In-Vitro Fertilization (IVF)

In vitro fertilization literally means ‘fertilization in glass’. It is the most advanced procedure in the Assisted reproductive technology (ART ), where an egg is combined with sperm outside the body, in vitro (in glass). The process involves monitoring and stimulating a woman’s ovulatory process, removing an ovum (egg ) from the woman’s ovaries and letting the sperm fertilize them in a liquid in a laboratory. The fertilised egg (zygote) undergoes embryo culture for 2–6 days, and is then transferred into the woman’s uterus.Basically, there are FOUR basic steps in IVF:

 

Step 1: Stimulation – Controlled ovarian hyperstimulation (COH)

1. Fertility Medicines (fertility drugs), are given to the woman to boost egg growth.

2. During this step, the woman will undergo transvaginal scan to examine the ovaries and blood tests to check hormone levels.

 

Step 2: Egg retrieval

A minor surgery, called follicular aspiration, is done to remove the eggs from the woman’s body. The surgery is done as an outpatient procedure. This is performed under sedation or general anaesthesia. Before the egg retrieval, the patient should comply with the instructions below:

1. Nil by mouth (strictly no food and drink) from midnight before egg retrieval

2. Do not put on contact lens, make up, perfume and nail polish on the day of egg retrieval

3. Leave valuable things at home

4. Arrange somebody to take you home after the egg retrieval because you cannot drive within 24 hours after the procedure

 

Using ultrasound images as a guide a thin needle is inserted through the vagina and into the ovary and sacs (follicles) containing the eggs. The needle is connected to a suction device, which pulls the eggs and fluid out of each follicle, one at a time. The procedure is repeated for the other ovary. The procedure will take 15 minutes to half an hour to complete, depending on the number of follicles to be aspirated. There may be some cramping pain after the procedure, but it will go away within a day.

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Step 3: Insemination and Fertilization

The man’s sperm is placed together with the best quality eggs. The mixing of the sperm and egg is called insemination. Eggs and sperm are then stored in an environmentally controlled chamber. The sperm most often enters (fertilizes) an egg a few hours after insemination. If there is low chance of fertilization, the sperm may be directly injected into the egg. This is called intracytoplasmic sperm injection (ICSI). When the fertilized egg divides, it becomes an embryo. Laboratory staff will regularly monitor the embryo to make sure it is growing properly. Watch this video about: Intracytoplasmic sperm injection.

 

Step 4: Embryo transfer

There are two types of transfers that can occur in an IVF procedure: a standard 2-3 day transfer or a blastocyst transfer day 5. Embryo transfer (ET) requires no sedation or anaesthesia and similar to IUI. However, Embryo transfer requires ultrasound guidance. A speculum is inserted into the vagina to hold it open. Subsequently a thin tube (catheter) containing the embryos is inserted into the woman’s vagina, through the cervix and up into the womb. This is done under Ultrasound guidance which enables to visualise the insertion of ET catheter into the uterus to ensure that the embryos will be placed near the fundus and minimise the trauma to the uterine lining. The whole procedure just takes 5 to 10 minutes to complete. If an embryo sticks to (implants) in the lining of the womb and grows, pregnancy results. More than one embryo may be placed into the womb at the same time, which can lead to twins, triplets, or more. The exact number of embryos transferred is a complex issue that depends on many factors, especially the woman’s age. The balance embryos may be frozen for future use.

1. You will lie down on the exam table as you normally do for a pelvic exam.

2. Your doctor will insert a very small, thin and flexible catheter into your cervix.

3. The washed sperm sample is injected right into your uterus. Some women may experience a temporary, menstrual-like cramping and be advised to rest for a short time before going home.