What is in vitro fertilization?
In vitro fertilization (IVF) is the process of retrieving eggs and sperm and combining them in a lab for fertilization. One or more healthy embryos are selected to implant in the woman’s uterus and then the woman is monitored to to ensure the embryo implants and a successful pregnancy has been achieved.
Step 1. Ovarian stimulation
Controlled ovarian hyperstimulation (COH) is the first step where the ovaries are stimulated to produce multiple mature eggs that can be analyzed to select the healthiest viable fertilized eggs for embryo transfer. In order to stimulate multiple mature eggs in one cycle, medications and hormones are prescribed.
Step 2. Ovarian stimulation monitoring
Women prescribed hormone therapy prior to egg retrieval are carefully monitored by vaginal ultrasound and hormone blood tests. Ultrasounds are scheduled at the beginning of ovarian stimulation and then every few days once follicle growth is established. Monitoring continues until at least three follicles reach maturity and egg retrieval is scheduled.
Step 3. Egg retrieval
Once multiple eggs are mature, the eggs will be retrieved for fertilization in the laboratory.
A fine needle is attached to the side of the ultrasound probe used for vaginal scans and the probe is gently placed in the vagina and advanced into the ovary. The needle penetrates each follicle in both ovaries and drains the fluid from inside each follicle. The follicular fluid is immediately sent to laboratory and examined by the embryologist for the presence of an egg.
Our state-of-the-art operating suite is designed to be directly adjacent to our laboratory for your convenience and comfort.
Step 4. Hormone therapy to prepare the uterus
Hormone therapy is prescribed after egg retrieval in order to support implantation of the embryo after fertilization.
- Estrogen: to develop and support the endometrium (uterine lining).
- Progesterone: to support the endometrium in pregnancy.
- Medrol: to help implantation.
- Doxycycline: to prevent infection and to support a favorable uterine environment for implantation.
Step 5. Fertilization
After the woman’s eggs have been retrieved, a healthy sample of about 100,000 sperm from the male partner are added in laboratory conditions in order for the sperm to fertilize the egg.
After fertilization, an embryologist examines the eggs under microscope to determine how many eggs have been fertilized. Fertilized eggs are then cultured and stored for transplantation.
The embryologist’s skill and experience, as well as the conditions in the laboratory, are the major factors that determine the success rate of a fertility centre.
Step 6. Embryo transfer
Embryo transfer takes place two to five days after egg retrieval and fertilization. The decision about when to transfer the embryos is made on an individual basis and depends on the number and quality of embryos.
The optimal number of embryos to transfer is determined by our specialists to minimize the risk of multiples pregnancy and maximize the chance of pregnancy.
One or more embryos are then transplanted into the womb and 2 weeks after the transfer, a pregnancy test will confirm the embryo has implanted successfully. An ultrasound scan is usually scheduled two weeks after a positive pregnancy test to confirm the ongoing pregnancy.
When is in vitro fertilization recommended?
IVF is used to treat blocked, damaged, or absent fallopian tubes, as well as endometriosis, unexplained infertility or advanced maternal age. It is also recommended to treat many male infertility factors such as azoospermia, sperm with abnormal structure or function, blocked or absent vas deferens or genetic causes of male infertility.
Risks of in vitro fertilization
Although IVF is a safe treatment, there are potential risks.
Some women may experience side affects from IVF-related medications (headaches, bloating, mood swings, abdominal pain or ovarian hyperstimulation)
Ovarian hyperstimulation syndrome (OHSS) occurs when the ovaries over respond to medication stimulation and produce an excessive number of eggs. This only occurs in less than 1% of IVF treatments.
There is a very low risk of complication but egg retrieval can cause pelvic infection or significant bleeding. Additionally, there is a very minor risk of a negative reaction to anesthesia and damage to the bowel and bladder or abdominal organs.
Transferring multiple embryos carries the risk of multiples pregnancy. Multiples birth , whether conceived naturally or through IVF, pose health risks to both the mother and unborn children. Maternal complications include increased risk of gestational diabetes (diabetes during pregnancy), hypertension (high blood pressure) and hemorrhage.
Embryo implantation & development
Fetal complications include increased risk for premature birth or miscarriage, cerebral palsy and low birth weight. In the event of a triplet pregnancy a reduction to singleton or twins is strongly recommended.