In-Vitro fertilization Process
WHAT IS IVF?
In-vitro fertilization involves the process of pregnancy that by-passes the fallopian tubes by fertilization of the egg (oocyte) and sperm performed in the laboratory.
This means that we need to extract the oocytes from the woman's body and collect the man's sperm to combine them both in the laboratory to form an embryo (an early form of a baby), which is then transferred into the woman’s womb for pregnancy.
HOW IS IVF DONE?
IVF is done through a few processes/steps followed by the woman and the man. If it’s only the woman, then a donor sperm is prepared.
COUPLE’S FIRST CONSULT:
The first consultation for a fertility consult is a very critical and highly involved one as information is extracted and investigations are done to determine the bottleneck leading to difficulty in falling pregnant.
- History taking
- This is a conversation that is held by the fertility specialist and the patient where you put the doctor in the loop of how long you have been trying to conceive, the pattern of menstruation if ever you've been pregnant before, and the outcomes, medical illnesses, medication is taken, type of occupation and exposure, history of previous surgeries, and if any means of intervention have been done previously.
- Physical Exam
- This involves the woman being checked by the doctor for any obvious problems that can be detected during the examination.
- The exam includes checking the different systems like the breast, thyroid, abdomen, vagina, etc.
- Pelvic sonar
- This is when the ultrasound (sonar) is done to examine the womb for any abnormalities and the ovaries assessed to check the follicular (egg) count.
- The transvaginal (intra-vaginal) sonar is usually performed for better accuracy.
- Blood Investigations
- Blood is taken to assess the hormone status of the female so all detected irregularities can be corrected prior.
- Specifically for the reproductive hormones, the woman is asked to take blood during her menstrual bleed on the second day of her menstruation to accurately assess her hormone status.
- A specific test to check the reserves of the ovary called AMH (antimullerian hormone) is also done to indicate the probability of pregnancy.
- Other STI blood tests like HIV and syphilis are also taken on both partners in preparation for treatment before the pregnancy if anything is detected.
THE IVF PROCESS
On the woman:
Day 2: START OF IVF PROCESS consult
- To start the IVF process, the woman is seen on the second day of her menstrual cycle.
- She is then assessed through a transvaginal sonar for the follicular (egg) count size of the follicles and to ensure no abnormal cysts are present at the start of the cycle.
- Medication is then prescribed according to her specific findings: her age, BMI, hormone levels, and follicular count.
- Education is given on how and when to use the medication.
- Medication is usually started on day 3 of the cycle and is mostly daily injections for an average of 10 days. Don't worry, the smallest needles available are used, and yes, you do it at home (mostly in the evenings) by yourself or with the help of anyone you have available.
- The date of review is given to check on follicular growth/ response to medication. After 5 days of being on medication, this is usually around Day 8 of the cycle.
Day 8 EGG MONITORING consult
- During this follow up visit, a transvaginal sonar shall be done to trace the ovarian and endometrial lining response to the medication. Here, the medication can be adjusted up, down or kept the same depending on your response. The recommended expected follicular size is 18mm and an endometrial lining of 8mm.
+/- Day 12 Oocyte monitoring consult
- Follow up visit is usually towards the finalization of the stimulation process leading close to the maturity/readiness of the follicles. Here, the trigger/ release of the oocyte in preparation for the aspiration of the oocytes is usually planned once the expected size is reached.
- This involves a once-off injection that is responsible for the oocytes' maturity and the oocyte's release from the follicles. This is usually given 36 hrs before the aspiration procedure.
- Depending on your response to the medication, other ovulation trigger methods can be used, and more than one injection can be given.
EGG RETRIEVAL / OOCYTE ASPIRATION PROCEDURE
- Known as transvaginal oocyte aspiration (TVOA) or Oocyte pick up (OPU) procedure.
- This procedure removes the eggs from the ovaries and is for most people around day 14 of menstruation.
- The procedure is done under conscious sedation (you are made to have a short nap). A drip is inserted, and medication is given through the drip to temporarily reduce consciousness and pain sensation.
- A needle is then inserted vaginally under sonar guidance to reach the ovaries and aspirate the oocytes.
- The eggs are immediately received by the laboratory, assessed, and prepared for fertilization.
- This is the same day that sperm is needed and used for fertilization. So, if fresh sperm is used, your partner needs to come in on that day to produce the sample.
- Embryo transfer is done between 3 or day 5 after fertilization. So this would be around day 19 of the same menstrual cycle.
- You are fully conscious during this procedure, and it remains painless.
- A small tube/catheter is used to transfer the embryo/s into the womb for implantation.
- If any embryos remain, these are frozen and preserved for future use or other options available.
- A pregnancy test is done 2 weeks after embryo transfer. This is around day 30 of the same menstrual cycle. It is done through a blood test. So, within a period of 1 month, the process of IVF is started and completed with results!
On the man:
- SEMEN ANALYSIS
- Semen analysis is done on the first consultation to check the quality and quantity of the sperm.
- The semen is produced through masturbation and collected by the man into a specimen container provided.
- It is then taken by our embryologist to be assessed under a microscope.
- The quantity check on the sperm involves the sperm count and concentration of sperm per ml of semen.
- The quality check on the sperm involves checking the shape of sperm and their motility (swimming ability) which are vital for successful fertilization.
- PHYSICAL EXAM
There are other conditions that a man can suffer from that lead to poor sperm quality and quantity. The man is then also examined for the absence or presence of the testicles, their normal or abnormal size, scrotal swelling, penile skin shortening, etc.
- SEMEN PRODUCTION:
On the day of oocyte aspiration on the female, the male partner then provides us with a fresh semen sample that shall be used on that day to fertilize the retrieved eggs.