The IVF Process

More than 40 years since Louise Brown—the very first IVF baby—was born, she remains the living proof that reproductive miracles do happen, albeit with a little help from science. IVF continues to write histories today. Since Louise’s birth in 1978, CNN reported in 2018 that around 8 million babies were born worldwide through in vitro fertilization (IVF) and other assisted reproductive technology (ART) treatments.

What Is IVF?

In vitro fertilization (IVF) is an ART treatment that combines eggs and sperm outside the body and in a petri dish. Following successful fertilization, one or more embryos are transferred back to the uterus to initiate pregnancy.

IVF is a suitable option for couples experiencing infertility due to advanced age and health conditions, which include:

• Ovulation disorders, which results in very few or no eggs ripe for fertilization
• Blocked or damaged fallopian tubes, which prevent sperm from fertilizing the egg, and preventing the embryo from traveling down the uterus
• Endometriosis, a condition where the uterine lining forms outside the womb
• Uterine fibroids, which may prevent the embryo from being implanted into the womb
• Male factor infertility, including poor sperm production, quality and function, which prevent sperm from fertilizing the egg(s)
• Genetic disorders that may be passed down to the child. In such cases, preimplantation genetic testing through IVF is advised.
• Unexplained infertility, despite the couple being in optimal health

IVF may also be recommended if other fertility treatments such as intrauterine insemination (IUI) prove to be unsuccessful.

IVF Cycle Timeline

(Source: Carolinas Fertility Institute)

Each IVF journey is unique, yet the basics of the procedure remain the same. An IVF cycle, which can take 4 to 6 weeks, is composed of the following steps:

Step 1: Ovarian Hyperstimulation

An IVF cycle begins with fertility medications to stimulate the ovaries to produce multiple mature eggs. The most common medications prescribed are follicle-stimulating hormone (FSH) and luteinizing hormone (LH) injections, which should be taken daily. Blood tests and ultrasounds will also be performed to monitor follicular development. At the final stages of ovarian hyperstimulation, human chorionic gonadotropin (hCG) hormones are administered to prevent premature ovulation before egg retrieval.

Step 2: Egg Retrieval

Thirty-four to 36 hours after ovarian hyperstimulation, egg retrieval or egg pick-up is performed. Under intravenous sedation, an ultrasound-guided needle is inserted through the vaginal wall and into the ovarian follicles to aspirate the eggs. These harvested eggs will either be cultured in an incubator to prepare for fertilization, or frozen in subzero temperatures for later use.

Step 3: Sperm Retrieval

For couples who will be using fresh sperm, a semen sample needs to be collected (through masturbation) on the morning of the egg retrieval. In certain situations, such as if the male has undergone a previous vasectomy, sperm may be harvested via testicular aspiration. Alternatively, donor sperm may be used. Once obtained, the sperm is analyzed, and the best sperm are selected for insemination.

Step 4: Fertilization

Egg and sperm are placed together in a petri dish and incubated overnight to facilitate natural fertilization. In cases where semen quality and/or quality are an issue, a single sperm may be injected directly into an egg for fertilization in a process known as intracytoplasmic sperm injection (ICSI). If fertilization is successful, the resulting embryos are further allowed to grow until they are ready to be implanted into the womb. This may take up to 5 days.

Step 5: Embryo Transfer

Two to 5 days after egg and sperm retrieval, the cultured embryo is placed in a catheter, which, in turn, is inserted vaginally through the cervix and into the uterus. The process of embryo transfer takes as little as 5 minutes and require little to no anesthesia. Up to three embryos may be transferred at once to increase the chances of pregnancy, as well as increase chances of multiple pregnancy.

After embryo transfer comes the grueling 2-week wait, after which a blood test is done to confirm pregnancy.

Among several fertility treatments, IVF is the most common and effective with an average success rate of 40% for women 35 years and below. This, however, depends on certain factors, including maternal age, primary cause of infertility, embryo quality, lifestyle factors and more.