- IVF (In Vitro Fertilization)
Many couples struggle to conceive and turn to other methods to start a family, In-Vitro Fertilization (IVF) is one of the most successful and therefore, well-known methods of assisted reproduction technology (ART).
IVF works by extracting an egg from the female partner and taking sperm from the male partner (or using a donor egg or sperm where appropriate) and combining them in a laboratory before transferring the embryo(s) into the woman’s uterus (a donor/surrogate may also be used).
IVF is an option for many couples who have struggled to conceive naturally or those that suffer from:
- Age – woman over 40 are more likely to experience fertility issues for a variety of reasons
- Genetics or the risk of passing on genetic predispositions that reduce quality of life – embryos can be scanned for some but not all abnormalities, if found a donor sperm or egg may be used for insemination
- Fallopian tube damage/blockage resulting in reduced access to the uterus for an egg to be fertilized or for an embryo to pass to the uterus
- Ovulation disorders: are common and result in fewer eggs being available for fertilization
- Ovarian failure: this condition results in the loss of normal ovarian function and is considered premature ovarian failure in women under 40. Ovarian failure means an imbalance in the amount of estrogen being produced or eggs not being released regularly
- Endometriosis: a condition where uterine tissue implants itself and grows outside of the uterus, affecting the functioning of the uterus, fallopian tubes and ovaries
- Uterine fibroids: are common in women in their 30s and 40s, while benign, these tumors grow on the wall of the uterus and can interfere with the implantation of a fertilized egg
- Uterine fibroids: When the fallopian tubes have been cut or removed, IVF may offer an alternative method of conception
- Impaired sperm production/function: Below-average sperm concentration, weak mobility or abnormalities in the shape and size of sperm may hinder sperm function and therefore, insemination
- Unexplained fertility: unfortunately, there’s not always a reason for infertility, IVF can be an option for conception even when there is no determined underlying cause for infertility
- Fertility preservation: this is especially common in women who are about to undergo treatment for cancer which can harm the eggs. In this instance eggs are harvested and frozen in an unfertilized state
IVF can be an emotionally and physically draining process, ensuring your physician understands and respects your needs is pivotal to the process. Before starting IVF there are several tests to undergo before embarking on the extraction, fertilization and implantation process which can take about two weeks.
Before embarking on the IVF journey it is important that patients understand the process may need to be completed more than once for it to lead to a successful conception and that conception is unfortunately not guaranteed.
Before beginning the IVF cycle you will need to undergo:
- Ovarian reserve testing, determining:
- Quantity of eggs
- Quality of eggs
- Concentration of follicle stimulating hormone (FSH)
- Estradiol (estrogen) in the blood during the first days of the menstrual cycle
- Antimullerian (hormone) in the blood during the first days of the menstrual cycle
- Semen analysis
- Infectious disease and HIV screening
- Mock embryo transfer, determines the depth of the uterus and which technique can be used successfully to implant the embryos into the uterus
- Uterine cavity exam
An IVF cycle involves:
Ovulation induction: synthetic hormones are used to stimulate your ovaries into producing multiple eggs as not all eggs will be viable for fertilization.
During ovulation stimulation, it is likely you will be on several medications to stimulate egg production and increase hormone levels to prepare the uterine lining, common medications include:
- One or both of an injectable medication containing follicle stimulation hormone (FSH) and/or Luteinizing hormone (LH) – increasing egg production
- Human chorionic gonadotropin (HCG) which helps the eggs to mature, this step is typically taken after 8-14 days, when the follicles are ready for retrieval
- Medications to prevent premature ovulation – this ensures eggs will be ready to extract at the same time
- Medications to prepare the uterine lining
A vaginal ultrasound and/or a blood test will typically be conducted around 2 weeks after ovarian stimulation.
At this stage, some IVF is stopped according to the response of the follicles and ovulation. If this occurs, other medications will be recommended, or existing medications adjusted in order to promote the desired level of ovarian stimulation in order to move onto the next step.
Egg retrieval: is typically conducted in your doctor’s office, 34-36 hours after the final injections and before ovulation occurs. In egg retrieval:
- An ultrasound probe is used to identify follicles before a needle is inserted to retrieve the eggs, OR
- A laparoscopy is used to guide the needle and extract the eggs
- Multiple eggs are typically retrieved
- Mature eggs are placed in a culture medium and incubated. Mature, healthy eggs are mixed with sperm to attempt to create embryos.
Sperm retrieval: sperm donation through masturbation on the morning of the egg retrieval will come from your partner or a donor. Sperm are separated from seminal fluid in the laboratory
Fertilization: can occur via:
- Insemination: healthy sperm and egg are mixed together and inseminated overnight.
- Intracytoplasmic sperm injection (ICSI): one healthy sperm is injected directly onto each mature egg – used if semen quality and production are problematic or if fertilization in previous IVF cycles have failed.
Embryo transfer: the last step in the IVF cycle typically takes place 2-6 days after egg retrieval. In this step:
- A catheter will be inserted into your vagina, through the cervix and into the uterus
- A syringe with the embryos suspended in fluid will be attached to the end of the catheter, using the syringe, the embryos are then placed into the uterus via the catheter
After the embryo transfer, if successful, the embryo will implant in the uterine lining in 6-10 days approximately.
IVF can be a lengthy and draining process for many couples. Bloom Health will connect you with consultants experienced and trained in fertility issues and family planning.
Contact us today for more information.
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