The IVF Process
It’s not easy to undergo IVF treatments. IVF is expensive, complicated and invasive. Most of the procedures involves the woman’s body and these procedures can be painful: she would need to inject herself with hormones. They are invasive: think numerous transvaginal ultrasounds and guess how they collect the follicles and transfer the embryos? yep with a catheter through the vagina, baby. Its time consuming: you need to make numerous trips to the clinic. In addition IVF is expensive and the chances of success are pretty slim. When you go for IVF be prepared to go on an emotional rollercoaster ride of hope and disappoint. It may take many cycles before you conceive. It’s also possible that even with IVF you will not be successful.
In case you don’t know yet, baby making, biologically speaking, may be divided into 3 phases: ovulation where the woman produces an egg from her ovaries, fertilisation where said egg is joined with a sperm and develops into an embryo, and implantation where the embryo gets implanted in the uterus and grows. The IVF process closely follows the natural cycle: basically produce an egg(s), take the egg(s) out of the woman, fertilise the egg (s) with sperm in a laboratory then put the embryo(s) back in the woman and hope for the best.
There are 5 basic steps to the IVF process.
1) First step is to stimulate the development and release of follicles from the woman’s ovaries. In this stage, the woman takes oral meds and injections to stimulate her ovaries to produce as many eggs as they can. If you decide to do IVF you will get familiar with medicines like GonalF, Puregon or Menopur which are follicle stimulating hormones. As the name suggests these medicines stimulates the development and release of follicles. Inside a follicle is an egg. Depending on the dosage and her responsiveness to these medicines, a woman could produce up to 10 or more eggs in one cycle. Younger women (under 30) are able to produce as many as 25 eggs while those in their 40s may struggle to produce even a single egg per cycle. The follicle stimulating hormones are usually taken daily from day 2 to day 12 of the woman’s cycle. Depending on the clinic’s protocol the woman may need to inject herself up to twice a day. She may need to visit the clinic on days 2, day 5, day 8, then daily afterwards for ultrasounds and blood tests. The development of the follicles is monitored by transvaginal ultrasounds to measure the size of the growing egg and blood tests (yes more pricking) for hormone levels.
2) The second step is to retrieve or harvest the eggs. Once the follicles are at least 18mm in size (as measured in an ultrasound), the woman gets her trigger shot. Within 36 hours of the trigger shot, the eggs are retrieved. The egg retrieval is usually done in an operating room. If there are numerous eggs the procedure may be done under general anaesthesia. Your legs are going to be strapped in stirrups and the doctor is going to puncture your ovaries with a needle and suck out the follicles. There is going to be some blood and maybe a little discomfort during and after retrieval.
3) Third step is fertilisation. The husband (or whoever male is your sperm provider) would have to masturbate in a clinical environment and ehem, collect the specimen for the IVF clinic’s handling. The sperm is put through a centerfuge and only those healthy ones are used. There are two ways to fertilise the eggs in the laboratory. The first one is by putting collected egg and sperms together in a Petri dish and one of the sperms get to be the lucky one to fertilise the egg. The second method is ICSI short for Intracytoplasmic Sperm Injection in which a single sperm (don’t ask me how this single sperm gets choosen) but this one lucky sperm is injected directly inside the egg thereby fertilising it, that is there is no need for the sperms to swim for the egg, a lucky one is shoved in the door. The embryo (egg and sperm together) is then grown in the laboratory for 2-5 days. The embryo may then be transferred to the uterus (fresh embryo transfer) or frozen for future use.
4) The fourth step is transferring the embryo into the woman’s uterus (womb). After fertilisation, the embryo grows form a single cell to become two, then four, then eight cells and so on. Within 2-5 days of retrieval, the embryo is transferred to the womb. Similar to the egg retrieval, transfer may be done in an operating room with the help of ultrasound. Blood tests will be done to check that hormone levels are good and ultrasounds will check that the uterus lining is ready before the transfer is confirmed. Injections of progesterone may also be given before and after transfer to support the uterus lining.
5) The fifth step is the dreaded wait between transfer and pregnancy test. Hormones supplements especially progesterone are taken to support the pregnancy. Within two weeks of transfer, blood tests can confirm whether there is a pregnancy or not.
Chances of pregnancy generally goes down with the woman’s age. Not every IVF procedure results in a pregnancy, and not every IVF pregnancy results in a live birth. Before deciding to do IVF, be sure to arm yourself with as much information as you can. It’s physically, emotionally and financially draining. There are many success stories and they are inspiring but it’s also important to be realistic with what IVF can do for you.
Read here for our first IVF attempt at Kato and our second IVF at Lee Women Hospital.