IVF Process Step-by-Step

When you think of fertility treatments, in vitro fertilization (IVF) probably comes on the top of your list. There is a reason for it. The IVF process step by step has been around, for decades now and most of you must know the basic idea behind IVF: bringing egg and sperm together in the lab for fertilization. But there is so much more about IVF before and after that. 

IVF is commonly used to treat:

• Older women with fertility issues
• Women with endometriosis
• Women with damaged or blocked fallopian tubes
• Male infertility is caused by low sperm count or blockage

Here’s a close look at the IVF process step by step timeline.

What IVF treatment process step-by-step means?

In vitro fertilization (IVF) is known to be a complex procedure that is opt to help with fertility or prevent genetic problems and assist with the conception of a child. 

During IVF mature eggs are retrieved from ovaries then fertilized by sperm in the lab. Later the fertilized egg or eggs are transferred to the uterus. Nearly it takes three weeks’ time frame for one full IVF cycle. Many times these steps are split into parts and the process takes longer. 

IVF is known as the most effective form of assisted reproductive technology. In this procedure, your egg and your partner’s sperm or embryos can be used. In some cases egg, sperm, or embryos from a known or unknown donor can be used. Also in some cases, a gestational carrier (a woman who gets the embryo implanted in her uterus) may be considered.

There are many factors that need to be taken into consideration for having a healthy baby through IVF, like age and the cause of infertility. IVF is time-consuming, invasive, and expensive. During the procedure, if more than one embryo is transferred to your uterus, it can result in multiple pregnancies.

Your doctor can help you to understand how this IVF works and the potential risks and whether this treatment is right for you or not.  

Why is IVF treatment done?

In vitro fertilization (IVF) is a well-known treatment for infertility or genetic problems. Prior to going for IVF you and your partner can try for less-invasive treatment options like fertility drugs to boost the production of eggs or intrauterine insemination, it is a procedure in which sperm are placed directly in your uterus near the time of ovulation.

For women above 40 years of age, IVF is offered as the primary treatment for infertility. IVF can also opt if you have any health conditions. For instance, IVF may be an option if you or your partner has:

• Damaged or blocked fallopian tubes: If the fallopian tube is damaged or block then it becomes difficult for an egg to be fertilized or for an embryo to travel to the uterus.
• Ovulation disorders: If ovulation is infrequent or absent, then fewer eggs are available for fertilization.
• Uterine fibroids: Fibroids are benign tumors that are found on the walls of the uterus. These are quite common in women in their 30s and 40s. These uterine fibroids can interfere with the implantation of the fertilized egg.
• Endometriosis: Endometriosis occurs when the uterine tissue implants and grows outside the uterus. This often affects the function of the ovaries, uterus, and fallopian tube.
• Previous tubal sterilization or removal: If you have had tubal ligation that is a type of sterilization in which your fallopian tubes are blocked or cut to permanently prevent pregnancy and now you want to conceive. Then IVF stands as the only alternative to tubal ligation reversal.
• Impaired sperm production or function: If the sperm concentration is below average, weak in mobility, or abnormality in size and shape can make it difficult for sperm to fertilize an egg. When semen abnormalities are diagnosed then your partner may need to seek specialist help to determine if there are correctable problems or underlying health concerns.
• Unexplained infertility: It means even after evaluation for common causes no cause of infertility is found.
• A genetic disorder: If you or your partner is at risk of passing on a genetic disorder to your child, then you may consider IVF as the best option to go for. As in this after the eggs are harvested and fertilized, they are screened for certain genetic problems. Although all genetic problems cannot be identified. Later the embryos that don’t contain identified problems can be transferred to the uterus.
• Fertility preservation for cancer or other health conditions: If you are about to start cancer treatment like radiation or chemotherapy that could affect your fertility. In such scenario, IVF for fertility preservation can be an option. Eggs from women are harvested and frozen in an unfertilized state for later use.

These are some of the cases for which IVF is the best option to go for.   

How to prepare for IVF treatment Process Step-by-Step?

While choosing an IVF clinic, always keep in mind that the clinic’s success rate depends on many factors, like patients’ age, medical issues, as well as the clinic’s treatment population and treatment approaches. You should also ask for detailed information regarding the cost associated with each step of the procedure. 

Before starting the IVF cycle using your eggs and sperm, you and your partner will need to go through several screenings, including:

• Ovarian reserve testing: To know the quality and quantity of your eggs, your doctor may test the concentration of follicle-stimulating hormone (FSH), anti-mullerian hormone, estradiol (estrogen) in your blood for the first few days of your menstrual cycle. Test results, along with an ultrasound of your ovaries are helpful in predicting how your ovaries will respond to fertility medication.
• Semen analysis: This is usually done as an initial fertility evaluation, but if not done then your doctor will recommend semen analysis prior to starting with the IVF treatment cycle. 
• Infectious disease screening: Both of you will be screened for infectious diseases, such as HIV.
• Practice (mock) embryo transfer: Your doctor may conduct a mock embryo transfer to know the depth of your uterine cavity and the technique to successfully place the embryo into your uterus.
• Uterine exam: Prior staring to IVF your doctor will examine the inner lining of the uterus. This might involve a sonohysterography (In this fluid is injected through the cervix into your uterus) and an ultrasound to get the images of your uterine cavity. Sometimes it may also include hysteroscopy (In which a thin, lighted telescope is inserted through your vagina and cervix into your uterus).

Questions to Consider Before Beginning the IVF Cycle

How many embryos will be transferred? 

Usually, the number of embryos transferred is based on age and the number of eggs retrieved. As the rate of implantation is lower in the case of older women, so more embryos are transferred, except for women who are using donor eggs or genetically tested embryos.

Most doctors follow specific guidelines to avoid multiple pregnancies and in some countries, legislation limits the number of embryos that can be transferred.  

What will you do with any extra embryos?

These extra embryos can be stored for future use. Usually, all embryos do not survive the freezing and thawing process, but most will. Cryopreservation is helpful in making future IVF processes less expensive and less invasive. You can also donate unused embryos to other couples who needs it or can also donate for the research facility. You can also choose to discard the unused embryos.

How will you handle multiple pregnancies?

Usually in IVF more than one embryo is transferred to your uterus that can lead to multiple pregnancies and it can be health risk for you and your babies. In some cases, fetal reduction can be opted to help a woman deliver fewer babies with fewer health risks. However pursuing fetal reduction is a major decision with emotional, ethical, and psychological consequences.

IVF Process Step by Step Timeline

Here are the details about the IVF Process Step by Step!

Step 1 – Ovarian Stimulation

You will be given a fertility drug to start with the process of stimulation or superovulation. In other words, the drugs containing Follicle Stimulating Hormone will send a message to your body to produce more than just one egg a month.

If the number of eggs are more than your chances of having successful fertilization later in the treatment increase. 

During this step, you will undergo transvaginal ultrasounds and blood tests routinely to check on your ovaries and monitor your hormone levels.

Step 2 – Egg and Sperm Retrieval

A day before your eggs are scheduled for retrieval, you will be given a hormone injection to help your eggs mature quickly.

Later, you will undergo a minor surgical procedure known as follicular aspiration, to remove eggs. Generally, this is performed as an outpatient surgery in your doctor’s clinic.

During this procedure, an ultrasound is done to guide a thin needle into each of your ovaries through your vagina. In this needle, a device is attached to it that suctions the eggs out at a time.

This part is a little painful but don’t worry as you will probably be given medication beforehand so that you don’t feel discomfort. Post-procedure you may experience some cramping, but it will usually disappear within a day. 

While your eggs are being removed, your partner will be asked to provide a sperm sample. You also have an option to choose donor sperm. To get the healthiest ones, the sperm are put into high-speed wash and spin cycle. 

Step 3 – Fertilization

Now is the beginning of the IVF process that everyone is familiar with; combining the best sperm with the best eggs. This stage is known as insemination.

Usually, it takes few hours for a sperm to fertilize an egg. Sometimes doctors prefer to inject sperm directly into the egg instead of going through the process known as intracytoplasmic sperm injection (ICSI).

Step 4 – Blastocyst Culture

This step involves the observation of embryos by embryologists until it reaches the blastocyst stage, known as blastocyst culture. Once the sperm fertilizes the egg, it becomes an embryo. The embryologist then puts the embryo into a special incubator, where the embryo is provided with the proper conditions to develop and grow. Proper monitoring of the embryo is done for 3-5 days, till the blastocyst stage.

Step 5 – Embryo Transfer

Once the eggs are collected you will receive another medication. This is given to prepare the lining of your uterus to receive the embryos that will be transferred back into you.

Nearly after three to five days after fertilization, the embryo will be placed in your uterus with the help of a catheter. This procedure is conducted in your doctor’s clinic while you are awake.

Multiple embryos are transferred back into your uterus with the hope that at least one will get implanted in the lining of your uterus and start developing. Sometimes it is seen that more than one embryo gets implanted, this is why multiples are common in IVF. 

IVF process timeline is of nearly four weeks. But sometimes the process is split into parts to make it easier.  

Steps After The IVF Procedure

After embryo transfer, you can resume back your daily activities. However, your ovaries may still be enlarged. You should avoid vigorous activities, which can cause discomfort.

Here are few typical side effects:

• Shortly after the procedure, you may pass a small amount of clear or bloody fluid due to the swabbing of the cervix before the embryo transfer.
• Breast tenderness due to high level of estrogen levels
• Mild cramping
• Mild bloating
• Constipation

If you feel moderate or severe pain after the embryo transfer, you should contact your doctor. Your doctor will evaluate you for complications like infection, twisting of an ovary, and severe ovarian hyperstimulation syndrome. 

Results

Nearly 12 days to two weeks after egg retrieval, your doctor will take a blood sample to detect whether you are pregnant. 

• If you are pregnant: In this case, your doctor will refer you to an obstetrician or other pregnancy specialists for prenatal care.
• If you are not pregnant: In this case, you will stop taking progesterone and will get your period within a week. If you don’t get your period or get unusual bleeding, contact your doctor immediately. Now, if you are willing to take another chance with IVF then your doctor may suggest steps you can take to enhance your chances of getting pregnant.

IVF Success Rates

These days IVF is quite successful. As per a study of nearly 156,000 women, the average live birth rate for the first cycle was 29.5%. This is comparable to the success rate for a natural cycle in couples with healthy fertility.

Through repeated cycles, you may get succeeded. As per this same study it was found that after consecutive six cycles, the cumulative live birth rate was 65.3%. these six cycles nearly took place over 2 years.

Age also plays an important role in your success, along with the reason for your infertility. Using an egg donor will also affect your success.  

Risks

IVF is generally safe, but with any medical procedure, some risk is associated. So before going forward your doctor should explain to you all the possible side effects and risks associated with the procedure.

• In 10% of women going through IVF procedures, ovarian hyperstimulation syndrome (OHSS) may occur. For most of the women, symptoms will be mild, and they will recover soon. For some women, OHSS can be more serious and sometimes even need hospitalization. Less than 1% of women going through egg retrieval may face blood clots or kidney failure due to OHSS.
• During or after the egg retrieval procedure you may experience cramping and discomfort. Some of the rare complications that may occur are accidental puncture of the bladder, bowel, or blood vessels, pelvic infection, or bleeding from the ovary or pelvic vessels.

If pelvic infection occurs then you will be treated with intravenous antibiotics. But in some rare cases where severe infection occurs, the doctor may need to surgically remove uterus, ovaries or fallopian tubes.   

• During the embryo transfer procedure you may experience cramping. In rare cases after the embryo transfer women may experience cramping, spotting or bleeding. And is some of the very rare cases, infection can occur and it is treated with antibiotics.
• There is a risk of multiple pregnancies, which can lead to twins, triplets or more. Multiple pregnancies can be risky for both, mother and the babies. So it is better to discuss with your doctor how many embryos to transfer, this is because transferring more than necessary will increase your chances of conceiving twins or more. In some cases where embryos have been tested with PGT, typically only a single embryo is transferred.
• As per research it is said that IVF may slightly increase the risk of premature delivery or the child may be born with low birth weight.
• Nearly 2% to 5% of women who conceived through IVF usually have ectopic pregnancy it is a case where fertilized egg gets implanted outside the uterus, usually in a fallopian tube. The fertilized egg cannot survive outside the uterus, so there is no way to carry this pregnancy.
• Going through IVF procedure can be emotionally, physically, and financially draining. Support from family, friends, and counsellors can help you and your partner to go through the ups and downs of the procedure.

Discussing the above risk factor with your doctor before going for IVF will help you to understand how the procedure is done and be mentally prepared.

Conclusion

In-vitro fertilization is a complex procedure that is used to help with fertility or prevent genetic issues and assist with the conception of child.

During IVF procedure, eggs are retrieved from the ovaries and fertilized by sperm in the lab. Then the fertilized egg or eggs are transferred to the uterus. It takes nearly three weeks for an IVF cycle to complete. IVF is known as the most effective form of assisted reproductive technology. 

If you are planning to opt for IVF your doctor can help you understand how IVF works, the potential risks and whether it is the right treatment for you or not.  

FAQs

How long is the IVF process from start to finish?

The IVF process step by step takes around four weeks. After the fertility testing is completed IVF treatment begins. Usually fertility testing includes assessing your ovarian reserve or egg quality, semen analysis, and uterine cavity.

Is IVF a painful process?

IVF injections play a critical role in IVF process step by step. These injections help in stimulating your ovaries to produce mature eggs that are then harvested and fertilized with sperm.in most of the cases IVF injections don’t cause much pain.

How many injections do you need for IVF treatment?

For nearly 10 to 12 a woman is scheduled for IVF injection shots. These shots are hormonal stimulant designed to help her body produce more mature eggs. These eggs are then retrieved and fertilized.

How difficult is IVF?

IVF  process step by step might be a stressful procedure, it’s hard on body, but more over it is a mentally and emotionally draining process. However, it can still help you conceive a baby successfully and fulfill your dream of parenthood. 

References

https://www.pennmedicine.org/updates/blogs/fertility-blog/2020/april

https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716

https://www.verywellfamily.com/understanding-ivf-treatment-step-by-step-1960200

https://monashivf.com/services/fertility-treatment-options

https://www.arcfertility.com

https://txfertility.com/in-vitro-fertilization-ivf/

https://www.piedmont.org/living-better

https://www.nhs.uk/conditions/ivf/what-happens/