In vitro fertilisation (IVF) – Procedure & How It Works?

Overview 

In vitro fertilisation (IVF) is often used as a treatment when a woman has trouble conceiving in normal ways. IVF is the fertility procedure with the highest rate of success.

The process of in vitro fertilisation (IVF) includes taking a sample of a man’s sperm and a woman’s eggs and mixing them in a laboratory dish. The transferred embryo, or occasionally more than one embryo, is fertilised and then placed in the woman’s uterus.

What is In vitro fertilisation (IVF)? 

In vitro fertilisation (IVF) is the most popular assisted reproductive technology which is used to treat patients who have difficulty conceiving or getting pregnant. This refers to techniques that involve fusing oocytes outside of the body. 

“In vitro” refers to the outside of a living body. Oocytes are fertilised in a petri dish.

Why is IVF required? 

IVF is required as the treatment for infertility and a few hereditary issues.

Consider opting for IVF if you or your partner have any of the following conditions.

• Decreased sperm count.
• Fallopian tube complications.
• Complications from endometriosis.
• Disorders like polycystic ovary syndrome cause ovulation issues.
• Whether one of the partners has undergone sterilisation.
• To prevent passing on inherited genetic diseases to the offspring

Using donated sperm or eggs is an option for some people. One might suggest using donor sperm or donor eggs for a couple who is concerned about passing on a major genetic condition to their offspring.

Cancer patients may occasionally have their healthy eggs or sperm frozen before beginning cancer treatment, which might negatively impact their fertility. When the cancer treatment is over, these eggs or sperm can be thawed and used in IVF.

IVF may be used to start a family by single persons, as well as sexually and gender-diverse people.

How to prepare for IVF treatment?

• As preparation for IVF, a person will get a uterine and fallopian tube examination before IVF to ensure no problems necessitating surgical correction. 

• The male partner’s semen is analysed as part of the pre-cycle testing, which also involves a hormonal examination to measure thyroid function, STI testing for both spouses and ovarian reserve testing.

• The length of time that women take fertility medications for ovarian stimulation is usually 8 to 14 days. On average, it is about 10–11 days. To mature numerous eggs for egg retrieval, ovarian stimulation is performed. 

• Fertility medicines are used to increase egg production even when ovulation is normal since pregnancy rates are higher when there are more eggs because more embryos can be created, allowing for more embryo transfers.

• IVF often requires retrieving 10 to 20 eggs on average. On average, only around two-thirds of them have the right level of maturity. Thus, not all of them are viable to use.

• To try to get the most eggs possible while preventing the emergence of ovarian hyper-stimulation syndrome (OHSS), a doctor will carefully design a protocol. 

• The patient will regularly be observed using hormone tests and vaginal ultrasounds for the best outcome, and most of the time, IVF fertility medications are injected. 

• After an ultrasound indicates that the patient has sufficiently large ovarian follicles and the appropriate level of oestrogen, they will be given a trigger shot of hCG or another medicine.

• The injection replaces the woman’s natural luteinising hormone surge, which boosts the last stage of egg maturation, enabling fertilisation.

IVF Cycle 

An IVF cycle consists of several phases, each with its own set of steps. The stages are ovulation stimulation, egg harvesting, insemination and embryo implantation.

The treatment cycle usually starts on, or as close to, the first day of the menstrual cycle. The patient will frequently be injected with hormone drugs. There are three different types of medications, each serving a different purpose.

• Ovarian stimulation medications contain Follicle-stimulating hormone (FSH) and luteinising hormone (LH), which promote the ovary follicles (fluid-filled sacs, each containing one egg) maturation and enable ovulation. These are two common hormones present naturally in the body.

• Ovulation is delayed until another hormonal medication suitably matures numerous eggs.

• The third, referred to as the trigger, prompts the egg’s timely release so that it can be retrieved or collected.

IVF step-by-step process 

• Blood test – The doctor will recommend a blood test on the first day of the menstrual period.

• Hormone stimulation – The hormone stimulation treatment will begin on the second or third day of the menstrual cycle. The patient will start taking medication to trigger the follicles and boost them to release several eggs.

• Trigger shot – The patient will give themselves hormonal shots that will cause the ovary to mature and release an egg after the eggs have reached a particular size.

• Egg retrieval – The eggs of the woman will be retrieved (collected) approximately 34–36 hours following the trigger shot. The fertility specialist will introduce a small needle into the vaginal wall to remove the eggs from the follicles.

• Semen sample – On the same day as the egg collection, the patient’s partner will supply a semen sample if fresh sperm is used. Surgical treatment can also assist in removing sperm straight from the testicles. In addition, one can also use donor sperm that has been frozen.

• Fertilisation – Healthy sperm and eggs are combined for fertilisation and incubated in a dish overnight. A single healthy sperm is inserted into a mature egg during a process known as intracytoplasmic sperm injection (ICSI), which is necessary for specific circumstances. When the sperm quality is poor, this might be useful.

• Embryo transfer – The fertility doctor will implant an embryo in the uterus in 3 to 5 days following egg extraction. Sometimes more than one embryo is transferred. However, this is uncommon. The doctor might choose to postpone a transfer in particular circumstances. 

Depending on the particular situation, any healthy embryos that aren’t transferred may be preserved and used in the future.

• Test for pregnancy – The patient is advised to wait two weeks after the embryo transfer to perform the test. A blood test is the best way to determine pregnancy, which is more accurate than a home pregnancy test.

Risks of IVF 

It is essential to remember that there is a chance of failing to conceive with IVF, which can be distressing and emotionally painful.

The ovaries may be overstimulated, a medical concern that can have severe consequences. The medical term for this is ovarian hyperstimulation syndrome or OHSS.

Side effects of IVF medicines 

Here are a few side effects of taking IVF medicines.

• Tiredness and mood changes.
• The injection site may experience some bruising and pain. Using different sites for the injections can help.
• Nausea and vomiting.
• Short-term adverse reactions, including itchiness or reddening of the skin where the injection was made.
• Increased vaginal discharge and breast sensitivity
• Ovarian hyperstimulation syndrome (OHSS) 

Most OHSS symptoms (nausea, bloating, and ovarian discomfort) are moderate. Within a few days of the egg retrieval, the symptoms usually disappear on their own. 

When OHSS is severe, the abdomen and lungs may accumulate a lot of fluid. This may result in significantly enlarged ovaries, dehydration, difficulty breathing and excruciating stomach pain. OHSS can very rarely (in less than 1% of women undergoing egg retrieval for IVF) result in blood clots and kidney failure.

Does an IVF pregnancy have more or different risks? 

There is a chance of difficulties in every pregnancy. There are numerous factors, such as older age (over age 38), obesity and smoking, that may raise the likelihood of experiencing a pregnancy problem.

Certain pregnancy issues are more likely to affect women who get pregnant through IVF.

• Elevated blood pressure
• Vaginal bleeding
• Blood clots in early pregnancy 
• Preterm delivery
• Caesarean section birth
• Having a child with a congenital disorder.

An individual’s particular situation will determine the chance of difficulties. Before beginning treatment, a person should talk to the doctor or the reproductive clinic about the advantages and disadvantages of having IVF.

Contraindications 

The IVF technique has no specific contraindications. Yet, if IVF were successful, it shouldn’t be done on women who are at high risk for pregnancy-related morbidity and mortality. 

These high-risk conditions can include, but are not limited to, 

• Eisenmenger syndrome, 
• Severe valvular stenosis, 
• Pulmonary hypertension, and 
• Coarctation of the aorta. 

Marfan syndrome is another example. Infertility treatment (IVF) with oocyte aspiration and fertilisation with the partner’s sperm is an option for women with these severe medical conditions who want to have a biological child. Still, the embryos will be transferred to a gestational carrier.

Conclusion 

In vitro fertilisation is a boom in the medicinal field. A team of medical professionals—including doctors, nurses, embryologists, and other staff members—is necessary to treat patients successfully. 

To help the patient manage the complexity of IVF treatment, effective communication between staff and patients is essential. Furthermore, it’s important to recognise the elevated psychological stress that many patients experience during IVF. 

Patients frequently lack appropriate emotional support from their close social connections. Lower conception rates are caused by a lack of support, which is also one of the major causes of IVF treatment attrition. 

All members of the treatment team must make an effort to keep lines of communication open with the patients and deliver patient-centred care.