What is IVF?
So, you’re giving in-vitro fertilisation (IVF) serious thought. The process may be one of the most rewarding things you’ll ever do, but no one will ever tell you it’s easy. Emotions can run high and will require you to draw on some inner strength to keep going until you fall pregnant and give birth. So how is IVF carried out?
But what is IVF, the facts and is it right for you?
What is IVF? – Step by Step
If it’s decided that IVF (artificial insemination) is the right thing for you, a good clinic will take the time to understand your fears and concerns and be thorough with you in order to produce an unique treatment plan that’s right for you as a couple. This will involve doing a number of initial tests to see how well the woman is likely to respond to ovarian stimulation.
In designing a treatment plan, your doctor will consider which drugs are most suitable for the woman. Don’t get excited – there aren’t any thrilling side effects. You’ll be closely monitored from the point you start taking the recommended drugs. Some women have to take ‘down-regulating’ drugs to shut down their normal cycle before beginning ovarian stimulation with another drug – called a long protocol. Other women can start ovarian stimulation immediately with a short protocol. Often before this question is answered women will want to know, ‘What is IVF going to cost?’
What is IVF & How Does IVF Work? – Quick Overview Video: The IVF Process Explained:
What is IVF? – Ovarian stimulation
So, the woman’s period has started. That means it’s day one and a couple starting IVF will call the clinic to book a scan.
What is IVF like? Well, get used to giving up a bit of control. After this point, take a gulp – it’s time for your doctor to take charge of your menstrual cycle. The drugs containing the hormones FSH and LH he gives you should mimic what normally happens inside your body, but super sized. They’ll trigger the growth of egg-containing follicles, prevent premature ovulation, cause egg maturation and build up the thickness of the womb lining ready to (hopefully) harbour a growing embryo.
Expect the pleasure of daily injections for a couple of weeks. If the woman can’t bear to do it herself, her partner will have to get handy with a syringe or simple pen applicator – see it as a bonding exercise, or learning a new skill! In this time, you’ll be monitored with regular ultrasound scans and more of those needles with blood tests to check your levels of oestrogen. At this time, drug dosage may be reduced or increased.
If things go well, the woman’s womb lining reaches 8mm in thickness and follicles have developed well, your doctor will take you off the stimulating drugs. It might not be springtime and you might not be the Easter Bunny but it’s time to prepare for egg collection.
IVF Information: What is IVF? – Egg collection
Yes, you’ve guessed it – another injection at this stage will fast-track your eggs to maturation in just 36 hours. This injection contains the pregnancy hormone human chorionic gonadotrophin (hCG). Because you have to administer this exactly 36 hours before your appointment, it might be you have to get up in the middle of the night.
You can be a bit relieved at this stage, as you’ll come off your other stimulating drugs. Egg harvesting may make the woman feel a bit like a piece of meat, and no doubt you’ll both be nervous about the outcome of the day. You’ll already know roughly how many follicles will be collected but not al of these will contain eggs. Remember, it’s not just about the number of eggs collected by the quality of the ones that are. All you really need is one good egg. That’s the golden egg to the IVF process!
As usual, it’s the woman that will have to experience the procedure while her partner looks on. No wonder men can feel so useless during IVF! While it’s over in less than half an hour, the woman will need some sedation or light anaesthetic while the eggs are gathered through the vaginal wall. While your gynaecologist will draw out the follicle-containing fluid from the ovaries, the embryologist will be on hand to whisk it away and search for eggs under the microscope. There’s no getting away from it, the experience makes many women feel groggy, tired and sore.
After this, the woman will be back onto another drug, this one is progesterone, designed to support you though pregnancy. But hurrah! This isn’t usually injected but a pessary is used, which is like a tampon soaked in progesterone. Normally, this hormone would be released from the follicle as it breaks down.
What is IVF? – Sperm collection and preparation
On the same day a woman gives her eggs, the man will be asked to produce a sample of sperm. They are then preened and pampered in the laboratory and the doctor separates out the strongest and healthiest of the little lads for fertilisation using IVF or ICSI if sperm motility is poor.
What is IVF? – Fertilisation by IVF or ICSI to create embryos
It’s about time your embryologist really got on the job. He or she has been waiting in the wings but now it’s their chance to shine. Your embryologist grades the eggs, making a decision on which ones, if any, are mature enough to make an embryo. It’s at this stage they decide whether to do normal IVF or ICSI.
What is IVF again? So, in most cases (although ICSI is getting more popular) the eggs and sperm are placed into a glass dish to get jiggy. It’s up to the sperm to swim to the egg and bury themselves into it all by themselves. Within a couple of hours, one sperm has usually won the fight against the other 100,000 and the next morning (while you’re feeling nervous at home), the embryologist will look at how many eggs have successfully been fertilised. With ICSI, the embryologist will inject the best sperm straight into the egg. This is often done if the man has a low sperm count, a high number of abnormally shaped sperm, or if the eggs have a high level of anti-sperm antibodies. Some clinics now fertilise eggs with ICSI as a matter of course.
After a couple of days, embryos have to (rather unfairly) sit something like an exam in which the embryologist grades them on how healthy they are and how likely they are to develop to full-term. They look for anything odd in the chromosomes, check they’re developing normally and in specific circumstances may screen for any serious genetic disorders that run in your family. Of course, every couple wants the highest grade embryos but successful pregnancies do result from what appear in the lab to be low-grade embryos.
Your embryologist also has to decide whether any of your spare embryos are worth freezing for future transfer. Only the best can withstand the freezing and defrosting process – not an easy task!
What is IVF? – Embryo transfer
Traditionally, embryos are transferred after 2 or 3 days but now blastocyst transfer is becoming more popular, where embryos aren’t placed in the womb until 5 or 6 days after conception. You can read up on this in our article on blastocyst transfer.
Whenever it happens, the experience will be the same. The woman remains awake for the procedure, which means you’ll get to say hello to the little embryos before they’re popped in. Bizarrely, you may be asked to have a full bladder to make the transfer easier so any nerves will be overshadowed by the desperate need for a pee! The embryos will be pushed up a slim tube through the cervix and into the womb.
If you’ve got this far, you’ll be desperately hoping that the pregnancy test a couple of weeks later will show up positive. Most women can’t wait that long and test themselves at home but this can be misleading and isn’t encouraged.
The psychological impact of the whole IVF process on the body and mind is huge for both the man and the woman. At InterTrust Fertility, we know it’s a time of emotional highs and lows and our excellent staff will care for you both every step of the way towards achieving your pregnancy. If you’re interested in research, take a look on IVF.net, an industry focused website.
TOPIC: What is IVF?