IVF Process

What is involved with in vitro fertilization?

There are five basic steps in the IVF and embryo transfer process which include the following:

-Monitor and stimulate the development of healthy egg(s) in the ovaries

-Collect the eggs.

-Secure the sperm.

-Combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and early embryo growth.

-Transfer embryos into the uterus.

Below is an example of a typical calendar layout for an IVF cycle, which takes approximately 7-8 weeks from start to finish.

Step 1: Fertility medications are prescribed to control the timing of the egg ripening and to increase the chance of collecting multiple eggs during one of the woman's cycles. This is often referred to as ovulation induction. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. 

Below is one of my own pictures of some of the medication I was on during my IUI cycles. A typical IVF cycle will have four times this amount of medication including: 

        

Oral Contraceptives: Regulate and help time egg harvesting.

Lupron: Temporarily suppresses pituitary and ovarian hormone production and prevents ovulation from occurring prior to oocyte retrieval. 

Gonadotropins: Stimulate the development of multiple ovarian follicles so that multiple eggs can be retrieved from the ovaries. Can be injected either under the skin (subcutaneously) or into the muscle (intramuscularly). 

Human Chorionic Gonadotropin Hormone (HCG): HCG induces the final maturity of the egg and initiates release of the eggs from the follicles. HCG is given intramuscularly. The egg retrieval is scheduled approximately 34 to 36 hours after the injection, before the actual release of any eggs.

Progesterone: A hormone essential for establishing and maintaining pregnancy. Progesterone may be administered in a few different forms including vaginal suppositories, intramuscular injections and oral preparations. 

Antibiotics: Given the night before the egg retrieval to possibly minimize the risk of infection.

Steroids: Prevent the body from rejecting the transferred embryos.

http://www.infertilityspecialistnewyork.com

Egg development is monitored using ultrasound to examine the ovaries, and urine or blood test samples are taken to check hormone levels.

Numerous mature follicles (black circles) seen inside an ovary during an ultrasound on an injectable IVF cycle.

 

Step 2: Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity. Sedation and local anesthesia are provided to reduce and remove potential discomfort. The eggs are removed from the ovaries using a hollow needle, a procedure called follicular aspiration. Some women may experience cramping on the day of retrieval, which usually subsides the following day; however, a feeling of fullness or pressure may continue for several weeks following the procedure.

Step 3: Sperm, usually obtained by ejaculation is prepared for combining with the eggs.

Step 4: In a process called insemination, the sperm and eggs are placed in incubators located in the laboratory. The incubators enable fertilization to occur.

 In some cases where there is a lower probability of fertilization,intracytoplasmic sperm injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. 

The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.

Step 5: The embryos are usually transferred into the woman's uterus from one to six days later, but in most cases the transfer occurs between two to three days following egg retrieval. At this stage, the fertilized egg has developed into a two-to-four cell embryo. The transfer process involves a speculum which is inserted into the vagina to expose the cervix. A predetermined number of embryos are suspended in fluid and gently placed through a catheter into the womb. This process is often guided by ultrasound. The procedure is usually painless, but some women experience mild cramping.

These steps are followed by rest and watching for early pregnancy symptoms. A blood test and potentially an ultrasound will be used to determine if successful implantation and pregnancy have occurred. Remaining embryos can be frozen and kept in long term storage for use at a later date.

   http://www.americanpregnancy.org/infertility/ivf.html/