This Article will briefly tell you the Steps involve for In vitro Fertilization. Every case is unique, and it is impossible to predict exactly how your cycle will go, we can sketch out a basic timeline and tell you about the most important landmarks along the way. This is just a general steps in the path of in-vitro fertilization. The treatment plan should be customized for every individual by the treating doctor during consultation.
A brief introduction to IVF
In Vitro Fertilization in latin that means “Fertilization in the glass.” Infertility is a highly personal and emotional subject and it’s a medical problem that is growing. Because of the personalized nature of infertility—the inability to conceive or take a baby to term—there is no one rule as to when to seek treatment but there are guidelines including:
- Couples over the age of 35 and six months of unprotected intercourse with no pregnancy;
- Couples under the age of 30 with one year of unprotected intercourse with no pregnancy,
- Known medical or health issues that could impact natural conception (i.e., cancer, diabetes, sterilization procedures, etc.) It’s important to note, however, that every couple is different and a consultation might in order much sooner. If nothing else than to provide peace of mind.
IVF process actually starts weeks earlier. IVF is not a single treatment but a series of procedures. An average IVF cycle takes about 6 to 8 weeks from consultation to transfer, but depending on the specific circumstances of each the path is similar for every patient. What varies is how your body responds at each stage. The stages can be as below.
- Baseline ultrasound
- Initiation of hormonal pills as per requirements
- Ovarian stimulation and follicular monitoring
- Trigger shot for maturation, rupture of follicle and oocyte retrieval
- Fertilization and embryo formation
- Embryo transfer (Fresh or Frozen)
- Pregnancy test (15 days after transfer)
- Early antenatal ultrasound (4-5 weeks gestation)
Pretreatment preparation for IVF: Comprehensive lab tests give a clearer picture of your fertility, so that your fertility experts can offer you an individualized IVF protocol. Common pre-IVF testing includes:
- A blood panel
- Infectious disease screening
- Uterine evaluation
- Male fertility testing, including a sperm analysis
Transvaginal ultrasound scan is done to examine their ovaries and ovarian reserve. Uterine evaluation is done for endometrial thickness and Fallopian tube.
In some cases, patients may develop uterine fibroids, infections of the fallopian tubes or ovarian cysts or endometrium’s. If any ovarian pathology is detected, the IVF treatment would be carried out after the cysts are resolved by Medical or surgical management wo. If the baseline ultrasound is normal, we will begin injections for ovarian stimulation.
Initiation of hormonal pills as per requirements
Some patients are advised hormonal medications at the start of their IVF cycle. The reasons are listed as follows
- This reduces the use of GnRH-agonists
- This reduces the chances of developing ovarian cysts before IVF
- This is associated with better ovarian response during ovarian stimulation and finally more number of eggs are retrieved
- This also assists in synchronous follicle growth, which means all follicles are of similar size which eventually leads to better retrieval rates when ovum or egg pick up is done.
The stimulatory medication prescribed for a patient is individualized. The medicines are injected subcutaneously that is just below the surface of the skin.
It may include all or any combination or one of the following medications:
- Fertility medications (for about two weeks): Oral fertility medications like Clomid and/or injectable follicle stimulation hormones (Follistim and Gonal-F) are used to stimulate the follicles in your ovaries to mature more eggs than they typically would in a normal cycle. The goal is to produce at least 4 eggs with the use of fertility medication.
- Monitoring visits (during the fertility medication phase): Ultrasounds and blood tests are used during this time to keep a close eye on the development of your follicles and eggs. This is the most time-consuming part of the IVF process, requiring an average 5-7 office visits.
Trigger shot for maturation and oocyte retrieval
Trigger shot for maturation : After about 10-12 days of fertility medication, once monitoring shows that your follicles have grown to an appropriate size, it is time to trigger the final maturation of the eggs with hCG and schedule the ultrasound egg retrieval 36 hours later.
- Oocyte or Egg retrieval: This is a day procedure performed in the clinic under sedation. There is minimal risk, but you will want to take the day off work and arrange for someone to pick you up. If you are going through IVF with a partner who will be providing a semen specimen, it will be collected on the same day as your egg retrieval or the sperm could be frozen before.
Fertilization and Blastocyst Culture
- Egg and sperm are combined in the lab: If all goes well, fertilization occurs and embryos are created. There are several options that can be used at this stage to try to increase the chances of a successful pregnancy.
- Intracytoplasmic sperm injection (ICSI) is a good option when male infertility is a factor. In this procedure a single healthy sperm is injected directly into an egg.
- Assisted hatching is a procedure where a tiny hole is made in an embryo’s outer membrane (the zona pellucida) to try to increase the rate of implantation after transfer.
- Preimplantation genetic screening (PGS) or diagnosis (PGD) can help to ensure that only healthy embryos are transferred. As genetic abnormality is a leading cause of miscarriage, this testing is often helpful in cases of recurrent pregnancy loss.
Embryo transfer-fresh or frozen
- Within 3-6 days after fertilization, embryos are evaluated for transfer: Daily monitoring helps experts decide which embryos have the best chance of surviving transfer, and IVF Lab Daily Reports keep you informed of their progress.
- Embryo or blastocyst transfer: Approximately 3 days after fertilization, embryos are ready for transfer, but some patients prefer to wait a few days until they have reached the blastocyst stage (generally 5 days after fertilization). The embryo or blastocyst is instilled into the uterus via a thin, flexible plastic tube, which is gently passed through the opening in the cervix leading to the interior of the uterus. You will not need sedation for this procedure. It is generally painless but some women may experience mild cramping. You can watch the transfer as it happens with ultrasound technology.
After IVF , Progesterone support
Progesterone is a hormone which helps to support the uterine lining during pregnancy and helps a healthy pregnancy develop in the early stages. Progesterone supplementation is known to improve the chance of success of IVF.
For this reason, we prescribe progesterone injections around the time the embryo transfer is planned and after the transfer patients will take it either by injection and/or orally or by the vaginal route .
Progesterone is the same hormone the ovaries produce and is used in a dose that is not excessive. It is usually continued at least until the pregnancy test and longer once the patient is confirmed to be pregnant , for the first three months .
After the transfer, you will take a progesterone supplement to help support the uterine lining and encourage implantation.
- Pregnancy test #1: Approximately 12 days after the embryo/blastocyst transfer, you will take your first pregnancy test in the clinic.
- Pregnancy test #2: This repeat test is done within one week of the first positive test. If it is positive, we will schedule you for an ultrasound after 2-3 weeks, and then you can transfer your care to an OB GYN
If the ultrasound confirms a normal pregnancy, Oral as well as vaginal medications to support the pregnancy and those recommended in early pregnancy. Since these pregnancies are precious, The patients are asked to follow up the antenatal period and look after their pregnancy carefully till term.
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