IVF Abroad - Patient's Guide

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A step by step guide for IVF

In Vitro Fertilization is a procedure that helped thousands of couples all over the world to have a baby. It is a procedure involving combining the egg and sperm in an embryology laboratory creating and embryo which then can be placed in the woman’s uterus.

We live in a world where almost everyone have heard about IVF but most of the people do not really know how the procedure really looks like. We will take you through the whole process of IVF step by step.

three pictures with patients and doctors

The 1st step: Consultation

On the scheduled consultation you will have an appointment with a personal fertility specialist. He will want to know all about your and your partner’s medical history and you will need appropriate documents for that (you will be said what is needed before the consultation so do not worry). The specialist will talk you through the whole process and you should get a plan with dates and timelines. Remember to plan your time ahead in connection with your work and other responsibilities.
You will be also starting to prepare for the ovarian stimulation by taking birth control. Taking birth control can reduce the chances of cysts to form that could interfere at the beginning of the cycle. It also helps with synchronizing the egg follicles and allows better control of the timing of the cycle.

The 2nd step: Stimulation

This step is mostly all about the ovarian stimulation and a bit about monitoring.
One egg a month usually matures in a normal, natural ovulating cycle and the point of an IVF cycle is to have as many matured eggs as possible. More matured eggs increase your chances of a successful in vitro treatment. That is why the ovarian stimulation is done. The patient is injected with medication for about 8 to 14 days. This medication stimulates the ovaries so that they start producing eggs. While undergoing this medication treatment you will need to visit the clinic about 7 or 8 times for the morning monitoring tests. Those testes are the transvaginal ultrasound for measurements of the egg follicles growth and the uterine lining thickness as well as bloodwork to measure your estrogen level.
After each monitoring you should receive a phone call from the clinic about your treatment’s progress and all the information you need for taking further action.

The 3rd step: Egg retrieval

The female patient lays in a lithotomy position and is under sedation, general anesthesia and a paracervical block. Using the ultrasound the doctor very carefully so not injure any organs inserts a needle into the ovarian follicle. A suction device is placed at the other end of the needle which gently draws follicle fluids with the cellular material and the oocyte (if it all goes well of course)
Then this material is given to the IVF laboratory’s technician who identifies and quantifies the ova. This is followed by aspirating other follicles and then the needle is withdrawn from the first ovary and put into the second ovary and the same is done. Then the needle is withdrawn, there could be a little bleeding involved but that will heal very fast and it is not a problem.

The 4th step: Embryo development

After retrieving the eggs the embryologists start the fertilization process which can be done in two ways:

  • The conventional fertilization – healthy sperm is isolated and exposed to the eggs in the laboratory and the fertilization happens in a natural way;
  • Intracytoplasmic Sperm Injection (ICSI) – This method is used when the quality and quantity of the sperm is to low and cannot effectively penetrate the egg.

The quality of the sperm is the basis of making the decision between the conventional fertilization and Intracytoplasmic Sperm Injection. Standard testes are done to know about the sperm quality.

The 5th step: Embryo transfer

A simple and quick procedure which does not involve anesthesia or recovery time. In the morning of the transfer the embryologist will make a final evaluation of the embryos and you will be recommended the amount of embryos to be transferred. This recommendation is dependent on the quality and age of the embryos. Additionally other aspects of your case like history of previous treatments and your age also have impact on the final recommendation. Often a patient will be recommended a single embryo transfer if the chances or similar to a case with multiple embryos which reduces the risk of multi birth.
When you and your physician decide on the number of embryos to be transferred then the transfer catheter is loaded with the chosen amount of embryos. Finally the transfer starts during which the catheter is inserted and the embryo is pushed into the uterus. When the transfer is completed the catheter is removed. At the end of the transfer the embryologist will check if the embryo was released and you will get instructions on what lays ahead next.

The 6th step: The final test

18 days after the egg retrieval a pregnancy test is done – if the hCG level is over 100 it means it is positive (but do not get scared a lot of pregnancies start with the hCG level below 100). The test is repeated after two or three days to confirm if the pregnancy is really a success or not. The hCG level should double every two days. If the second test comes out positive a third and last test is done to be 100% sure and there will be an ultrasound scheduled for about 6 weeks ahead. Till this time the physician will look for a heartbeat to confirm the pregnancy.