AN OVERVIEW OF THE IVF PROCEDURE

Shortly before midnight, on the 25^th of July, 1978, the world witnessed the birth of the first IVF baby-Louise Joy Brown. While the headlines invoked a rather mixed response; it was a fresh ray of hope for millions of couples that face difficulty conceiving. Not long after, in October of the same year, the second test tube baby- Durga alias Kanupriya Aggarwal was born in India.  Now, almost 43 years and over 8 million IVF-assisted births later, the IVF procedure has come a long way. 

IVF stands for In-vitro Fertilization. This involves a sequence of procedures that deal with the fertilization of the egg by a sperm externally, usually in a petri dish, followed by the transfer of the embryo i.e. the ‘fertilized egg’ into the uterus. The entire IVF journey usually lasts for about 5-8 weeks and can broadly be divided into seven steps:

STEPS IN AN IVF TREATMENT

The initial consultation and the preparatory tests involve the evaluation of your uterus, and fallopian tubes, hormonal evaluation as well as analysis of the semen of your male partner. This is done to evaluate the feasibility of the procedure in your case and to ensure the preparedness of the body for the upcoming procedures. The treatment generally starts on the second day of your menstrual cycle. However, this may differ in some patients, in which case, your doctor will inform you regarding the right day.

• Ovarian Stimulation begins on Day 2 or Day 3 of the Menstrual Cycle and continues for the next 8-14 days (11 days on average). 
• In this step, medications are administered, usually in the form of subcutaneous injections (or intramuscular injections), to induce the maturation of more than one follicle (a sac of fluid containing the egg) in the ovary (as opposed to what occurs in the natural menstrual cycle) to increase the chances of pregnancy. 
• Once a significant number of follicles have matured to the required stage,  the patient is administered a “Trigger shot”. 
• This may vary or fall between day 12 or 13 of the menstrual cycle.

• Once the “Trigger shot” has been given, the eggs are harvested about 34-36 hours later, approximately on Day 13 of the Menstrual Cycle.
• You will be put under general anaesthesia. The doctor will then, through an ultrasound-guided procedure, using a transvaginal probe (through the vagina) insert a needle into the follicles present in the ovary. 
• The follicles and the follicular fluid are carefully and gently suctioned out into a test tube through the needle. 
• The procedure takes about 30-40 minutes. 
• Slight discomfort is normal and usually wears off. 
• These eggs will then be assessed by your doctor for maturity and incubated in a nutritive culture medium. 
• In cases of donor eggs, the retrieved eggs are frozen or vitrified at this point and this process is called oocyte vitrification. 
• On average, 7-12 eggs are extracted, although the number may differ according to underlying health conditions.

• Your partner will be asked for the sperm sample on the same day as the egg retrieval. A frozen sperm sample that was collected earlier can also be used after thawing. 
• The sample is washed off any dirt or debris and taken to the lab for fertilization.

Fertilization can take place either through- 

1. Conventional Insemination – Where the eggs retrieved earlier are put in a petri dish along with the sperm sample collected. The egg and sperm are allowed to mix together naturally in the petri dish to form an embryo. Out of the many sperm present, one will inseminate the egg to create an embryo.
2. Intra-Cytoplasmic Sperm Injection (ICSI) – Where a single sperm is injected directly into the egg by an embryologist in order to inseminate it.

This procedure is done on the same day as the egg and sperm retrieval- which on average falls after 10-14 days of the ovarian stimulation. The egg is then examined for fertilization the next day.

Step 5: Embryo Development

• The fertilized egg is now called an embryo.  
• The progress of embryo development is carefully monitored in an incubator. 
• They are usually evaluated on Day 3 of the Embryo Development stage for transfer into the uterus. Sometimes, they can be transferred on the Day 5 stage as well. 
• If there are multiple embryos that are viable for implantation, they may be frozen at this stage. 
• In cases where the embryo has to undergo genetic testing or in cases of assisted hatching, it is usually incubated till the blastocyst stage (Day 5-Day 6 of Embryo Development Stage). 

Meanwhile, during this period, the mother is injected with hormones such as estrogen and progesterone to prepare the uterus for implantation.

Step 6: Embryo Transfer

Embryo Transfer can take place in two methods: 

1. The Embryo transfer is usually done on Day 3 (Cleavage Stage ) or Day 5 (blastocyst stage) of the Embryo Development Stage. i.e. Day 17- Day 22 of the same Menstrual Cycle.
2. The Embryo is Frozen or Vitrified for transfer in the next Menstrual Cycle. This process is termed as Frozen Embryo Transfer.

The decision on the best time for transfer is taken after evaluation of the body’s condition.

• The number of embryos to be transferred can be discussed with your doctor, although the transfer of a single embryo is the safest. Multiple embryo transfer is generally recommended for older women, above 40.
• This procedure is very quick and does not require the use of anaesthesia. 
• The embryo is loaded into a syringe attached to a catheter (a flexible plastic pipe). The catheter is inserted through the cervix into your uterus. Through abdominal ultrasound, care is taken that the embryo is placed at the correct location for implantation. 
• In the case of Frozen Embryo Transfer, the embryo is thawed to room temperature before the procedure.
• Once done, you will be required to stay still for the next 20-30 minutes so as to not displace the embryo, after which you can go home.

A pregnancy test can be taken two weeks later to determine successful implantation and impregnation. The success of a cycle can be attributed to a number of factors such as age, diet and lifestyle. 

If an IVF cycle is unsuccessful, you can try another round of Frozen Embryo Transfer, if you have embryos left after the first transfer, after a few months. If the embryos get exhausted before success, then you may be recommended to try for another cycle of IVF. The cumulative success chances of achieving pregnancy through IVF increase with each cycle. On average, a couple goes through about 2.5 IVF cycles to achieve success

Speak with our experts to know more about the IVF journey

Ferticare can help you on your way to becoming pregnant. Ferticare will assist at every step of the process. It starts from the initial consultation to determining the best fertility therapy for you. We provide patients with tailored, cost-effective treatment plans and link them with the best physician for their requirements.

Meet with one of our fertility specialists if you are having difficulty becoming pregnant. We can help if you have any more questions regarding the procedures.

Visit www.ferticare.in right away or arrange a consultation!