What is IVF

In Vitro Fertilization (IVF) is the process in which insemination and fertiization between egg and sperm take place outdside the body in a laboratory. The fertilized embryo is deposited into the woman’s uterus via catheter in a process called embryonic transfer. The desired result of an IVF cycle is successful implantation and the beginning of a healthy pregnancy.

Infertility is defined as the inability to become pregnant after 1 year of unprotected sex, 6 months if over the age of 35. For many couples, the decision to use IVF to start or grow their family comes after months or even years of struggling with infertility.

The journey starts with a visit to the OB/GYN or primary care physician and then to a Reproductive Endocrinologist or fertility specialist. First steps include attempting to improve fertility using hormone treatment, medication or minimally invasive procedures. Intrauterine Insemination (IUI), in which sperm is placed inside the uterus to facilitate fertilization, is typically attempted before going with the fully assisted reproductive method of IVF.

Deciding to try to conceive through IVF is a big decision, as the procedure is more invasive than other methods, and the emotional and financial impact is much higher. However, the reward can be great, and we want to help make the process more clear and eliminate some of the fear that comes with the unknown.

There are 6 basic steps to In Vitro Fertilization:

Step 1: Ovarian Stimulation

Fertility drugs are prescribed to stimulate the ovaries into producing multiple eggs on the desired schedule. There are varying levels of hormones used in conjunction with a woman’s natural menstrual cycle to achieve this step. Some of the medication will be given by injection, administered by you and/or your partner at home. During this process, a woman will undergo frequent ultrasounds and blood tests to see how the ovaries are responding to the hormones.

Step 2: Egg Retrieval

When the eggs have reached full maturation they are ready to be retrieved. This is done through a minor surgical procedure using an ultrasound-guided needle to pierce the vaginal wall to reach the ovaries. This process is called follicular aspiration, and is done under conscious sedation or general anesthesia.  Ideally, at least 12-15 eggs are retrieved. This is a short procedure, lasting around 20 minutes, and may result in minor abdominal cramping and light spotting.

Step 3: Sperm Collection

On the day of egg retrieval the sperm is collected through ejaculation or testicular aspiration. It is then put through a process called “washing” to remove inactive sperm and seminal fluid and isolate the best candidates for fertilization.

Step 4: Fertilization

The sperm and eggs are incubated together, and after 12-24 hours are inspected for signs of fertilization. In 70% of cases, the egg will be fertilized during this process. In cases of male infertility resulting from low sperm count or motility, a procedure called Intracytoplasmic Sperm Injection (ICSI) is used. Here, an embryologist will inject a carefully selected healthy sperm directly into the egg using a thin needle. When fertilization occurs, the egg is transferred to a special incubator and monitored closely for 2-5 days until it consists of 6-8 cells.

Step 5: Embryonic Transfer

In this phase, a predetermined number of embryos are transferred into the uterus. This is done through a thin catheter inserted into the uterus through the cervix. This procedure is typically not done under anesthesia. After the transfer, the patient will lie on her back for a couple of hours before going home for more rest.

Step 6: The Waiting Game

Even with all of the injections, exams and procedures you’ve endured in the IVF process, this last step can be the hardest. Now you will rest and look for early signs of pregnancy. This is known as the “Two Week Wait”. Within these two weeks after the transfer, you will take a pregnancy test. This will be a blood test administered by the doctor. They will also test progesterone levels at this point, and possibly over the next few days.

If the test is positive, you will continue to be monitored closely throughout the early pregnancy. While women who conceive naturally will have only a few ultrasounds throughout pregnancy, you will have them very frequently, especially in the first trimester.

If the test is negative, you and your partner will need to make a decision as to how you will proceed. Remember, no one can make this decision except you.