The IVF treatment program requires many appointments with specialists, who prepare the couple for the technique. The couple should be informed about complex steps such as the injection of hormonal medications, the risks and side effects, as well as the waiting times required. The treatments are expensive. For the fertility ivf this is important.
- Stimulation of the ovaries
The first step is to give the woman a hormonal treatment, usually a GnRH(Gonadotropin Releasing Hormone) agonist to rest the ovaries.
Thereafter, the treatment aims to increase the number of follicles produced by the ovaries and to control the timing of ovulation. The woman should receive gonadotropin injections with FSH or LH activity to stimulate the follicles to mature and allow them to produce several oocytes.
When follicles have grown sufficiently and hormone levels are adequate, ovulation is triggered by an injection of HCG hormone (Human Chorionic Gonadotropin).
Pelvic ultrasound and blood tests are performed at each step to assess follicle growth.
More follicles, more eggs
The woman’s ovaries usually produce and release a single mature egg per cycle . Although this is sufficient for normal conception, for successful in vitro fertilization, it is best to obtain more mature eggs. It is therefore necessary to stimulate the ovarian activity of the patient more than usual. The drugs administered during an in vitro fertilization treatment cause the development of several ovarian follicles, thus increasing the possible number of eggs, thus the chances of obtaining an implantable embryo.
Removal of mature oocytes
After 32 to 36 hours of hormonal stimulation, the mature oocytes are removed using a small tube and a needle that is introduced into the vagina. This procedure is performed under local or general anesthesia with ultrasound control because it can be very painful. The oocytes are then selected in the laboratory.
The sperm is taken a few hours earlier (or thawed the same day), and the sperm are separated from the seminal fluid and stored at 37 ° C.
A few hours after their harvest, the spermatozoa and oocytes are put in contact in a culture liquid for several hours at body temperature. The motile spermatozoa come spontaneously, without external help, in contact with the oocyte. But only one sperm will fertilize this one. In general, on average, 50% of oocytes are fertilized.Fertilized oocytes (or zygotes) begin to multiply. In 24 hours, the zygotes become embryos of 2 to 4 cells. At the infertility center this will be essential.
Two to five days after fertilization, one or two embryos are transferred to the woman’s uterus. Embryo transfer is a simple, painless procedure performed by means of a thin, flexible catheter introduced vaginally into the uterus. The embryo is deposited inside the uterus and develops there until its implantation.
- After this stage, the woman can usually resume her normal activities.
- One or more embryos (called supernumeraries) can also be preserved by freezing for subsequent trials.
- Thereafter, the doctor can give hormonal medical treatment, and of course prescriptions to do pregnancy tests to see if IVF has been effective.
- Several cycles of treatment are sometimes necessary before the pregnancy succeeds. And unfortunately, some couples do not put in pregnancy despite several tests.