to learn more about your medical history and to prepare a personalized IVF treatment plan that addresses your specific goals and maximizes your chances of succeeding. After comprehensively testing your hormone levels on the third day of your cycle and after additional initial testing has been done, your doctor will start preparing you to start an IVF cycle.

Stimulation of the ovaries

Typically, a woman produces a mature egg once a month in the menstrual cycle. Fertility drugs signal the ovaries to increase egg production and produce more eggs. This process of stimulation may take seven to ten days, during which your doctor will monitor the progress of your fertility treatment using ultrasounds to examine the ovaries and will do blood tests to monitor your hormone levels.

Egg retrieval

When the eggs are ready for extraction from the woman’s ovaries, a short procedure must be performed at the egg extraction clinic. This is done under general anesthesia to ensure that the patient is comfortable. Most women are able to go home after a few hours.

On the same day, the partner to the procedure will provide a fresh semen sample to the lab. In the case of frozen semen from a donor, the clinic will test this sample before the retrieval gets under way. After aspiration of the eggs, the patient must start taking the hormone progesterone to prepare the uterus for implantation of the embryo. Implantation will take place 5-6 days later.

Embryo development

The role of embryologists working in an IVF lab is to combine the sperm and the eggs in order for fertilization to take place. Fertilized eggs, at this stage already called “embryos” and are transferred to laboratory incubators in order to continue to develop. The sperm fertilizes the egg a few hours later. If the embryologist thinks that the chances of fertilization are low, the sperm can be injected directly into the egg. This process is called an “intracytoplasmic sperm injection (ICSI)”.

Embryo selection

The embryologists in the IVF lab regularly monitor your embryos to make sure that they are growing properly. Within about five days, a normal embryo develops into many cells that actively divide. At this point, individuals or couples who are at risk of transmitting a genetic disorder to their child or women or have a history of IVF failures or miscarriages may consider undergoing genetic testing (Genetic diagnosis before transferring the embryos to the uterus – PGS and PGD).

The embryologists will then evaluate the quality of the embryos and determine which are the healthiest.

Embryo transfer

For someone who meets the criteria for treatment, the popular recommendation is to transfer a single carefully selected healthy embryo. This is the first choice that needs to be made by the couple because it is known that transferring multiple embryos is associated with multiple pregnancies, which are high-risk pregnancies, compared to transferring only one embryo that has the best chance of a healthy pregnancy. This recommendation changes as the woman’s age increases as the chances of conceiving diminish. In this case, transferring more than one embryo is recommended in order to increase the chances of conception.

Three to five days after extracting the eggs and the fertilization, the embryos are transferred back to the woman’s uterus. This procedure takes place in the clinic using a catheter that is inserted through the cervix. Most women are able to return to regular activity the following day. If an embryo attaches itself to the endometrium and grows, it results in pregnancy. All unused embryos can be frozen for transfer in the future.

After the transfer

To help thicken the endometrium in order to make it easier for the embryo to implant, progesterone treatment usually continues for two weeks after the embryo has been transferred. A blood test to confirm pregnancy is performed a few days after the embryo is transferred. If the pregnancy is confirmed, progesterone should usually continue to be taken for another three to four weeks until the placenta begins to produce enough progesterone to support the pregnancy on its own. If there is no pregnancy, you can decide together with your doctor whether to start another IVF cycle.

It’s recommended to read about diagnostic hysteroscopy and uterine x-rays before starting fertility treatments. These are extremely important tests that can save time and a great deal of heartache.

And… the question of all questions is why does it happen that good quality embryos don’t implant?

The most common question asked about IVF treatments is why does pregnancy not occur in spite of the transfer of a good quality embryo. This is because some embryos are genetically abnormal. Genetic abnormalities can occur among both young and older women but, as age increases and the ovarian reserve diminishes, the amount of genetically normal embryos will decrease.