What is the IVF process?

6 fertility expert(s) answered this question

Answer from: Raúl Olivares, MD

Gynaecologist, Medical Director & Owner
Barcelona IVF

IVF is quite a simple process that consists of three different phases. The first one is the test stimulation in which patients usually take some injections, mostly subcutaneous injections that are going to do three different things.

One group of injections are going to stimulate the ovaries to create multiple follicles. There are other groups of injections that are going to block the natural ovulation of the patient, we don’t want the patient to ovulate in a moment in which we don’t have a good number of follicles. The third type of drug is also subcutaneous injections that are going to be taken at the end of the process when we are going to trigger the ovulation.

Once this ovulation has been triggered, we proceed with the second phase, which is the laboratory phase. First, we are going to get the eggs in a procedure done in the operation room, under very light sedation. The patient is breathing on her own, so we don’t need to intubate her, and it takes like 10 minutes to collect the eggs. After that, the man provides the sperm, or we use the sperm from the donor, we inseminate the eggs, in our case, we do ICSI almost in all cases. We choose the sperm that is injected into the eggs. Then, we leave the embryos in incubators called time-lapse. There are different brands, but the technology is called time-lapse until day-5.

When they reach the so-called blastocyst stage, we choose the embryos that can be transferred, and the transfer itself is a very easy procedure. It’s like if you were going to have a pap smear, you don’t need any kind of sedation, and we just place a very thin catheter inside the uterus, and inside this catheter, there is going to be one or two embryos.

After the transfer, you need a couple of hours of rest, and that’s it. You can start a normal life and go through the third phase, which is the two waiting weeks period until you can have your pregnancy test. During these days, there’s nothing special you can do, we believe that patients can do nothing to change the outcome, so basically, consider yourself pregnant and do all the things that a pregnant woman is supposed to do.

Answer from: Guillermo Quea Campos

Gynaecologist, Specialist in Reproductive Medicine
Pronatal Fertility Clinics

The process begins with the diagnosis of there being no pregnancy achieved and have decided the appropriate treatment. There are five basic steps of IVF: 1- stimulation, also called controlled ovarian stimulation,
2- puncture egg retrieval,
3- insemination and fertilisation,
4- embryo culture and 5- embryo transfer.
All of them together have the desired objective to help get the patient pregnant.

Answer from: Tomas Frgala, PhD

Gynaecologist, Head Physician at UNICA Clinic - Brno
Unica Clinics – Prague and Brno

For the In Vitro Fertilization or the conception in glass or in the lab as we can translate it, we need healthy eggs or oocytes, we need healthy sperm cells for the gentlemen and then their connection or joining is mediated or performed in the lab. The ensuing embryos are cultivated and then, on Day 3 or Day 5, evaluated and usually one of them is picked for the transfer. The remaining ones are cryopreserved and saved for under stable conditions for later. It’s relatively easy to obtain the male gametes (the sperm cells). Usually it’s a question of a couple of minutes and it’s independent of any cycles or time frames. It’s much more difficult to get or obtain healthy ripe eggs from the woman because in the natural cycle, there’s usually just one follicle and one egg that becomes ripe for ovulation. In the process, we need to stimulate the ovaries, we need to respect the natural run of things: the natural menstruation or ovulation cycle. Usually the stimulation of the ovaries is started from day two of the cycle and the result should be an oocyte pickup around the day 14 of the cycle where we obtained not one egg but sometimes 5, 10, 15 or even more depending on the capacity of the ovaries and their reaction to the stimulation.

Answer from: Santiago Eduardo Novoa, MD

Gynaecologist, specialised in Reproductive Medicine
Instituto iGin

IVF includes a couple of stages. First, we need to make the ovaries work harder than they used to do in a normal cycle – for that we are going to give some medication for the patients. This is the stage that we call controlled ovarian stimulation. So once we are advancing that stimulation and we have a good number of eggs in the ovaries, we need to pick up those eggs and this is done in the operating room under anesthesia. Once we have the eggs in the lab, we are going to fertilize them to create embryos and we need to culture the embryos till Day 3 or Day 5 – it depends on the policy of the lab and when the embryos are ready, are of good quality, normally we go for an eSET, so an “elective single embryo transfer” and we put the embryo inside the uterus and then, of course, we need to wait as in any other kind of pregnancy (the spontaneous ones I mean) for the implantation to a place. 10 days after the embryo transfer, we are going to perform the first pregnancy test.

Answer from: Harry Karpouzis, MD, MRCOG, DIUE

Gynaecologist, Founder & Scientific Director
Pelargos IVF Medical Group

IVF usually starts with stimulation of the ovaries, and this can happen in the natural cycle, in a semi-natural cycle, which means with the help of oral medication. In a mini IVF, which means IVF with a low-dose medication or in a medicated IVF, which means with an injection that helps to stimulate the ovaries and produce many follicles.

During the stimulation of the ovaries, ultrasound, some blood tests might be needed, depending on the results of these, the doses of the medication can change. After 9 to 12 days of medication whilst we keep an eye on the follicles with ultrasound monitoring, and we usually have a trigger injection which helps to release the eggs from the growing follicle and to 35 to 57 hours after that, we have a procedure which is called the egg collection. It can happen either with local anaesthesia in cycles that do not have many follicles, in semi-natural cycles or under sedation. It is a process through which we put a needle under ultrasound guidance to the growing follicle of the ovaries, we suck the fluid, which we give the embryologists who at the same time is looking for eggs.

After egg collection and while on the same day and the partner needs to give sperm sometimes, this sperm can be a frozen sample. The embryologist in the lab is going ahead with the fertilization procedure. The fertilization can happen in normal IVF whilst we leave the eggs and sperm in special cultures, and the eggs are getting fertilised outside the body by themselves.

Usually, when we have some sperm abnormalities, low sperm, we use a procedure called ICSI. This means the embryologist takes the sperm and injects it inside the egg, it can increase the chance of fertilization.
Of course, we have new ICSI variations like IMSI, PICSI, other options that we can use depending on the case.
After 24 hours, we have day 1 of the embryos, which means the fertilized eggs. We leave those embryos to grow in special cultures. We keep an eye on them, and on day 3, for example, we can take the embryo out and have a look at it.
Nowadays, we can use an Embryoscope, which constantly monitors the division of the cells of the embryo without the need of taking them out and having to look at them. We let the embryos grow. Ideally, we wait till day 5, in that case, they are called blastocysts, then 2,3,5 days later at the stage of the blastocyst, we take 1 or 2 embryos, rarely more than that, sometimes for a woman at a more advanced age, and we transfer the embryo or the embryos inside the womb.

This is the procedure where we put a catheter, usually without sedation, and we leave the embryos inside the lining of the womb, it is called embryo transfer. 12 days later, the woman keeps taking some medication to support the pregnancy, and the woman can do the test to find out if she’s pregnant or not.

Answer from: Elias Tsakos, MD, FRCOG

Gynaecologist, Medical Director

The IVF process consists of two parts. The first one is what we call the pre-IVF process. It consists of all the tests,  investigations, and examinations we do before embarking on IVF. During that phase, we try to identify any factors that need to be optimized before proceeding with the IVF procedure itself.  It affects both the man and the woman at the same time following the optimization of all the physical and psychological, and mental factors that we may identify.  We proceed to the IVF process itself,  which again consists of two phases and two parts.

The first one is the medical stimulation phase,  which lasts for about 10 days. During that time, we stimulate the woman’s eggs by providing medications, usually injections but sometimes tablets or a combination and injections.

When this procedure is finalized, we perform the egg collection, and in vitro fertilization, and embryo transfer.  Following the embryo transfer, we have the last phase of IVF, which is the luteal phase. During this time, we provide specific medication and physical and emotional support to the couple to sustain the pregnancy that has been implanted.

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