What is IVF?
Explained in easy to understand terms 😊
How it is, without the emotions….well just a little.
IVF stands for In Vitro Fertilisation. In vitro meaning “in glass” and fertilisation meaning “where an egg is combined with sperm outside of the human body”.
You would have probably heard of the ‘test tube baby’. That’s right. The world’s first IVF baby was successfully achieved in 1978 in the UK. 40 years on, science has ventured productively forward where we can now genetically test embryos for hereditary factors of disease or disorders as well as freeze human eggs for future parenthood.
IVF is one of the main treatments of Assisted Reproductive Treatment (ART) which most people have heard about. However there are other treatments used to assist women in becoming pregnant which also fall under this category of ‘Assisted Reproductive Treatment (ART)’. These are: Ovulation Induction, Intrauterine Insemination (IUI), Donor conception, Gamete Intra Fallopian Transfer (GIFT), Intracytoplasmic Sperm Injection (ICSI), Pre Genetic Testing (PGT) formally known as PGD, and Surrogacy. We will explain in a future blog. For now, let’s look at IVF.
Did you know?
15% of couples - nearly 1 in 6 have difficulties conceiving.
This is after a year of trying. Did you know being unable to conceive is not just a woman’s ‘problem’.
Infertility is the result of female factors in 1/3 of cases as well as male factors in another 1/3 of cases. The other 1/3 is a combination of both or unknown factors.
IVF process – Step by Step
Depending on individual fertility circumstances, there may be other medical investigatory procedures prior to the IVF process. E.g. blood tests, laparoscopy, endometriosis surgery, hysterosalpingogram (HSG) are common ones.
- CD 1 is the start of an IVF treatment cycle. The day you get your period.
- Stimulation phase. Normally once a month, your body produces 1 egg which is released. With IVF, you start injecting hormones - follicle-stimulating hormones (FSH) each day to produce numerous follicles which will contain an egg. This phase lasts for approximately 8- 14 days depending on which IVF protocol your fertility specialist prescribes you. You will become bloated as many follicles grow so loose comfortable clothing is a must. Some women find this stage ok to deal with as the needles are very fine. Some needles! However many others experience symptoms of headaches and irritability from the hormones.
- Ultrasounds & blood: You have transvaginal ultrasounds (you’ll know what that is) and blood tests to check how your ovaries and follicles are developing to the FSH and medication may be adjusted. You will be monitored closely towards the end of the stimulation phase. The number of follicles is an approximate guess to the number of eggs they will collect. But, not every follicle will contain an egg and not every follicle will contain a mature egg. A cautious hope is the feeling.
- Trigger Injection: When the hormones in the blood levels are optimum and follicle size within acceptable range, you will have a ‘trigger injection’. This is timed with precision and prepares the follicles for ovulation. Approximately 36 hours after the trigger injection, you will be scheduled for egg retrieval also called egg pick up or OPU/EPU. ‘O’ for Oocyte which is egg! Egg retrieval is like manual ovulation.
- Egg Retrieval: Egg retrieval procedure is a day surgery hospital procedure done under general anaesthetic. It takes about 30 minutes. The fertility specialist uses an ultrasound to guide a needle into each follicle to aspire the fluid and passes this to the scientist close by. A microscope is used where they will check for an egg in each follicle fluid. Research says the average number of eggs is 8 – 15. This is also dependant on the age of the woman and simply everyone is different. The amount is usually written on the patients palm so you know how many actual eggs they collected when you awake. It’s either like winning a small lottery or someone’s stolen your most precious keepsake. You can’t get it back. You keep looking that maybe you saw it wrong through the wakeful anaesthetic. More on that later. Finally you will need a support person to drive you home and most feel ok to go back to work or normal duties. Others will need to rest. Whatever the result, you do breathe a sigh of relief at this stage, but only for a short time.
- Sperm Collection: Fresh sperm is collected the morning of egg retrieval. So most times you are given a sample container to take home and advised to refrigerate and bring to the clinic. Alternatively you may be advised to produce a sample at the clinic. There’s nothing to worry about guys! Every guy is there for the same reason and when you come out looking really relaxed from those 1980 videos they put on for you, we wish we could feel the same.
- Fertilisation: So the sperm is examined, washed and graded by quality of shape, tail size, swimming speed etc. The best ones are selected ready to meet the eggs to fertilise naturally in a special mixture in a dish. ICSI may be used to inject the sperm into the egg to help fertilisation if there is male-factor infertility or after repeated IVF failures. Prepare yourself that it is quite normal that not all your eggs will fertilise.
- Embryo development: Once the sperm fertilises an egg, it forms an embryo. These are transferred to a nutrient rich incubator where the cells continuously divide to continue its growth. Research has provided cell division timelines on how many cells an embryo should have at every day of growth, however this does vary. Embryos may be transferred on day 3 (where they have 7-10 cells) or day 5 (where it is a blastocyst with 80-150 cells). The blastocyst is a mass of cells at the near stage of implanting into the uterine lining. Studies support increase pregnancy success rates when an embryo makes it to day 5 growth and this has become the treatment of choice for majority of patients. In saying this, there are many pregnancies from day 3 transfers, including my first child. The debate still goes on which is best and this only adds more anxiety to how many embryos will survive. In fact 30 – 60 % of embryos do not make it to day 5. Numbers to transfer are yet again reduced.
This is an anxious time as we wait desperately for the embryologist to call with how many fertilised and how many cells they have. Thank-fully the internet provides either relief or more anxiety as we search and compare from websites to trawling through forums for answers.
- Embryo Transfer: We tread excitedly cautious for the embryologists news on how many embryos make it to day 5/6 transfer day, however it is an exciting day. A day where you can transfer either 1 or a maximum of 2 embryos to increase implantation chances. Counsellors and the medical team have discussed all the pros and cons and patients decide how many they’d like to transfer. The transfer procedure is done in the clinic and like having a pap smear, a few minutes, and no anaesthetic. The embryo/s is vacuumed up into a slim catheter and inserted carefully into the uterus. You can get up and continue on your day and the embryo will not fall out! Some prefer to rest or have acupuncture soon after. You are officially PUPO 😊 Pregnant until Proven Otherwise, a popular acronym in fertility forums.
The remaining embryos are flash frozen by a process called ‘vitrification’, to be used as a Frozen Embryo Transfer later if the current cycle results in a negative pregnancy.
- Progesterone Support: Progesterone is normally produced by the ovaries approximately mid menstrual cycle when an egg is release. This hormone thickens the lining of the uterus (the endometrium) getting it ready for a fertilised egg i.e. the embryo to implant. If no embryo implants, the lining is shed in what we call our period. During IVF there is no ovulation so no progesterone is produced and we supplement this with progesterone suppositories or via daily intramuscular injections. These continue to support the lining thickness right up to the pregnancy blood test day to confirm if the IVF has been successful in a clinical pregnancy.
- The Two Week Wait (2WW): This is the most trying time emotionally for everyone. You just wait and try to continue with life. Most clinics do provide counselling services now which help support you, but it’s definitely not a good time to receive any ‘just relax’ encouragements. In fact there is no time during an IVF cycle or on the’ trying to conceive’ journey to hear this. The amount of hormones will show them reactions that even you never saw coming. The TWW is the time we have very little control over the outcome, not that we did before, but we can’t do anything. We have a thousand ‘what it’s’, and worries. We walk like we’re on clouds because we think the embryo will fall out. God forbid someone bumps into you, you just dislodged my embryo!!! Sex! ‘And you can’t wait’ you shout. It could really rip off then!
Pregnancy testing yourself: It is so hard but try not to test! hCG the pregnancy hormone doesn’t show the day after transfer or many days after. Sometimes a pregnancy test might come up positive when it’s reacting to some hormones from your trigger injection. It just makes you in an emotional mess. As hard as it is, try and wait.
- Final blood test – the blood test will measure a hormone called hCG (human chorionic gonadotropin) which is only produced when there is a positive pregnancy.
Depending on the protocol your fertility specialist gives you, an IVF cycle from start to finish is about 3-4 weeks. Some people are fortunate and get pregnant on the 1 IVF cycle, for others it is multiple. It is not uncommon to hear of 20 cycles, 30 cycles or more. The next question is:
When is enough, enough?
Disclaimer: All information found on Fertile Horizons.com.au including this blog is the opinion of the author unless otherwise noted. It is no substitute for consulting a health care professional. Anything relating to medical and health conditions, products and treatments is for information purposes only. Please see your doctor or fertility specialist before starting any alternative treatments, supplements or programs or if you have any medical concerns.