IVF: The complete step-by-step process

May 03, 2021

In Vitro Fertilisation or IVF started around 40 years ago and has been successfully used to deliver healthy babies to women who are unable to conceive. IVF literally means ‘fertilisation in glass’. However, in the best IVF hospital in Bangalore, today it is done in plastic. The process involves fertilising the egg with the sperm of the father outside the body, in an incubator, and then selecting and putting the healthiest embryo back into the woman’s uterus. The process leading to this stage takes about three to four weeks.

Following are the steps of IVF in detail:

Testing and Ovarian Stimulation

Before starting the process (of IVF) your uterus and fallopian tubes will be tested to make sure there aren’t any irregularities and no surgical repairs are needed. This includes thyroid function evaluation, ovarian reserve, testing for sexually transmitted diseases, and semen analysis of the male. Fertility prescribed in most cases for ovarian stimulation for 8-14 days. This helps in maturing multiple eggs for egg retrieval. Fertility drugs are given irrespective of the ovulation being normal or not, to produce more than one egg. This increases the chances of pregnancy. On average, 10 – 20 eggs are usually retrieved, though not all of them might not be viable (two-thirds achieve appropriate maturity on an average).

The physician will use his expertise to try to get the maximum number of eggs while safeguarding you from the risk of developing ovarian hyper-stimulation syndrome (OHSS). Once the eggs are injected, you’ll be monitored using hormonal testing and vaginal ultrasounds. Once it has been determined via ultrasound that you have a considerable number of large enough follicles and the estrogen level reaches the appropriate level, you’ll be given a trigger shot of hCG or other medication. The trigger shot substitutes the naturally occurring luteinizing hormone surge a woman gets that initiates the final stages of egg maturation.

Retrieval of the egg

Eggs from follicles in your ovaries will be surgically removed 34 to 36 hours after getting the trigger shot (before the eggs ovulate). A small needle is guided by ultrasound through the top of the vagina into one ovary and then the other. As you’ll be under sedation, it’s unlikely you’ll feel any pain or discomfort. 

Once the needle enters the follicles, the follicular fluid is removed using suction which brings the eggs along with the fluid. This process takes less than 30 minutes. Minor cramps are associated with this procedure, which usually go away the next day. You might also feel some pressure within, as the ovaries will get expanded due to ovarian stimulation. This may last a few weeks. 

The fluid containing the egg(s) is suctioned by the IVF physician and collected in a test tube. Then it’s the embryologist’s job to find and separate the eggs in each test tube. The number of eggs removed depends on various factors: your age, ovarian reserve, how your body responded to ovarian stimulation and in some cases, the ability to access the ovaries with the help of a needle. 

Fertilization

Eggs that have successfully matured are transferred into a special culture medium and placed in an incubator. Within a few hours, they are fertilized with the sperm. There are two ways to fertilize an egg: conventional insemination or intra-cytoplasmic injection (ICSI). The selection of the method depends on the IVF team (physicians and embryologists) and various factors related to the couple. Both methods have an equal success rate. ICSI is opted in 70% of the cases when certain factors make fertilization difficult, such as poor semen quality and previous failed attempts at In Vitro Fertilisation.

Transfer of the embryo

When to do the embryo transfer completely depends upon the couple and the IVF team, but it must be done between 1 to 6 days after egg retrieval. In case you wish to do genetic testing, a biopsy from the embryo is taken usually on Day 5 or 6. While testing is being done, the embryos are frozen and stored in the lab. Once the genetic results are out, the selected embryo is thawed and placed in the uterus. This might happen between 1 to 2 months after the egg retrieval. 

The number of embryos produced depends on a number of factors related to the couple. In the past, multiple embryos were transferred in order to increase the chances of success. This, however, resulted in twins and, on rare occasions, triplets. Both can cause pre-term birth and health complications to both the mother and the babies. Thus, transferring only one embryo is the safest route and this will obviously be the healthiest one. 

The embryo is transferred into the uterus using a flexible, soft and thin catheter. An abdominal ultrasound guides the catheter to make sure the embryo is placed at the best possible location. Pain and discomfort are rare. Good embryos that were not used for transfer are usually frozen in case the cycle is not successful or a couple wants more children following a successful first cycle.

If all goes well, the healthy embryo continues to develop, and hatches and implants in the uterine lining within 1-2 days following embryo transfer.

Pregnancy Test

A pregnancy test will be done about 12 days after the embryo transfer. Once there is good news and the pregnancy is confirmed, the next order of business is blood tests and eventually ultrasounds to confirm viability and whether there are multiple pregnancies. If the pregnancy appears normal at 9-10 weeks, you’ll be referred back to your obstetrician!

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