WHAT IS IN VITRO FERTILIZATION (IVF)?
In vitro fertilization is a method of assisted reproduction, which is used to help infertile couples to conceive a child. This method has been proven to be particularly effective, bringing thousands of healthy children to the world, for the past 35 years.
During IVF, mature eggs are collected from the woman’s ovaries and are fertilized outside the woman’s body, in an IVF laboratory. Then, the fertilized eggs (embryos) are left to grow in the laboratory and are then transferred back to the woman’s uterus, with the hope of a successful pregnancy to follow. An IVF fertility cycle lasts about two weeks.
IVF is not usually the first step to treat infertility. On the contrary, your partner and you have the ability to try less invasive treatment options before you try IVF, such as taking fertility drugs to increase the production of eggs or intrauterine insemination (IUI) – a procedure that sperm is placed directly into a woman’s uterus, near the ovulation period.
HOW SUCCESSFUL IS IVF?
The success rates of IVF treatments vary from clinic to clinic and depend on many factors, such as the woman’s age, and the cause of infertility. It is also very important to understand that the pregnancy success rates are not the same as the birth success rates. Approximately 15 - 45% of pregnancies achieved by IVF lead to births. The specific factors affecting your individual success rate will be discussed with our doctors, in order to provide you with the most updated individualized fertility treatment.
WHY TO CHOOSE IVF?
IVF is appropriate if your partner or you have:
- Damaged or blocked fallopian tubes in women, which prevent sperm from reaching the egg.
- Ovulation disorders in women
- Premature menopause (loss of normal ovarian function before the age of 40)
- Endometriosis, which affects the function of the ovaries, uterus and fallopian tubes
- Uterine fibroids (benign tumors in the wall of the uterus), which can cause infertility by interfering with the uterus cavity by locking the fallopian tubes or altering the position of the cervix, thus preventing the sperm from reaching the uterus.
- Previous fallopian tube sterilization or removal
- Male infertility, such as low sperm count, low mobility of sperm or poor quality sperm (increased rate of morphologic abnormalities), which reduces the chance of fertilization.
In cases of male infertility, the method of intracellular injection (ICSI) - injection of sperm into the egg, is used to fertilize eggs. More particularly, the ICSI is a special form of IVF in which a single sperm is injected into an egg.
- Advanced reproductive age
- Cases of unexplained infertility, where, despite a complete evaluation for known causes of both the man and the woman, the cause of infertility is not identified.
- A genetic disorder
If your partner or you are a carrier of a genetic disorder, a process, which includes IVF, called Pre-implantation Genetic Diagnosis (PGD) can be applied. The Pre-implantation Genetic Diagnosis is the process of genetic analysis of a living fetus in order to determine the presence, absence or change of a particular gene or chromosome before transferring the embryo to the uterus.
- Retention of fertility in women with cancer or other health problems
Women can freeze their eggs (oocyte cryopreservation) for future use, or freeze their embryos (embryo cryopreservation) for future use. Women who have no functional uterus or the pregnancy poses a serious risk to their health can choose IVF pregnancy with another woman (surrogate mother). In this case, the woman's eggs are fertilized with her husband's sperm, but the resulting embryos are placed in the uterus of a surrogate mother for gestation.
THE IVF PROCEDURE
IVF is not a simple process, but a number of different stages. The stages involved in this process are:
Follicular stimulationA combination of medications (fertility drugs) and hormones are usually given to a woman in order to stimulate her ovaries to recruit and mature many follicles so as to take more than the usual one egg per cycle. This is to enable the collection of multiple oocytes, and hence to increase the probability of successful IVF. In each case there is the possibility of some of the eggs collected not to be fertilized or not to develop normally after fertilization. During the medication period, the development of eggs is monitored by blood tests and transvaginal ultrasound to ensure that their collection will be done at the right time.
Various protocols are used for ovarian stimulation, such as the long protocol, the short protocol and the antagonist protocol. Choosing the right protocol for you depends on your age, the levels of FSH and the previous stimulation (if it exists) of the woman.
Egg collectionThe egg collection is a relatively easy process that takes place in a sterile room in the presence of an anesthesiologist, since a mild anesthesia needed. It takes about 10 - 20 minutes, depending on the number of follicles in the ovary. It is required not to eat anything from the night before and to avoid water, candy or gum the morning of the egg retrieval. During the egg collection, the position of follicles is successfully ascertained using vaginal ultrasound. Then, a needle is directed through the vagina to the follicle and as it pierces the follicles one by one, it aspirates the content. The follicular fluid is delivered directly to the embryologist in the IVF laboratory, where the eggs are identified, isolated from the liquid and transferred to a suitable culture medium and suitable temperature.
After the egg collection you can normally eat, but it is preferable to have a light meal and plenty of fluids. You cannot drive or go to work on the same day. It is recommended to stay at home and rest.
Sperm collectionOn the day of the egg collection, the husband is required to give us his sperm. The collection of semen is done by masturbation into a sterile urine collection box, and for a better quality of semen, 3 – 4 days abstinence is recommended. However, because the collection of semen on a specific day can be difficult and stressful, the husband can provide the sample from his home earlier on the day of the egg collection, or a few days earlier, for it to be frozen (fresh samples are always preferred).
The sample is delivered to the laboratory, and it is kept in an oven at 37oC for a while, and then is subjected to a cleaning process, in order to detect the healthy sperm. In cases of azoospermia, the semen will be taken directly from the testicles with a biopsy. Also, if using semen from a donor it will be defrosted and prepared with the same procedure.
FertilizationA few hours after the egg collection and the sperm preparation, the fertilization takes place. To begin the process of fertilization, the eggs are placed in a petri dish, which contains a specific growth medium, for 2 to 3 hours. The sperm, after cleaning, is placed with the eggs and incubated together at 37oC, for 16 to 20 hours. The next morning, the embryologist will examine the oocytes to see which ones are fertilized, and then compose a detailed briefing on the outcome.
Fertilized eggs are now called embryos and are incubated in special laboratory conditions for another 48 - 96 hours, depending on the embryonic-transfer-stage, which is to be chosen by your doctor. The fertilization rate is usualy 80 – 100%.
Embryo-transferThe embryo-transfer is a simple procedure, which requires no anesthesia. Two to five days after the eggs are fertilized, the healthiest ones, according to specific morphological criteria, are selected for placement in the woman’s uterus. The selected embryos are aspirated into a thin tube (catheter) and guided into the woman's uterus. One to three embryos may be transferred, according to the age and medical history of the woman.
Following the procedure, a 24- to 48-hour rest is recommended. The remaining embryos that are not transferred can be frozen at this point and used in a next cycle of in vitro fertilization (IVF). While the partner is encouraged to be present, his/her presence is not necessary, if for some reason he/she cannot attend. However, it is always recommended to be accompanied from the clinic to the house. It is not uncommon to see vaginal fluids with blood before the pregnancy test. Approximately 50% of our patients see a little blood before the pregnancy test or even afterwards.
THINK POSITIVE! You should take a pregnancy test even if you have seen a little blood.