The decision to go ahead with in vitro fertilization is not an easy one, but once you and your spouse agree on it, the next step is to learn aboutÂ the IVF procedure step by step from start to finish. So what is the IVF procedure and what are the steps involved?
The IVF procedureÂ seems simple enough — eggs are retrieved, they are fertilized with sperm, and once an embryo forms it is transferred to the uterus and 9 months later you have your baby in your arms!
While the process of IVF can be easily explained, there are a lot of very precise and delicate procedures that have to be planned with clockwork precision and the slightest miscalculations can result in a failed IVF cycle. This is why it is important to learn about the IVF procedure in detail so that you know all the infertility treatment options so that you can make an informed decision.
IVF Procedure Step By Step Guide
An IVF procedureÂ can involve multiple IVF cycles — with one treatment cycle per menstrual cycle so be sure that you have the time and the resources for it. Talk to your doctor about IVF process costs as this is an important factor when deciding on treatment options. You can also ask your doctor for an IVF process step by step video as this will give you a clear understanding of all the IVF procedures that are involved in a treatment plan. These are the 5 steps of the IVF process in India
Step 1: Hormone Regulation
“Birth control pills at the start of an IVF treatment improve the chance of success and reduce the risk of ovarian hyperstimulation syndrome”
Â It may seem strange but the first step of the IVF procedure involves birth control pills. Birth control pills are taken prior to ovarian stimulation as they improve the response of the ovaries and increase the chance of success. Hormone regulation through birth control pills also reduces the risk of ovarian hyperstimulation syndrome — a medical condition in which the ovaries become swollen and painful.
Women who have irregular menstrual cycles are generally advised to take birth control pills for at least 3 cycles before they start taking medication to stimulate ovulation. This will help to control the menstrual cycle in order to time IVF cycles perfectlyand increase the success rate of their fertility treatments. This is why hormone regulation is a very important part of the IVF procedure.
Birth control pills to regulate hormonal levels are especially beneficial for older women and women with PCOS — this is because these women have a high level of luteinizing hormone (LH). The LH hormone plays a vital role in several reproductive processesÂ including ovulation and menstruation; high levels of this hormone impact the quality of eggs as well as the lining of the uterus and so hormone regulation can help to stabilize the levels of LH and thus increase your chances of success via IVF treatments.Â Birth control pills are recommended between 14-21 days before the day of your expected period.
If you are put on birth control pills to regulate your cycle, your doctor will also prescribe GnRHA (Gonadotropin Releasing Hormone Agonists). GnRHA will have to be taken along with your birth control pills for 4-6 days prior to the onset of your period. This ensures the success of the second stage of fertility treatments which is the ovarian stimulation phase. If a woman goes directly from taking birth control pills to ovarian stimulation medications, she runs a higher risk of compromising the stimulation process which means that her chances of success would be lower.
Step 2: Ovarian Stimulation
“Normally, the ovaries release only 1 egg per menstrual cycle but with ovarian stimulation medications, the ovaries can produce over15 eggs in a cycle”
Ovarian stimulation is the second step of the IVF procedure and is necessary in order to increase the number of eggs released by the ovaries. Normally, the ovaries release only 1 egg per menstrual cycle but with ovarian stimulation medications, the ovaries can produce up to 20 eggs per cycle. IVF success rates are directly connected to the number of retrievable eggs per cycle and so ideally, ovarian stimulation medications should produce 15 retrievable eggs. This method is also known as controlled ovarian hyperstimulation.
Controlled ovarian hyperstimulation generally includes the following drugs:
1. GnRHA Drugs: Medication to suppress ovulation until the developing eggs are ready. It is given between days 2-7 of the menstrual cycle.
2. FSH (follicle stimulating hormone) Injections: Medication to stimulate the development of multiple eggs. It is given between days 3-9 of the menstrual cycle.
3. HCG (human chorionic gonadotropin) Injections: Medication to cause the final maturation of eggs. This one-time hCG “trigger” shot is given approximately 8 days from the first day of ovarian stimulation.
You will need to take ultrasound tests as well as blood tests so that your progress can be monitored every step of the way. Your fertility doctor will suggest changes to your IVF medications and injections depending on the rate of development of your eggs as well as your hormone levels. The timing of your hCG injection is very important as your eggs will need to be retrieved 36 hours later.
Step 3: Egg Retrieval
“The entire egg retrieval procedure takes approximately 10 minutes”
Egg retrieval is all about timing and so you will have to go back to the fertility clinic 36 hours from the time of your hCG injection. The procedure used to retrieve the eggs is called ultrasound directed follicular aspiration (UDFA) and you will be sedated as this IVF procedure is minimally invasive. During this IVF procedure, the doctor passes a thin needle through the upper vaginal wall and gently suctions out the ripe eggs.
The viable eggs are identified, delicately rinsed, and then placed in plastic culture dishes. The eggs are placed into an incubator so that environmental conditions can be controlled. The entire egg retrieval procedure takes approximately 10 minutes but you will be monitored for an hour before you can go home. At this time, your doctor will be able to tell you exactly how many eggs were retrieved during the process.
You might experience mild or moderate cramping for the next few hours and so your doctor may prescribe oral pain medication. Your age plays an important role in the number of retrievable eggs — women who are below 35 have more eggs as compared to women over 40.
Step 4: Fertilization
“It takes 3 days for the fertilized eggs to turn into embryos and reach a maturity stage where they can be tested for genetic viability”
The next step of the IVF process is the fertilization of the retrieved eggs with sperm from your husband or a donor. The egg fertilization process takes place within 4 hours of their aspiration. The sperm are “washed” so that only the most active sperm can be extracted from the sample. The sperm and eggs are then mixed and placed back into the incubator.
The normal sperm parameter is approximately 50,000 – 100,000 motile sperm so if the sperm count in the sample is very low or if they have low motility, your fertility doctor may recommend an intra-cytoplasmic sperm injection (ICSI). In an ICSI procedure, the embryologist injects a single sperm directly into an egg in order to fertilize it.
There is evidence of fertilization within just 24 hours although it takes 3 days for the fertilized eggs to turn into embryos and reach a maturity stage where they can be tested for genetic viability. It generally takes 24-48 hours to get the results of these tests. This means that you will have to wait for 5 days from the day your eggs are retrieved to find out if there are anyviable embryos for the next step which is the embryo transfer.
Step 5: Embryo Transfer
“The embryologist selects the healthiest egg(s) and they are then transferred directly into your cervix using a small plastic tube”
Â The final step of the IVF procedure is the embryo transfer and it is the most exciting phase of the entire IVF treatment process. The embryologist selects the healthiest egg(s) and they are then transferred directly into your cervix using a small plastic tube. This procedure is not invasive and so you will not be put under general anaesthesia although you can ask for a mild sedative to help you relax during the procedure.
Your doctor will have a discussion with you as to how many embryos should be transferred during a single IVF cycle. Transferring more than one embryo will increase your chances of pregnancy but it will also increase the risk of a multiple pregnancyÂ which can have a negative impact on the health of your babies. Many European countries now mandate that only one embryo can be transferred but in India, you can still opt for multiple embryo transfers. Your doctor may suggest transferring 2 or 3 embryosÂ if you are 40 or older to increase your chances of a successful implantation.
You know have the answer to “what is the IVF process” and as you can see, an IVF cycle process is anything but simple. If your fertility doctor has provided a process of IVF video, watch it with your spouse several times so that you are familiar with every stage of the treatment process. The entire IVF cycle can take between 4-6 weeks so plan your schedule and ensure that you are available for all the procedures, tests, and monitoring that is required as part of the IVF process.
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