Most people are familiar with at least the concept of In Vitro Fertilisation, or IVF. But do we really know what happens during the IVF process?
If you’re about to go into IVF, or a member of your family or friends is beginning their IVF journey, a good understanding of the process is a must. Not only does it mean you know what’s coming, but you can better prepare for everything beforehand.
First, let’s give you a quick rundown of In Vitro Fertilisation. It’s one of several ARTs, or Assisted Reproductive Technologies, that infertile couples can use to get pregnant. Of all the ARTs, IVF is probably one of the most well known. At a basic level, it involves fertilising eggs with sperm outside of the body, before implanting them back in.
The success rate of IVF is quite high, especially with older mothers. Although individual rates vary for each clinic, average success rates are about 90% for women under 35, 85% in women 35-39, and 45% in women age 40-44.
Now, IVF isn’t a simple process, or even a single procedure..
but rather a series of steps undertaken over several weeks. Let’s look at them now.
1. Egg Collection
The first step in the IVF process is collecting eggs from the mother-to-be’s ovaries. To do this, doctors will give the patient injections of Follicle Stimulating Hormone (or FSH), which encourages the development of sacs on the ovaries that contain eggs. The injection process takes about two weeks, before the doctors can remove the eggs using a needle to aspirate them out. This is a very simple process, and is painless. Patients can undertake the procedure in theatre, but under a very light anaesthetic.
2. Sperm Preparation
At the same time as the eggs are being collected from the mother, the father supplies the sperm and it is prepared for fertilisation by the doctors. There are a few different ways the sample can be prepared, and the one most suitable will depend on the medical history of the man, and the nature (if any) of his fertility issues. One of the most common methods is called Density Gradient Preparation. In this method, the semen is added to a test-tube containing a substance that filters out sperm with low or poor motility. The sperm sample may also be spun to ensure the sperm are concentrated as close together as possible before insemination.
There are two ways that insemination can take place, and the method will depend on the quality of the sperm being used. If dad-to-be has no fertility issues, doctors will undertake a standard insemination. This involves the doctors combining the eggs and sperm in a dish and leaving them overnight. For future dads with fertility issues, particularly to do with motility, the doctor will likely choose to do a Intracytoplasmic Sperm Injection. This sounds scary, but it basically involves the doctors injecting a single sperm into each egg before leaving them overnight to fertilise.
After the eggs and sperm have been left overnight to fertilise, the doctors will come to check their progress. They’re looking for signs that the eggs and sperm have become embryos, and are ready to be grown in the lab before being implanted. All of the dishes that contain growing embryos are separated from the ones in which fertilisation did not occur and are put aside. They will be monitored closely until they are ready to be implanted.
5. Embryo Culture
The fertilised embryos can be grown in the lab for up to six days after the eggs have been taken from the ovaries, before they are eventually transferred. The timing of the transfer will depend on the individual circumstances of the patient. Usually, their doctor will give them a choice between the Cleavage Stage, which is around the two or three day culture mark, and Extended/Blastocyst Stage, which is around the four or five day mark. The first stage is usually chosen by parents with only a few embryos, while the second stage is common in parents with more embryos available.
6. Embryo Transfer
Once the doctors have assessed the embryos, and ensured they’re fertilised and ready to go, they will choose the most advanced one to be transferred. To do this, the doctors put the embryo into a thin, soft plastic tube and place it back in the uterus. The process is very straightforward, and is similar to a pap smear in the way it is done, meaning anaesthetic is not required.
7. Success or Not
Once the embryos are transferred back into the uterus they will keep growing until they attach themselves to the wall of the uterus. There is no guarantee that they will attach, and if they do not the IVF process can be repeated. However, if they do attach, the pregnancy is officially underway!