Steps in In-Vitro Fertilization (IVF)
Do you fear hearing the words ‘In-Vitro Fertilization’ (IVF)? If yes, stop fearing. IVF is one of the most common processes used everywhere to assist people in fulfilling their dream of becoming parents, which might otherwise not have been possible. The process of IVF involves fertilizing the egg with the sperm in an incubator outside the body, followed by transferring the best embryo back to the woman’s uterus. The whole process until the embryo transfer stage takes 3–4 weeks, generally. The whole process involves the following steps:
Step 1: Starting the treatment
Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH), produced via the pituitary gland, cooperate in the development and release of an egg from a fluid-filled follicle within the ovary during a regular menstrual cycle. Only one among numerous follicles grows each month, becoming mature enough to ovulate. An increase in LH begins about 2 weeks before menstruation and continues until the woman ovulates, releasing an egg from the ovary.
During IVF, it is desirable for the maturation of several eggs to take place at the same time with FSH injections with the help of a trigger injection that is given to mature the developing eggs before collection. There are different types of IVF treatment: with pituitary suppression before starting stimulation (also known as long downregulation) and with pituitary suppression after the stimulation has begun (also known as an antagonist cycle).
The doctors at Yashoda Hospital & Research Centre, Nehru Nagar, Ghaziabad, are well experienced, and with the help of the best machines, they will design the best type of treatment you may require. They will give you all the information you need about the type of specific treatment cycle you need, including the timeline and medications. They will also help you know how to administer your daily FSH injections and provide you with other instructions for any other medications you may require during the treatment cycle.
Step 2: Ovarian stimulation
In this stage, the ovaries are stimulated with medication to enhance the growth of follicles containing eggs. This is done through daily FSH injections between 9-14 days. In order to stimulate the growth of multiple follicles, the dose of FSH used is generally slightly higher than what a woman produces naturally. Regular ultrasounds and blood tests are done to monitor the response of the ovaries.
Step 3: Trigger injection
The ovarian stimulation phase ends once ultrasounds depict that the number and size of the follicles are adequate. The FSH injections and the GnRH agonist or antagonist, known as a pituitary suppressant, are also stopped. After the fertility coordinator has confirmed your procedure time, he or she may advise you of the actual time to administer your trigger injection. A trigger injection is used to help in the egg’s final maturation and loosen it from the follicle wall. Retrieving the egg takes place on the second morning after the final injection, usually 34–36 hours later. The timing is very important.
Step 4: Egg retrieval & semen collection
While you are lightly sedated, the doctor will perform egg retrieval. In this, a probe with a fine needle attached is guided by ultrasound and passed through the vaginal canal and into each follicle in the ovary. The fluid in the follicle is then taken out or extracted into a test tube so that it can be studied under a microscope to find eggs. Depending on the number of follicles that have grown, this procedure may take 20-30 minutes.
After the egg is retrieved, you may be asked to rest for at least an hour before going home. The doctors at Yashoda Hospital & Research Centre, Nehru Nagar, Ghaziabad, always advise you to take a day off work and also to avoid any strenuous exercise.
Your partner may be asked to produce his semen sample on the day of the egg retrieval procedure. If your partner or you have any concerns related to sample collection, you may discuss them with the doctor before starting the treatment cycle. The sample may be collected at the hospital in a separate men’s room or may even be collected at home and given at the hospital. You may also freeze one of your partner’s semen samples as a backup.
Step 5: Fertilization (insemination) & embryo development
About 4 hours after egg retrieval, the sperm sample, washed and concentrated, is added to the eggs. Both the sperm and the eggs are placed in an incubator overnight to be examined the next day for signs of fertilization in the eggs. If the sperm sample appears normal, around 60-70% of eggs may fertilize.
An embryologist may speak with you and discuss the results of fertilization, which may help to alleviate your concerns. The fertilized eggs are then placed in the incubator for an additional 48 hours. The doctor may even recommend Intracytoplasmic Sperm Injection (ICSI) as part of the treatment in case the sperm quality is low (in terms of motility, sperm count, or morphology). ICSI is an advanced form of treatment for male infertility in which a single sperm is directly injected into a single mature egg.
Step 6: Embryo Transfer
The transfer of the embryo generally takes place 2-5 days after egg retrieval. The embryo that is chosen for transfer is placed in a thin plastic catheter. The catheter is passed through the cervix and into the uterus, and the embryo is gently released. This process is usually painless and takes only a few minutes to complete. Usually, only one embryo is transferred. Although, in some exceptional cases, two embryos may be transferred based on individual circumstances and embryo quality.
Some of the left-over embryos may be suitable for vitrification and rapid freezing, and these frozen embryos may be used in subsequent cycles if the first one is not successful. This option is available to all patients undergoing IVF treatment, but embryos must not show any signs of abnormal or slow development or fragmentation (cell breakdown) to be suitable for freezing.
Step 7: Luteal Phase
The luteal phase occurs between the embryo transfer and the pregnancy test and lasts two weeks. During this phase, it is very important that you look after yourself and take care of your health and well-being. Doctors may advise you to avoid strenuous exercise for 24 hours after the embryo transfer. Sometimes, tiredness, nausea, cramping, and bloating may occur due to the progesterone medication that you have begun after the egg retrieval. If you are in pain, you can take an analgesic. You can also consult with doctors if you are concerned about any symptoms.
Vaginal spotting or bleeding may occur before you are due for your pregnancy test, but this does not always signify that the treatment was not successful. You must continue using the treatment medication unless a full period occurs or you consult the doctor, who may recommend that you have blood tests.
Step 8: Pregnancy Test
The pregnancy blood test is due about 14 days after the embryo transfer. Thereafter, the doctor will provide you with the next steps you may have to follow to have a healthy child.
Need to consult a doctor or specialist for IVF in Delhi NCR?
The Centre for Infertility and IVF at Yashoda Hospital & Research Centre, Nehru Nagar, Ghaziabad, has a team of the best doctors who have helped couples fulfil their dreams of parenthood. Our doctors work hard to ensure that patients receive the best possible care at every stage of their treatment. Infertility is becoming more of a social issue in our country, with 15% of infertile couples. Our doctors are always ready to provide you with the best support and are always ready to address all your queries. Book an appointment at Yashoda hospital and get the best IVF treatment in Delhi NCR, Ghaziabad.
Dr. Gauri Agarwal has over 15 years of experience in genecology and infertility and is one of the best internationally recognized Infertility & IVF Specialists. She has received her training in IVF and embryology from some of the most prestigious institutions in Belgium and Singapore and is the Founder-Director of Seeds of Innocence, a well-known chain of IVF Centres and Genestrings Diagnostics Centre. One of the pioneers in implementing research, she has brought about new technologies and techniques such as PRP and genetic screening (PGS/PGD).