How is IVF done?
The IVF process begins with the first set of tests that includes blood tests and ultrasounds. The protocols differ with different clinics and individual applicants. However, every IVF process involves:
- Charting the ovulation cycle
- Medication to stabilize hormonal levels and ovulation
- Blood tests and ultrasound during periods
- Ovarian stimulation and ultrasound monitoring
- Retrieval of ova or eggs
- Transfer of embryo to the uterus
- Intake of progesterone during the waiting period
- Pregnancy test
Before the IVF Process
After the blood work and other tests are done, medical practitioners put the woman on appropriate medication such as:
- Birth control pills
- Gonadotropin-releasing Hormone (GnRH) agonist
- GnRH antagonist
The specific medication is based on the results of the blood work.
The IVF Cycle: Before Retrieval of the Egg
The IVF cycle starts at the beginning of the woman’s period. A transvaginal scan is done to determine the size of the ovaries and the presence of ovarian cysts if any.
Fertility drugs are given to stimulate the ovaries. Frequent ultrasounds are done to estimate the size of the follicles. A shot of Human Chorionic Gonadotrophin (hCG) is given when the largest follicle is about 18-20 mm in size and the estradiol/oestrogen levels are right.
The IVF Cycle: After Retrieval of the Egg
The ova are retrieved vaginally using a needle guided by ultrasound, between 34 to 36 hours after the hCG injection. The woman is given either general anesthesia or a light sedative during the procedure. The male partner is asked to provide a sperm sample either on the day or a few days before this, and the sample is stored.
The embryologist will place a single viable egg with around 10,000 healthy sperms in each culture dish. These are placed in special incubators for up to 24 hours. In case of severe male infertility, the embryologist will inseminate the egg with a robust sperm using a special needle. This process is called ICSI.
Three to five days after the retrieval, a healthy embryo is transferred to the uterus via a catheter.In certain cases, genetic testing on the embryo might be advised. Any surplus embryos are cryopreserved for another cycle.
Multiple IVF cycles: Why?
In a few cases, the IVF cycle will have to be terminated mid-cycle or repeated if there is no successful implantation of the embryo. Reasons for termination of the IVF process are:
- Presence of ovarian cysts
- Delay in ovarian response to fertility drugs
- Severe ovarian hyperstimulation
- Premature ovulation
The medications are adjusted or changed to deal with each of these to start a new cycle.