IVF – In Vitro Fertilization

IVF is the abbreviation of In Vitro Fertilization and is a sophisticated set of assisted human reproduction processes that has the potential to result in pregnancy. It is a treatment for infertility, a disorder in which most couples are unable to conceive despite at least a year of trying. It is also possible to avoid passing on genetic issues to a child through IVF.

Mature eggs are removed from ovaries and fertilized in a lab by sperm during in vitro fertilization. Subsequently, an embryo is created by implanting one or more of the fertilized eggs into the uterus, the organ in which babies develop. It is possible to use a couple’s own sperm and eggs for IVF. It could also involve sperm, eggs, or embryos from an unidentified or recognized donor. A gestational carrier, or someone who has an embryo implanted in their uterus, may be employed in certain situations.

Your age and the reason for your infertility are just two of the many variables that affect your chances of conceiving a healthy child with IVF.

However, the medical team of Chania Fertility Unit, which is supervised by Dr Matthaios Fraidakis, can assist you in determining whether IVF is best for you, how it operates and what to take care of, providing a guarantee of more than 30 years experience in the field of human assisted reproduction.

The reasons to do IVF

Genetic issues or infertility can be treated by in vitro fertilization. You and your partner may be able to explore other treatment options that entail fewer or no bodily procedures before undergoing IVF for infertility. Fertility medications, for instance, might stimulate the ovaries to produce more eggs. Close to the moment of ovulation, when an ovary produces an egg, sperm is directly inserted into the uterus through a process known as intrauterine insemination.

IVF is occasionally recommended as the primary treatment for infertility in adults over 40. You can also do it if you have specific medical conditions. IVF, for instance, might be a possibility if you or your partner have:

Problems with ovulation: There are fewer eggs accessible for sperm to fertilize if ovulation is absent or infrequent.
Endometriosis: This disease is caused by tissue that grows outside of the uterus and resembles the lining of the uterus. The uterus, fallopian tubes, and ovaries are frequently impacted by endometriosis.
Uterine fibroids: Tumors in the uterus are called fibroids. They’re usually not cancer. In individuals in their 30s and 40s, they are typical. A fertilized egg may have difficulty adhering to the uterine lining if it has fibroids.
Damage or obstruction to the fallopian tube: The fallopian tubes carry eggs from the ovaries to the uterus. It is difficult for an egg to be fertilized or for an embryo to pass through to the uterus if both tubes are damaged or obstructed.
Infertility without known cause: This occurs when an individual’s infertility cannot be explained by tests.
Previous contraceptive surgery: To permanently prevent pregnancy, the fallopian tubes can be cut or blocked during a procedure known as a tubal ligation. IVF may be helpful if you want to get pregnant following tubal ligation. If you are unable or unable to have surgery to reverse tubal ligation, this may be a possibility for you.
A wish to protect fertility because of a cancer diagnosis or other medical issues: Chemotherapy and radiation therapy for cancer can negatively impact fertility. IVF may be a viable option if you’re preparing to begin cancer treatment and would still like to have a child in the future. Their ovaries can yield eggs, which can then be preserved for later use. Another option is to fertilize the eggs and freeze them as embryos for later use.
Sperm-related problems: Sperm can have difficulty fertilizing an egg if they are few in quantity or if they exhibit peculiar changes in their size, shape, or motility. A consultation with an infertility specialist may be necessary if medical testing reveals abnormalities with sperm in order to determine whether there are any treatable issues or other health concerns.
A hereditary condition: Your healthcare provider may suggest an IVF procedure if you or your partner are at risk of passing on a genetic disease to your kid. Preimplantation genetic testing is the term for it. Following fertilization and harvesting, the eggs are examined for specific genetic issues. However, not all of these illnesses are detectable. Embryos that seem to be free of genetic defects may be implanted into the uterus.

A person may elect to do IVF with a surrogate to bear a fetus if they do not have a functioning uterus or if pregnancy offers a significant health risk to them. We refer to the individual as a gestational carrier. In this instance, sperm fertilizes your eggs, but the resulting embryos are deposited in the uterus of the gestational carrier.

IVF Preparation Methods

The first step is to locate a reliable fertility clinic. Numerous factors influence the success rate of a fertility clinic. These consist of the patients’ ages and conditions they treat, in addition to the clinic’s methods of care. A clinic representative should be able to provide you with comprehensive information regarding the fees associated with each stage of the process.

You and your partner will probably need to undergo a number of screening tests prior to beginning an IVF cycle with your own eggs and sperm. These consist of:

Testing for ovarian reserve: This entails obtaining blood tests to determine the body’s egg reserve. Another name for this is egg supply. The outcomes of the blood tests, which are frequently combined with an ovarian ultrasound, can assist in forecasting how your ovaries will react to fertility drugs.
Semen examination: The liquid that has sperm in it is called semen. Its analysis can verify the quantity, form, and motility of sperm. This testing could be included in the preliminary assessment of fertility. Alternatively, it could be carried out just before an IVF treatment cycle begins.
Screening for infectious diseases: Both you and your spouse will undergo screening for illnesses like HIV.
Practice transferring embryos: No actual embryo is implanted in the uterus during this test. It might be carried out to measure your uterus’s depth. It also aids in identifying the method most likely to be successful in the implantation of one or more real embryos.
The uterine exam. Before beginning IVF, the uterine lining is examined. This may entail undergoing a sonohysterography exam. A very tiny plastic tube is used to transfer fluid from the cervix into the uterus. The fluid aids in creating ultrasound pictures of the uterine lining that are more detailed. A test known as a hysteroscopy may be part of the uterine exam. To see into the uterus, a thin, flexible, illuminated telescope is passed through the cervix and vagina.

Prior to starting an IVF cycle, consider the following important questions:

How many embryos are going to be implanted? Age and the quantity of eggs collected are major factors in determining how many embryos are implanted in the uterus. With the exception of those who utilize young donor eggs, genetically screened embryos, or in certain other circumstances, more embryos are typically transferred because older individuals have a lower incidence of fertilized eggs adhering to the uterine lining.

The majority of medical experts adhere to strict protocols in order to avoid multiple pregnancies that result in triplets or more. There are legal restrictions on how many embryos that can be transplanted in different nations. Verify that the quantity of embryos that will be inserted into the uterus prior to the transfer surgery is something you and your healthcare team agree upon.

How are you going to handle any excess embryos? Extra embryos can be frozen and kept for a long time in case they are needed later. While not every embryo will make it through the freezing and thawing process, the majority will.

Having frozen embryos can reduce the cost and invasiveness of subsequent IVF cycles. Alternatively, you may be able to give any extra frozen embryos to a different couple or a research center. You might also decide to throw away any extra embryos. Make sure, before further embryos are generated, that you are comfortable making decisions about them.

How would you manage multiple pregnancies? IVF can result in multiple pregnancies if more than one embryo is implanted in your uterus. You and your children’s health are at stake because of this. Fetal reduction surgery is a procedure that can assist a woman in giving birth to fewer, healthier infants in certain situations. A big decision with moral, psychological, and emotional ramifications is to have a fetal reduction.
Have you considered the dangers associated with using a gestational carrier, donation eggs, sperm, or embryos? You can better grasp the concerns, including the donor’s legal rights, by consulting with a counselor who has received donor issues training. In order to help you become the legal parents of an embryo that is developing in your uterus, you might also require legal assistance in filing court documents.

What to anticipate

Upon completion of the necessary procedures, an IVF cycle may take two to three weeks. It can take more than one cycle. A cycle’s steps are as follows:

Procedure during IVF to produce mature eggs

In order to induce the ovaries to produce eggs instead of the solitary egg that typically develops each month, an IVF cycle starts with the use of hormones created in a lab. Because some eggs will not fertilize or develop properly when coupled with sperm, many eggs are required.

A few medications can be used to:

Ovaries Stimulation: Hormone shots that aid in the development of many eggs at once may be administered to you. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), or both may be included in the injection.
Promote egg maturity: The eggs can develop and become ready to be released from their follicles, or sacs, in the ovaries with the use of a hormone called human chorionic gonadotropin (HCG) or other medications.
Postpone ovulation: These medications stop the body from prematurely releasing developing eggs.
Get the uterine lining ready: On the day of the operation to harvest your eggs, you may begin taking progesterone supplements. Alternatively, you may take these supplements at the time of embryo transfer. They increase the likelihood that a fertilized egg will adhere to your uterine lining.

When and which medications to take is a decision made by your doctor.

Usually, ovarian stimulation takes one to two weeks before your eggs are ready to be harvested during the egg extraction process. To determine when the eggs are done, you might require:

Vaginal ultrasonography, a diagnostic procedure that tracks the growth of follicles in the ovaries. These are the fluid-filled ovaries’ maturing egg sacs.
Blood testing to see how you react to medications that stimulate the ovaries. As follicles grow, estrogen levels frequently increase. Low levels of progesterone persist until after ovulation.

IVF rounds may occasionally need to be stopped before the eggs are harvested. Among the causes of this are:

Insufficient follicular development.
Too soon is ovulation.
The development of an excess of follicles increases the risk of ovarian hyperstimulation syndrome.
Other health problems arise.

Your healthcare team may suggest adjusting your medication or dosage if your cycle is interrupted. Future IVF rounds may see a better response as a result of this. Alternatively, you can be told that you require an egg donor.

Egg extraction for IVF

This is how the eggs from one or both ovaries are harvested. It happens in a clinic or at your doctor’s office. The operation is performed 34–36 hours prior to ovulation and following the last dose of fertility medication.

You will be given medication to help you relax and prevent you from feeling pain before egg extraction.
To locate follicles, an ultrasonography equipment is inserted into the vagina. These are the ovarian sacs that hold individual eggs. The eggs are then extracted by inserting a thin needle into the vagina and into the follicles using ultrasound guidance. We refer to this procedure as transvaginal ultrasonography aspiration.
In the event that this method of accessing your ovaries is not possible, an ultrasound of the stomach region may be utilized to guide the needle through the stomach and into the ovaries. Using a needle attached to a suction apparatus, the eggs are extracted from the follicles. You can extract several eggs in roughly twenty minutes.
You can experience cramps and a pressured or full feeling after the treatment.
Developed eggs are incubated in a liquid medium. In an effort to generate embryos, mature, healthy eggs will be combined with sperm. But not every egg can successfully get fertilized.

Sperm extraction for IVF

On the morning of egg retrieval, a semen sample must be taken at your doctor’s office or clinic if you plan to use your partner’s sperm. Alternatively, sperm can be frozen after collection in advance.

Masturbation is the most common method used to obtain the semen sample. If a person is unable to ejaculate or their semen is devoid of sperm, they can try alternative techniques. For instance, testicular aspiration is a technique that removes sperm straight from the testicle using a needle or surgery. Donor sperm may also be utilized. In the laboratory, sperm are isolated from the semen fluid.

Fertilization

It is possible to attempt sperm fertilization of eggs using two popular methods:

Conventional seeding: Mature eggs and healthy sperm are combined and housed in a regulated space known as an incubator.
Injection of intracytoplasmic sperm (ICSI): Each fully developed egg receives an injection of one healthy sperm. When semen quantity or quality is a problem, ICSI is frequently used. Additionally, if previous IVF cycles’ attempts at fertilization failed, this option might be tried.

Before embryos are implanted in the uterus, extra treatments could be suggested in some circumstances. These consist of:

Hatching with assistance: An embryo “hatches” from the thin membrane that surrounds it about five to six days after conception. This permits the embryo to adhere to the uterine lining.

A method called assisted hatching may be suggested if you’re older and wish to become pregnant or if previous IVF attempts failed. Just prior to the embryo being inserted into the uterus, a hole is made in the embryo’s membrane. This facilitates the embryo’s hatch and attachment to the uterine lining. For frozen eggs or embryos, assisted hatching is also helpful since freezing can harden the membrane.

Genetic testing prior to implantation: Embryos are left to grow in the incubator until they are ready to have a tiny sample taken out. The sample is examined to check for specific genetic disorders or the appropriate number of chromosomes, which are thread-like structures of DNA. Every cell typically contains 46 chromosomes. It is possible to transfer embryos to the uterus that do not have chromosomes or genes that are impacted.

Preimplantation genetic testing can lower the chances that a parent will pass on a genetic problem. It can’t get rid of the risk completely. Prenatal testing may still be recommended during pregnancy.

Embryo transfer during IVF

The process of implanting one or more embryos into the uterus occurs in a clinic or at your doctor’s office. It usually happens two to six days following egg collection.

To aid in your relaxation, a light sedative may be administered. Although the process is usually painless, you could have some moderate discomfort.
A catheter is a long, thin, flexible tube that is inserted into the vagina, passes past the cervix, and enters the uterus.
A syringe attached to the end of the catheter holds one or more embryos in a small volume of fluid.
The embryo or embryos are inserted into the uterus using the syringe.

An embryo will adhere to your uterine lining approximately 6 to 10 days following egg retrieval if the treatment is successful.

After the IVF procedure

Following the transfer of the embryo, you can resume your regular daily schedule. You might still have enlarged ovaries, so you might feel uncomfortable during sex or during intense activities. Find out from your care team how long you should avoid these.

Common adverse effects consist of:

Shortly after the procedure, pass a small amount of clear or red fluid. This is because the cervix was swabbed prior to the embryo transfer.
Sensitivity in the breasts brought on by excessive estrogen.
Minor distension.
Light cramps.

If you experience extensive vaginal bleeding or moderate to severe pain following the embryo transfer, please contact your care team. It is probable that you will require monitoring for potential consequences such as infection, ovarian twisting, and ovarian hyperstimulation syndrome.

Results

You have a blood test to determine whether you are pregnant at least 12 days after egg retrieval.

If you are pregnant, you will probably be referred for prenatal care to an obstetrician or other pregnancy specialist.
You’ll stop taking progesterone and probably start your period in a week if you’re not pregnant. If you have irregular bleeding or don’t get your period, call your care team. Your medical team may recommend actions to increase your chances of becoming pregnant the following time if you decide to undergo another IVF round.

After utilizing IVF, the likelihood of having a healthy child depends on a number of factors, such as:

Mother’s age. Using your own eggs during IVF, your chances of becoming pregnant and giving birth to a healthy baby are higher the younger you are. Those over 40 are frequently advised to consider utilizing donated eggs in IVF procedures in order to increase the likelihood of success.
Status of embryos. Compared to less-developed embryo transfers, more-developed embryo transfers are associated with increased pregnancy rates. Yet, not every embryo makes it through the developmental stage. Discuss your particular issue with your care team.
Past reproductive records. Individuals who have previously given birth have a higher chance of success with IVF than those who have never given birth. IVF failure rates are higher for those who have already attempted the procedure more than once.
The reason behind infertility. Having normal egg production increases the likelihood that you will be able to conceive with IVF. Individuals with severe endometriosis have a lower chance of success with infertility treatments compared to those whose reason is unknown.
Aspects of lifestyle. Smoking can reduce an IVF patient’s chances of success. Smokers frequently have fewer eggs extracted during IVF and may experience more miscarriages. Additionally, obesity can reduce one’s chances of becoming pregnant and having children. Addiction to narcotics, alcohol, excessive coffee, and some medications can also be detrimental.