What is IVF?
In vitro fertilisation (IVF) is the process of taking an egg and introducing it to sperm, outside a woman’s body. “In vitro” means ‘in glass’ as the egg and sperm meet in a petri dish in a laboratory. If the sperm and egg join, an embryo is formed. Healthy embryos are placed back into the uterus to grow.
IVF can be undertaken with your own eggs and sperm or donor eggs and sperm.
The IVF Process
IVF involves five main stages
Stage 1: Controlling the menstrual cycle
Medication, such as the pill, an injection or nasal spray, may be used to suppress or regulate the menstrual cycle. This ensures the woman’s period doesn’t arrive too early or too late and the IVF treatment can be controlled. This may be used for up to 2 weeks.
Stage 2: Growing the eggs
The average woman produces one egg each menstrual cycle, alternating between the ovaries. With IVF, medication (follicle stimulation hormone) is used to stimulate and grow multiple eggs during the one cycle.
Depending on the number of eggs that grow (anywhere from 1 to 30) this step can be quite uncomfortable for the woman as both ovaries swell to cater for the larger number of eggs.
Your doctor will monitor this stage very closely and a number of vaginal internal ultrasounds will be done to make sure the eggs are growing well. Medication may be used to help them mature.
A final trigger injection or nasal spray will be used 34-38 hours before your appointment for egg collection. The trigger tells your body to begin ovulating.
At this stage, it is normal to feel quite uncomfortable, as your ovaries swell to contain all the new eggs you’re producing.
Stage 3: Egg collection
The time of the egg collection is crucial, as it needs to occur before your body ovulates naturally.
Egg collection requires a minor procedure at a hospital or clinic. At the hospital, you will be admitted and sedated.
In the theatre, the doctor will insert a long needle up the vagina. It will pierce the uterus wall and collect the eggs from the ovaries on each side. This procedure can take up to 15-20 minutes.
When all viable eggs have been collected, you will be taken to recovery. Once you’re awake, your doctor will let you know how many eggs they were able to collect.
You will wait recovery until you’re ready to go home. Someone will need to take you home as you won’t be able to drive and you may be groggy or in some pain.
On the day of egg collection and the few days following, your doctor will watch you closely for any signs of ovarian hyperstimulation syndrome.
Recovery from egg collection can take several days. Doctors generally advise 3 days of rest afterwards.
Stage 4: Fertilising the eggs
Your eggs will be taken to a lab and fertilized in one of two ways: direct mix or intra-cytoplasmic sperm injection (ICSI).
With the direct mix method, sperm is poured into the dish with the eggs and they are left to join naturally.
ICSI involves single sperms being inserted into eggs directly.
After about 18 hours the eggs are checked to see how many have fertilized and become embryos. The embryos are kept in the lab and allowed to grow for up to six days.
During the six days, your doctor will keep you informed about how your embryos are progressing. It is normal that not all emrbyos will survive the six days in the lab. For example, you may have 12 eggs collected, eight that fertilize to become embryos, six that survive the first 24 hours, and four that survive to three or five days (when they may be transferred).
Stage 5: Embryo transfer
If you recovered well from the egg collection, with no signs of hyperstimulation, you may be able to do a fresh embryo transfer. If you have to wait until the following cycle, you will do a frozen embryo transfer.
Depending on your doctor and your personal circumstances, you may have a three day or five day old embryo transferred.
The embryo transfer is a simple process that requires another visit to the hospital or clinic.
You will be awake throughout this procedure unless you require sedation for a specific reason (i.e. severe anxiety). If you remain awake, your partner or support person can usually be with you the whole time.
The transfer is similar to having a pap smear. You will lay on a bed and the doctor will use a catheter to put the embryo directly into the womb, through the vagina.
You can expect to see three professionals in the room during your transfer – your doctor, a nurse and the scientist. The scientist will be the one to bring the catheter with your embryo inside to the doctor. After the transfer, the scientist will take the catheter away and check under a microscope to ensure the embryo is no longer in it.
After the transfer you will be able to get dressed and go home. Your doctor may give you additional medication to encourage the embryo to implant, such as progesterone pessaries.