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The Five Steps of IVF
Stimulation of the reproductive cycle
To stimulate the reproductive cycle the patient is treated with several hormone preparations (Menopur, Metrodin, Gonal-F, Puregon) which enable the development of multiple oocytes. A number of mature oocytes leads to increased chances of fertilisation and pregnancy.
These hormonal preparations are:
A nose-spray (Suprefact) or an injection (Decapeptyl) from day 1 or day 21 of the reproductive cycle. This medication suppresses the production of hormones being released during the normal reproductive cycle. It also suppresses ovulation and
enables improved control of hormonal stimulation.
Several injections (Menopur, Metrodin, Gonal-F, Puregon); these contain hormones that are able to stimulate the ovaries to develop multiple oocytes.
During this hormonal stimulation stage blood tests must be taken regularly to check hormone levels and supervise the ovarian development.
The IVF team will assist with this stage and prescribe the necessary drugs. These controls are paramount, they must not be missed: the data obtained at this stage will be used to calculate new hormone dosages, which can vary from day to day. The data obtained will help to determine the precise date for a possible pick-up.
Egg Collection
When the control indicates that an ovulation is coming up, the patient will be given a further hormone preparation.
ovulation takes place you will be ready for a punction, during which the oocytes will be 'picked-up'.
The pick-up of the oocytes is a minor procedure which is carried out using ultrasound under local anaesthesia. The gynaecologist examines the ovaries using an ultrasound machine, which is inserted through the vagina. Using a needle attached to the ultrasound machine the gynaecologist pricks the follicles. The oocytes together with some fluid are then picked up into a tube.
It is possible for the patient and their partner to witness these events on a monitor.
Fertilisation
The laboratory evaluates the oocytes and puts them in a petri dish, which supplies the oocytes with the necessary nutrition. This nutrition simulates the natural environment in the uterine tubes.
The oxygen concentration and the temperature are exactly the same as in the female body thus ensuring that all conditions for a normal fertilisation are correct. If you feels OK after this treatment, it is possible to leave the hospital. During the evaluation of the oocytes there is an inspection of a sample of semen.
The most motile spermatozoids are selected and are united with the oocytes. After 48 hours it is possible to evaluate the fertilised oocytes, which have progressed into embryos.
The fertilised oocytes, which have properly developed, are re-implanted after 2 to 3 days. This process is called embryo-transfer. You will be told if the fertilised oocytes have not replicated.
Returning the embryos
Two or more fertilised oocytes may be re-implanted, which increases the chances for fertilisation. Superfluous embryos may be frozen for later use. The gynaecologists and the IVF team are there to assist with this decision.
The embryos are transferred to the uterine cavity 2 - 3 days after pick-up. There is no need
for anaesthesia. A thin tube is inserted through the vagina, into the uterine cavity. The tube contains a little fluid containing the embryos.
It takes 3 weeks before the final results of the procedure are known. After this stage the growth of the uterine endometrium is supported by a hormonal treatment (Utrogestan). Following a first blood test, the gynaecologist may decide to prescribe Pregnyl, once every 3 days, cyclogest, or gestone.
The Two Week Wait
It may be difficult to continue with your daily routine during the next 3 weeks. You may be struggling with all kinds of emotions including feelings of fear, despair, insecurity and hope. During this period you can count on support and advice from our team of Moderators and other members, these can be found on our message boards which can be located from the front page of the site. A good conversation with one of our team can be very rewarding. You should continue with your daily routine. Be positive; try not to focus on an uncertain pregnancy.
If after 2 weeks you haven't started your menstrual cycle, then it is necessary for you to undergo a blood test or HPT to see whether you are pregnant. If the test is positive, the gynaecologist will do an ultrasound in order to evaluate the pregnancy. If the ultrasound shows signs of a pulsating heart, then you can prepare for pregnancy.
If you do menstruate during those first three weeks, then your IVF treatment was unsuccessful.
Following a period of rest, it is possible for you to repeat the treatment or to have a frozen embryo re-implanted. Frozen embryos are less likely to be successful. You and your partner need to consider whether to continue with the treatment.