Basic Steps of IVF
In recent years, science has achieved critical breakthroughs, and nowadays many couples experience the birth of one or more children through assisted reproduction. Evidently, the high pregnancy rates following IVF result from the production and utilisation of ample, good quality eggs and subsequent embryos, and mainly, through the selection process of the most competent embryos based on morphological criteria, morphokinetic data (through Time lapse imaging-EMBRYOSCOPE analysis) and genetic diagnosis (Pre-implantation Genetic Diagnosis/ PGS)
The whole IVF process has been simplified over the last years minimizing the time required to reach the transfer of the embryos back in the uterus. The basic steps of IVF are the following:
Medical History and Laboratory Tests
The first and crucial step for a successful IVF outcome is the extensive documentation of the possible infertility factors that might be implicated in each case. To this end, our Clinicians will need a range of different exams to verify the cause of infertility. Some of these may be
- Hormonal Profiling for the Female patient (FSH, LH, E2, AMH, Prg)
- Analysis of Sperm Parameters
According the relevant Greek legislation for patients undergoing IVF, certain hematological tests should be performed prior to initiation of the treatment.
These tests include:
- Prenatal testing for the most common hereditary genetic diseases (such as b-Thalassemia and Cystic Fibrosis)
- Testing for the most common transmittable diseases (HIV, Hepatitis, VDRL etc)
When a couple has had many previous IVF attempts and/or miscarriages then further, more specialized tests should be carried out that may include:
- Testing of Blood Clotting (Thrombophilia)
- Immunological Tests
- Karyotype (testing of the DNA content of the future parents)
Key for a successful IVF attempt is the production of adequate, good quality eggs and subsequent embryos. To this end, the patient undergoes a short hormonal treatment usually based on 2 Gonadotropins (Follicle Stimulating Hormone [FSH]/ Lutenizing Hormone [LH]) which are hormones that are naturally produced and circulated in our bodies, and are utilized in slightly higher concentrations during IVF. The ovarian stimulation is closely monitored by measuring the hormone produced by the maturing follicles (Estradiol) and by ultrasound imaging of the growing follicles.
Egg Retrieval, preparation of Sperm and Fertilisation
The egg retrieval procedure takes place is a quick process, under intravenous short-duration analgesia (10 to 15 minutes), without loss of consciousness and painlessly. Within 30 to 60 minutes after the completion of the procedure, the patient may leave the Unit's premises.
Sperm is produced and prepared the same day as the oocyte retrieval. During sperm preparation, an adequate number of spermatozoa with good morphology and motility are selected for insemination or sperm injection. Normally, fertilization rate is about 60%.
Embryo transfer is a simple procedure that takes about 15 minutes without the need for anesthesia. A special catheter is inserted into the uterus, and the embryos are carefully placed into the endometrium. After this, the catheter is checked under the microscope for the unlikely presence of an embryo.
The patient remains at rest for 15 to 30 minutes. For the following 2 to 3 days, the patient is advised to simply reduce her activities, since it's not scientifically proved that absolute immobilization following the embryo transfer provides any tangible benefits. 12 to 14 days after the embryo transfer, a pregnancy test is carried out in order to determine the IVF outcome.
IVF with US
Different Stimulation Protocols
Your Clinician will recommend the most appropriate protocol for you, considering the history, the age, the ovarian response in previous attempts etc. In recent years, both us at Embryogenesis and internationally, have largely adopted the short protocol with the antagonist which is very friendly and equally effective as the long one. Its duration is only 10 to 12 days with much fewer injections.
- The Short Protocol
In the short protocol, the beginning takes place necessarily on the 1st day of the cycle and either an analog may be used (Suprefact / Daronda / Arvekap) or an antagonist (Cetrotide, Orgalutran). Before starting the short protocol a vaginal ultrasound is taking place so as to rule
- The Long Protocol
In the long protocol the start of the analog (Suprefact / Daronda / Arvekap) takes place at the 21st or the 1st day of the cycle. The first two weeks concern only the prescription of the analog while during the last two weeks the stimulating drug is being added (Gonal-F, Puregon, Altermon, Menogon, Menopur, Merional) without stopping the analog.
During this phase, an informal period can occur, which is expected, and therefore should not worry you at all. As a first day, we consider the appearance of little red blood (not the initial browny blood). You should never stop the "suppression" drugs (Suprefact / Daronda / Arvecap) as long as you started taking them, until the moment of the "midnight injection".
This injection (Pregnyl / Ovitrelle) is done for the final maturation of the oocytes. We call it this way, because it is done around midnight, and the oocyte retrieval can follow 36 hours later.
The pregnancy test (hCG measurement) should be done approximately 12 days after the embryo transfer day.
If the result is positive, we will plan a vaginal ultrasound two weeks later to see the developing embryo(s). The pregnancy after IVF does not differ from any other pregnancy following natural conception. It should be emphasized that any pregnancy either after IVF or after normal fertilization is unfortunately subjected to a miscarriage risk, which may be up to 15-20%.
If the test is negative, we firmly believe that the responsible scientific team should review with you the attempt and examine in detail the prospects for the future.