IVF can be physically and emotionally draining, however stress and anxiety can be reduced if you and your partner have a clear understanding of the procedures. Your fertility doctor may recommend that you and your partner learn as much as possible about the IVF process, which includes the following steps:
Stimulation of Ovaries
To begin, the woman will be given medications to stimulate her ovaries to form multiple eggs. Your doctor will monitor this process with blood tests and ultrasound. Your doctor will also discuss with you which medication protocol might work best. Usually, you will receive a drug known as a gonadotropin-releasing hormone agonist (an example is Lupron®) or a gonadotropin-releasing hormone antagonist (examples are Antagon® and Cetrotide®). These drugs prevent your ovaries from releasing eggs too early during your IVF cycle.
You will then be given one or more medications known as gonadotropins, which can stimulate your ovaries to produce many eggs. This is important, as your doctor may need to transfer multiple embryos into your uterus to get a reasonable success rate.
The gonadotropins are given daily as an injection in your abdomen, thigh, or upper arm. Your doctor will determine the most appropriate dose for you and will inform you of the possible risks, side effects, and benefits of these medications.
Egg Retrieval and Fertilization
Egg retrieval is a surgical procedure performed in an operating room. An anesthesiologist will be present during the procedure and may give you an intravenous sedation to make you sleepy.
During the egg retrieval procedure, your doctor will place a needle along with an ultrasound probe into your vagina. The needle will be gently moved through the back of your vagina into each mature follicle in your ovaries. Since the retrieval of eggs is done through the vagina, you will not have a cut or incision in your abdomen. The fluid from each follicle-along with the egg-is drawn through the needle. The egg retrieval procedure usually takes about 20 to 30 minutes, depending on the number of mature follicles you have.
The eggs are placed in a special dish in an incubator for a minimum of three hours prior to insemination. Emergency power is available to the incubator in case of power loss.
On the day of the egg retrieval, your male partner will need to produce a sperm specimen for the IVF laboratory to use to fertilize the eggs. Or, semen must be obtained from the donor. The man providing the semen should abstain from ejaculation for three to five days before the egg retrieval. In the cases of male factor infertility, standard insemination techniques may not be successful. If the man's sperm counts are very low or fertilization has failed to occur with a prior IVF attempt, special egg insemination techniques may be used to help the sperm fertilize the eggs. The ICSI technique is used to fertilize mature eggs in the event of sperm or egg abnormalities. Under the microscope, the embryologist picks up a single sperm and injects it directly into the egg.
After the egg retrieval procedure, you will most likely be asked to rest in the recovery suite for about one hour. You should arrange for someone to drive you home, where you should rest for the remainder of that day. Some women experience light vaginal bleeding and lower abdominal pain after egg retrieval.
Starting the day after your egg retrieval you will need to start taking a progesterone supplement-this helps to prepare the uterine lining for attachment of the embryos. Progesterone can be taken either as a daily injection or as a vaginal gel and should be continued until the day of your pregnancy test.
The day after retrieval, the inseminated eggs are studied for evidence of fertilization. To allow further cell division and growth, eggs are cultured for another 48 hours before the resulting embryos are considered ready for transfer. Your doctor will discuss the condition of your embryos and how many will be transferred into your uterus. In general, your doctor may transfer two to four embryos, depending on your age and other factors, such as the condition of your uterus. The embryos are transferred to your uterus through the cervix, using a catheter.
Following the embryo transfer procedure, your doctor may recommend that you rest in bed for the remainder of the day. Following this, you should avoid strenuous exercise as well as not engage in sexual intercourse until the day of your pregnancy test.
At this stage in the IVF process, advanced micromanipulation techniques, such as embryo biopsy or assisted hatching, may be performed.
Blastocyst Embryo Transfer
A blastocyst is an embryo that has developed for approximately five days after fertilization. Embryos that reach the blastocyst stage have a higher chance of implanting in the woman's uterus. Also, since fewer blastocysts are usually implanted, the possibility of a woman having multiple pregnancies is reduced.
However, some embryos will not develop to the blastocyst stage in vitro (in the dish in the IVF laboratory). About 50 percent of good quality embryos will develop into blastocysts. However, there is a risk that none will succeed. New techniques to support the growth of blastocyst are being developed which might allow for higher rates of successful blastocyst formation and transfer.
Your doctor will schedule a pregnancy test about two weeks after your egg retrieval.
Embryo Cryopreservation/Frozen Embryo Transfers (FET)
Cryopreservation or freezing offers a way to store embryos for a subsequent IVF cycle. Couples who have extra embryos available after an IVF procedure need to decide what to do with them. The extra embryos may be frozen, or cryopreserved, after fertilization. The embryos can be thawed and transferred into your uterus during a future cycle.
Frozen embryos may be stored for five years or more. To use frozen embryos, they must be thawed and examined to see if they survived freezing. Typically, 10-20% of the embryos do not survive the freezing and thawing process. Pregnancy rates with frozen embryos have been shown to be similar to nonfrozen embryos of equal quality. However, sometimes the best quality embryos are transferred to the uterus in the IVF cycle and the excess embryos frozen-this may be associated with a somewhat lower pregnancy rate.
Cryopreservation has several benefits-during a frozen embryo transfer (FET) cycle: the woman does not need to use medications, such as gonadotropins to stimulate her follicles, and the cycle is less physically demanding. In addition, the cost of a frozen embryo transfer cycle is much less than the cost of a regular IVF cycle.