What's Involved in IVF?

Despite what many (including myself previously) perceive the IVF process to be like, it’s not as simple as making an embryo, transferring it, and boom you’re pregnant. There’s so much more involved, and the numbers game is so much rougher than expected.

Each IVF protocol differs from person to person depending on their individual needs, but the basic foundation stays the same.

In general, these are the steps involved in an IVF cycle:

1. FSH (Follicle Stimulating Hormone)

Anywhere between generally day 1 - 3 of your cycle your Doctor will have you start taking an FSH daily, usually via subcutaneous injection. Typically in a natural menstrual cycle only one follicle on one ovary will become dominant and produce an egg. Using an FSH is one of the (if not THE) key aspects of an IVF cycle, as it causes many follicles to grow more dominantly and produce eggs. The important thing to note, however, is that although several follicles may grow, this does not guarantee that each of these growing follicles will produce an egg.

1. AN OVULATION SUPPRESSANT

Anywhere from day 1 - day 8 your doctor will have you start on some form (anything from a nasal spray to an injection) of medication which will prevent you from ovulating all of those valuable eggs before the day of egg retrieval.

1. A ‘TRIGGER SHOT’

This usually contains HCG or Lupron, or both. The hormone shot is given to mature the eggs that are growing, and prepare them for egg collection. It is usually given about 36 hours before the time of your egg retrieval. Timing of the trigger shot is imperative. If given too early the eggs may release from the follicle before your egg retrieval procedure. If given too late the eggs may not be ready for collection.

1. EGG RETRIEVAL

Scheduled 36 hours after the trigger injection, an egg retrieval procedure will take place. This is sometimes done under sedation, and sometimes done under a local anaesthetic. An ultrasound probe is inserted into the vagina. The doctor then uses the image from the ultrasound to guide a long, thin needle through the vagina wall and into each of the follicles growing on each ovary. One by one, the eggs are suctioned out of the follicles and are ‘collected’. It is important to note that not all growing follicles will contain eggs, and not all eggs collected will be ‘mature’ (meaning not all eggs collected will be able to be fertilised).

1. FERTILISATION

After egg retrieval, the fertilisation process takes place. In the case that a fresh semen sample is being provided, the sperm will be ‘washed’ and then combined with all of the mature eggs in a culture dish. They are then left to fertilise ‘naturally’ as they would in your body. In the case that you are using a frozen sample (perhaps you’re using donor sperm, or your partner is away) or if your partner is known to have suboptimal sperm quality, the laboratory may use a process called ICSI (Intracytoplasmic Sperm Injection) to fertilise the eggs manually. Regardless of the process used, the sperm and eggs are then stored in specialised culture incubators for approximately 17 hours before they are then assessed to determine if fertilisation that will produce an embryo did indeed occur.

1. BLASTOCYST

All eggs that have been successfully fertilised are then stored in a culture incubator for a number of days. Different clinics will assess progress at different intervals (e.g., some will assess 24 hours later, some will wait until day 3, and so on). Some clinics will transfer embryos that are developing well at day 3, however the most common practice is to wait until day five or six where embryos have reached what is called the ‘blastocyst’ stage where the embryo has developed to have approximately 100 cells. Unfortunately, not all eggs that are fertilised will reach this stage of development.

1. EMBRYO TRANSFER

If you are having a ‘fresh transfer’, this will take place around day 6. If you are freezing your embryo(s) before transfer this will take place approximately three weeks later. The embryo transfer procedure is minimally invasive, similar to a pap smear or an IUI. A speculum is inserted into the vagina so that your doctor can visualise the cervix. A thin catheter containing the embryo is then inserted past the cervix into the uterus, where the embryo is then expelled.

1. PREGNANCY TEST

Unfortunately despite the healthy development of an embryo to blastocyst stage, an embryo transfer does not guarantee a pregnancy. So, just as if you were trying to conceive naturally or via IUI, a blood test will be conducted two weeks post transfer to determine whether implantation has been successful.

So there you have it. The IVF process is far from simple. It involves a number of intricate steps, each of which may or may not be successful. Nothing is guaranteed.

That being said, it is still such an amazing resource that we have access to and I am so grateful to be able to include in my toolbox for tackling infertility.