IVF – In vitro fertilization is with no doubt one of the most revolutionary innovations of the 20th century in the field of reproductive medicine. Since its first successful implantation in 1978, it has helped multiple couples with fertility issues or single parents who wished to conceive a baby. Nowadays it’s even a common first-choice procedure for those wanting to conceive.
What is IVF (In Vitro Fertilization)?
In vitro fertilization is a type of assisted reproductive technology. “In vitro” is Latin for “in glass” – in other words, it’s process, taking place outside of a living organism, in this instance human’s body. And fertilization is combining a female egg and male sperm to create an embryo. The remarkable mechanism of IVF is fundamentally mimicking of the natural process of conception with “a little” help from health care professionals and technology. To simplify the mechanism of what the Fertility doctor(Reproductive endocrinologist) does – increase the number of eggs in your ovaries, retrieve them out of the body, and fertilize an egg with sperms in the laboratory – and there we have the embryo. That is the IVF cycle. Overall one cycle can take about 2-3 weeks. Let’s go through the process of in vitro baby-making in a little more depth, step-by-step:
1) Appointment and Testing
Before starting the actual IVF process the patient must undergo a general health assessment and comprehensive fertility testing. The doctor will review the necessary testing requirements depending on a particular case. Most commonly testing consists of routine Gynecological, Infectious disease, Metabolic, Genetic tests, and so on. And Ovarian reserve testing – mainly includes a blood test and ultrasound images, to check for maternal hormonal balance and the number of eggs in the ovary, besides that, evaluation of the uterine cavity is commonly required – to ensure there are no anatomical defects that will risk the success of embryo implantation- the last step of IVF cycle. And of course, we also need to evaluate male partners with tests like Semen analysis and infectious disease screening.
2) Ovarian stimulation
The first thing we need for a successful IVF procedure is stimulated ovaries since they are the source of matured eggs necessary for fertilization. The ovaries are stimulated artificially using reproductive hormones. For example FSH – a follicle-stimulating hormone, which, as the name implies, stimulates follicles. The naturally producing FSH in a female’s body stimulates only one egg a month(rarely two), ovarian stimulation by FSH injection is needed to make sure as many eggs are matured as possible, this is necessary to increase the chance of successful conception. The goal is to have at least 4 growing eggs at a particular IVF cycle, but it can even be up to 20. This stage of IVF lasts about 12-14 days and it does involve a lot of needles, as the patient needs to inject hormones daily. At the end of this stage, another hormone – hCG (human chorionic gonadotropin) sometimes referred to as the “trigger shot” is used to complete follicular maturation before its retrieving. Noteworthy to mention, it’s a common practice for doctors to prescribe oral contraceptive pills for some time before starting ovarian stimulation, the purpose for this is to help synchronize the follicles so that they grow at the same rate.
Matured eggs are then retrieved from the body, just before the ovulation occurs. The procedure is done with an aspirating needle that is guided by an ultrasound. It is a 15-30 minutes long, invasive procedure, although the woman feels nothing because it is typically done under general anesthesia. After retrieval procedure females are mostly put on another hormone – progesterone, for 2 weeks to get organism ready for probably implantation. During this time all a patient can really do is cross-fingers and wait for pregnancy results.
In this stage, the male sperm comes into play. The retrieved eggs are processed and “cleaned” and ready for fertilization, there 2 main mechanisms of fertilization.
a) In the first, more common way – spermatozoids and eggs are left in laboratory dishes, for 20-24 hours set at 37 degrees, to fertilize on their own. During this process, only one, of the many spermatozoids, will penetrate the outer layer of the egg and achieve fertilization.
b) ICSI – Intracytoplasmic sperm injection – is mostly used when there is a problem with sperm quality and it has difficulty fertilizing the egg on its own. ICSI procedure involves injecting single selected sperm into an egg using a special needleThe product of successful fertilization is an Embryo.
5) Embryo transfer
One of the final stages of the IVF cycle. Here the embryo is transferred into the mother’s or surrogate’s uterine cavity through a thin flexible tube for implantation. Most of the time 2 embryos are transferred but lately doctors recommend to only transfer one and freeze others, to reduce the risk of multiple pregnancies, since more babies=more pregnancy complications. Unfortunately, the Success of IVF does not depend entirely on the doctor or the process of treatment, but on the patient and the so-called “non-modifiable” risk factors. For example, the rate of IVF success decreases as the age of females increases, the quality of eggs in the ovary is tightly tied to maternal age. In that case considering egg donor might be advisable. Risk factors for low success rate are also: female reproductive tract anatomical defects, male infertility, unhealthy lifestyle and so on. The more risk factors there are, the more cycles will probably needed. he best odds for success comes from repeated treatment cycles. Needless to say, patients during this journey need considerable financial, physical and emotional support. As it’s an incredibly difficult decision to make it requires frequent consults with health care professionals.