IVF

In vitro fertilization (IVF) | Procedure & How It Works Detail Guide

IIVF, or in vitro fertilization, is a multi-step process that can result in pregnancy. It is a method for addressing infertility, which is defined as the inability to conceive after at least one year of trying for the majority of couples. Additionally, IVF can be utilized to avoid passing on genetic issues to offspring.

In the process of in vitro fertilization, eggs that have reached maturity are retrieved from the ovaries and combined with sperm in a laboratory. Following this, an operation is performed to implant one or more of the resulting embryos into the uterus, where fetal development occurs. A complete IVF cycle typically spans 2 to 3 weeks, although occasionally the various stages may be separated, resulting in a longer procedure.

Assisted reproductive technology, also known as in vitro fertilization, is a highly successful method of treating fertility. It involves the manipulation of eggs, sperm, and embryos. In vitro fertilization (IVF) can be performed using the eggs and sperm of a couple, or it may include the use of eggs, sperm, or embryos from a known or unknown donor. There are also instances where a gestational carrier, who has an embryo implanted in their uterus, may be utilized.

The success of conceiving a healthy child through IVF is influenced by various elements, including age and the underlying cause of infertility. Furthermore, the IVF process can be lengthy, costly, and intrusive. In cases where multiple embryos are implanted in the uterus, it may lead to a multiple pregnancy. Your healthcare providers are available to assist you in comprehending the process of IVF, potential hazards, and determining if it is suitable for your situation.

The Reason Behind its Execution

IVF, also known as in vitro fertilization, is a medical procedure used to address issues of infertility or genetic complications. Prior to undergoing IVF, there are alternative treatment options that may involve less or no invasive procedures. For instance, fertility medications can stimulate the ovaries to produce more eggs. Another option is intrauterine insemination, where sperm is placed directly into the uterus during ovulation to increase the chances of fertilization.

In some cases, IVF may be recommended as a primary solution for fertility issues in individuals who are 40 years or older. Additionally, it may be considered for those with specific medical conditions. For instance, IVF could be a viable choice for couples who have:

Obstruction or injury to the fallopian tubes

The fallopian tubes are responsible for transporting eggs from the ovaries to the uterus. If they are damaged or blocked, it can make it difficult for an egg to be fertilized or for an embryo to reach the uterus.

Disorders affecting ovulation

When ovulation does not occur or happens infrequently, there are fewer eggs available for fertilization by sperm.

Endometriosis

This condition occurs when the tissue that lines the uterus grows outside of it. It often affects the ovaries, uterus, and fallopian tubes.

Uterine fibroids

Fibroids are non-cancerous tumors that can form in the uterus. They are most commonly found in people in their 30s and 40s. Fibroids can interfere with the attachment of a fertilized egg to the uterine lining.

Past surgery for contraception

Tubal ligation is a surgical procedure that involves cutting or blocking the fallopian tubes to prevent pregnancy permanently. In cases where pregnancy is desired after tubal ligation, in vitro fertilization (IVF) may be an option. This can be considered if surgery to reverse the ligation is not desired or feasible.

Sperm-related issues

Low sperm count or abnormalities in sperm movement, size, or shape can make it difficult for them to fertilize an egg. If medical tests reveal problems with sperm, consulting an infertility specialist may be necessary to identify and address any underlying health concerns.

Unexplained infertility

When the cause of infertility cannot be determined through medical tests.

Genetic disorders

If there is a risk of passing on a genetic disorder to a child, a health care team may recommend a procedure known as preimplantation genetic testing during IVF. This involves checking the fertilized eggs for specific genetic problems. However, not all disorders can be detected in this manner. Embryos that do not show signs of genetic disorders can then be transferred to the uterus.

Desire to preserve fertility due to cancer or other health conditions

Cancer treatments, such as radiation or chemotherapy, can have a negative impact on fertility. In cases where cancer treatment is imminent, IVF may be an option for preserving the ability to have a child in the future. Eggs can be retrieved and frozen for future use, or they can be fertilized and frozen as embryos.

Individuals who are unable to carry a pregnancy due to a non-functioning uterus or potential health complications may opt for IVF with the assistance of a third party who will carry the pregnancy. This individual is referred to as a gestational carrier. In this scenario, the eggs are still fertilized with sperm, but the resulting embryos are transferred into the gestational carrier’s uterus.

Potential Dangers

The chances of experiencing certain health issues are increased by IVF. These risks range from short-term to long-term and may include:

Miscarriage

The likelihood of experiencing a miscarriage when conceiving with IVF using fresh embryos is comparable to that of natural conception, ranging from 15% for those in their 20s to over 50% for those in their 40s. This risk increases with the age of the pregnant individual.

Ectopic pregnancy

This is when a fertilized egg implants itself in tissue outside of the uterus, usually in a fallopian tube. The embryo cannot survive in this location and the pregnancy cannot continue. A small percentage of IVF users may experience an ectopic pregnancy.

Multiple pregnancy

IVF can increase the chances of having more than one baby. Multiple pregnancies carry a higher risk of pregnancy-related complications such as high blood pressure and diabetes, premature labor and delivery, low birth weight, and birth defects compared to single pregnancies.

Birth defects

Advanced maternal age is the primary risk factor for birth defects, regardless of the conception method. However, assisted reproductive technologies like IVF have been associated with a slightly higher risk of certain birth defects such as heart problems and digestive issues. Further research is needed to determine if IVF is the cause of this increased risk or if there are other contributing factors.

Premature delivery and low birth weight

Studies have shown that IVF may slightly increase the likelihood of premature delivery or low birth weight.

Cancer

Early studies suggested a potential link between certain medications used in IVF to stimulate egg production and a specific type of ovarian tumor. However, more recent studies have not found evidence to support this claim. There does not appear to be a significantly higher risk of breast, endometrial, cervical, or ovarian cancer following IVF.

Preparing for Your Task

If you want to begin, your first step should be to locate a reliable fertility clinic. For those residing in the United States, the Centers for Disease Control and Prevention and the Society for Assisted Reproductive Technology offer online resources regarding the pregnancy and live birth rates of individual clinics.

The success rate of a fertility clinic is influenced by various factors, such as the age and medical conditions of their patients, as well as the treatment methods utilized by the clinic. It is important to inquire about the expenses associated with each step of the procedure when speaking with a representative from the clinic. Prior to beginning an IVF cycle with your own eggs and sperm, it is common for you and your partner to undergo a series of screening tests. These tests may include:

Testing for Ovarian Reserve

This procedure includes undergoing blood tests to determine the number of eggs available in the body, also known as egg supply. The results of these tests, often combined with an ultrasound of the ovaries, can help predict the response of the ovaries to fertility medication.

Analysis of Semen

Semen is the fluid that contains sperm, and its analysis can assess the quantity, shape, and mobility of the sperm. This testing may be part of the initial fertility evaluation or done shortly before starting an IVF treatment cycle.

Screening for Infectious Diseases

Both you and your partner will undergo screening for diseases like HIV.

Simulated Embryo Transfer

This test does not involve placing a real embryo in the uterus but is done to determine the depth of the uterus and the most effective technique for inserting one or more actual embryos.

Examination of the Uterus

Before starting IVF, the lining of the uterus is checked, which may involve a test called sonohysterography. This test uses a thin plastic tube to send fluid through the cervix into the uterus, allowing for more detailed ultrasound images of the uterine lining. Alternatively, a hysteroscopy may be performed, where a thin, flexible, lighted telescope is inserted through the vagina and cervix into the uterus for a visual examination.

What to anticipate

Once the preparations have been finished, the process of IVF typically lasts for a period of 2 to 3 weeks. It is possible that multiple cycles may be required. The sequence of steps involved in a cycle are as follows:

Procedure for producing developed eggs

An IVF cycle begins with the administration of laboratory-produced hormones, which stimulate the ovaries to produce more than one egg per month. This is necessary because certain eggs may not successfully fertilize or develop when combined with sperm.

Medical treatments may be employed for the following purposes:

Stimulating the ovaries

In this procedure, hormones are administered through injections to promote the development of multiple eggs. The hormones used may include follicle-stimulating hormone (FSH), luteinizing hormone (LH), or a combination of both.

Facilitating egg maturation

Another hormone, known as human chorionic gonadotropin (HCG), or other medications, can aid in the maturation of eggs and prepare them for release from the follicles in the ovaries.

Preventing early ovulation

These medications work to delay the release of developing eggs from the body.

Preparing the uterine lining

To support the egg collection process, progesterone supplements may be taken on the day of the procedure. Alternatively, they may be taken when an embryo is transferred to the uterus, increasing the chances of successful implantation.

Your physician determines the appropriate medications to administer and the timing for their use. Typically, it will take 1 to 2 weeks of ovarian stimulation for your eggs to be prepared for collection through the egg retrieval process. To determine the readiness of the eggs, you may require:

A type of medical imaging called vaginal ultrasound is used to monitor the progress of follicles in the ovaries, which are fluid-filled sacs where eggs mature. Additionally, blood tests are performed to assess the body’s reaction to medication that stimulates the ovaries. Estrogen levels typically increase as follicles develop, while progesterone levels remain low until after ovulation.

At times, it may be necessary to cancel IVF cycles prior to egg retrieval. This can occur for various reasons such as:

  • Insufficient follicles are formed.
  • Ovulation occurs prematurely.
  • Excessive follicles are produced, increasing the chances of developing ovarian hyperstimulation syndrome.
  • Other medical complications may arise.

In the event that your cycle is cancelled, your medical team may suggest adjusting the medication or dosage in order to potentially improve your response in future IVF cycles. Alternatively, you may be advised to consider using an egg donor.

Oocyte Retrieval

The process of retrieving the eggs from either one or both ovaries is carried out in a doctor’s office or a clinic. It occurs within 34 to 36 hours after the last injection of fertility medication and prior to ovulation.

  • Medication will be administered before egg retrieval to induce relaxation and minimize pain.
  • A vaginal ultrasound is used to locate follicles, which are sacs in the ovaries containing eggs. A thin needle is then inserted through the ultrasound guide to collect the eggs, a process known as transvaginal ultrasound aspiration.
  • In cases where the ovaries cannot be reached through the vagina, an ultrasound of the abdomen may be used to guide the needle into the ovaries.
  • A suction device attached to a needle is used to remove the eggs from the follicles. This process takes approximately 20 minutes and multiple eggs can be retrieved.
  • After the procedure, cramping and feelings of fullness or pressure may be experienced.
  • Mature eggs are placed in a liquid to facilitate development and those that appear healthy and mature are combined with sperm to attempt embryo creation. However, not all eggs are successfully fertilized.

Retrieval of Sperm

To use your partner’s sperm, it is necessary to collect a semen sample at the doctor’s office or clinic on the day of the egg retrieval. Alternatively, the sperm can be collected beforehand and stored through freezing.

The most common way to collect a semen sample is through self-stimulation. However, alternative methods may be utilized if an individual is unable to ejaculate or has no sperm present in their semen. An alternative technique known as testicular aspiration involves extracting sperm directly from the testicle through a needle or surgical procedure. Alternatively, sperm from a donor can also be utilized. In a laboratory setting, the sperm is separated from the fluid in the semen.

Reproduction Enhancement

There are two commonly employed techniques for attempting to fertilize eggs with sperm:

Traditional fertilization

Mature eggs and viable sperm are combined and placed in a monitored setting known as an incubator.

Intracytoplasmic sperm injection (ICSI)

A single viable sperm is directly inserted into each mature egg. This method is commonly used when there are concerns about the quality or quantity of semen. It may also be utilized if previous attempts at fertilization during IVF cycles were unsuccessful.

Prior to placing embryos in the uterus, it may be advised to undergo other procedures in certain circumstances. These procedures may include: The process of assisted hatching involves the hatching of an embryo from its surrounding membrane, typically occurring 5 to 6 days after fertilization. This allows the embryo to successfully attach to the uterine lining.

For individuals who are of advanced age and are looking to conceive, or for those who have previously undergone unsuccessful IVF attempts, a method known as assisted hatching may be suggested. This technique involves creating a puncture in the membrane of the embryo just before it is inserted into the uterus. This aids in the hatching of the embryo and its attachment to the uterine lining. Assisted hatching is also beneficial for frozen eggs or embryos, as the freezing process can cause the membrane to harden.

  • Preimplantation genetic testing. The process of testing embryos for genetic diseases or the correct number of chromosomes involves allowing them to develop in an incubator until a small sample can be extracted. The sample is then examined to ensure that there are 46 chromosomes, and that there are no affected genes present. Those embryos without any genetic issues can then be transferred to the uterus.

The utilization of preimplantation genetic testing can reduce the likelihood of a parent transmitting a genetic issue, although it cannot entirely eliminate the risk. It may still be advisable to undergo prenatal testing during pregnancy.

Transfer of Embryos

The process of egg retrieval is illustrated in the first image. The second image depicts the technique of intracytoplasmic sperm injection (ICSI). The final image demonstrates the in vitro development of a blastocyst.

The process of transferring one or more embryos into the uterus is typically carried out at either your doctor’s office or a clinic, usually occurring 2 to 6 days after egg retrieval.

  • In order to help you relax, a mild sedative may be administered. While the process is typically painless, you may experience some mild cramping.
  • A flexible catheter, which is long and thin, is inserted through the cervix and into the uterus.
  • The catheter’s end is attached to a syringe that holds one or more embryos in a small amount of fluid.
  • The embryos are then carefully placed into the uterus using the syringe.

Assuming the procedure is successful, an embryo will implant itself onto the lining of the uterus within 6 to 10 days following the retrieval of the egg.

Following the process

Following the embryo transfer procedure, you can resume your regular daily activities. However, it is possible for your ovaries to still be swollen, making intense physical activities or sexual intercourse uncomfortable. It is advisable to consult your care team to determine the appropriate duration of time to refrain from these activities.

Possible side effects may include:

  • Experiencing a small quantity of clear or bloody fluid soon after the procedure is a common occurrence. This is a result of the cervix being swabbed prior to the embryo transfer.
  • Breast tenderness can be expected due to elevated estrogen levels.
  • Some may experience mild bloating.
  • Mild cramping may also occur.
  • Constipation may be a possible side effect.

If you experience moderate or severe pain, or heavy bleeding from the vagina after the embryo transfer, it is important to contact your care team. It may be necessary to receive a thorough examination to rule out any potential complications, including infection, ovarian twisting, and ovarian hyperstimulation syndrome.

Findings

A blood test is administered at least 12 days after egg retrieval to determine if pregnancy has occurred.

  • In the event that you are expecting a baby, you will most likely be directed to an obstetrician or other professional specializing in pregnancy for proper prenatal care.
  • However, if you are not currently pregnant, you will discontinue taking progesterone and can expect to have your menstrual cycle within a week. If you do not get your period or experience abnormal bleeding, please contact your healthcare team. If you are interested in attempting another round of IVF, your care team may recommend measures to increase your likelihood of conceiving in the future.

The likelihood of delivering a healthy infant through IVF is influenced by a variety of factors, such as:

The Impact of Maternal Age

The likelihood of getting pregnant and giving birth to a healthy baby through IVF using one’s own eggs is higher for younger women. People who are 40 years old and older are often advised to consider using donor eggs during IVF in order to increase their chances of success.

The Role of Embryo Status

According to research, transferring more developed embryos results in higher pregnancy rates compared to transferring less-developed embryos. However, not all embryos survive the developmental process. It is important to discuss your specific situation with your healthcare team.

Reproductive History

Individuals who have previously given birth are more likely to achieve pregnancy through IVF compared to those who have never given birth. Success rates may be lower for people who have already undergone multiple unsuccessful IVF cycles.

Underlying Cause of Infertility

Having a healthy supply of eggs increases the chances of successful pregnancy through IVF. Those with severe endometriosis have a lower chance of getting pregnant through IVF compared to those with unexplained infertility.

Impact of Lifestyle Factors

Habits such as smoking can decrease the chances of success with IVF. Smokers typically have a lower number of eggs retrieved during IVF and are at a higher risk for miscarriage. Obesity is also a contributing factor to lower chances of pregnancy and successful birth. The use of alcohol, drugs, excessive caffeine, and certain medications can also be detrimental.

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