I have been asked by a number of friends and family members what exactly happens in the lab during the IVF process. So today I will explain it here for those who are interested. (I know all my infertility bloggy friends already know this stuff...we're all like A.R.T. experts by now!! Right girls?) But I've found that most of the world doesn't really know what we're are talking about when we say IVF...so here's a breif explaination.
Normally, an egg and sperm are fertilized inside a woman’s body. If the fertilized egg attaches to the lining of the womb and continues to grow, a baby is born about 9 months later. This process is called natural or unassisted conception.
IVF is a form of assisted reproductive technology (A.R.T.). This means special medical techniques are used to help a woman become pregnant. IVF has been successfully used since 1978. It is most often tried when other, less expensive fertility techniques have failed.
There are five basic steps to IVF:
Step 1: Stimulation, also called super ovulation
Medicines, commonly called stimulation drugs, are given to the woman to boost her egg production. Normally, a woman produces one egg per month. Fertility drugs tell the ovaries to produce several eggs. During this step, the woman will have regular transvaginal ultrasounds to examine the ovaries and blood tests to check hormone levels (This is what I've been up to for all these days!)
Step 2: Egg retrieval
A minor surgery, called follicular aspiration, is done to remove the eggs from the woman’s body. Using ultrasound images as a guide, the health care provider inserts a thin needle through the vagina and into the ovary and follicles containing the eggs. The needle is connected to a suction device, which pulls the eggs and fluid out of each follicle, one at a time. The procedure is repeated for the other ovary.
Close up of Follicular fluid containing one egg
Step 3: Insemination and Fertilization
The man’s sperm is placed together with the best quality eggs and stored in an environmentally controlled chamber. The mixing of the sperm and egg is called insemination. The sperm usually enters (fertilizes) an egg a few hours after insemination. If the doctor thinks the chance of fertilization is low, the laboratory staff may directly inject the sperm into the egg. This is called intracytoplasmic sperm injection (ICSI). Many fertility programs routinely do ICSI on some of the eggs even if everything is normal.
This is the high powered microscope used to perform ICSI
Step 4: Embryo culture
When the fertilized egg divides, it becomes an embryo. Laboratory staff will regularly check the embryo in the incubator to make sure it is growing properly. Within 2-5 days, a normal embryo has several cells that are actively dividing.
Step 5: Embryo transfer
Embryos are placed into the woman’s womb 3 - 5 days after egg retrieval and fertilization. The procedure is done in the doctor’s office while the woman is awake. The doctor inserts a thin tube (catheter) containing the embryos into the woman’s vagina, through the cervix, and up into the womb. If an embryo sticks to (implants) in the lining of the womb and grows, pregnancy results. It is common for more than one embryo may be placed into the womb at the same time to increase the chance of pregnancy. (Of couse this also increases the chance of multiples.) The exact number of embryos transferred is a complex issue that depends on many factors, especially the woman’s age. I am in my late twenties, so most likely my doctor will choose to only transfer two at time. Unused embryos may be frozen and transfered at a later date if they survive the freezing and thawing process.
I realize that this blog post was more like a chapter out of a text book, and I'm sorry for that. I just hope that it was able to give a basic overview of what Ben and I are going through this week. I've been trying explaining it to close friends and family members so I thought it might make better sense with pictures.
My egg retrieval is tomorrow morning at 10:15 AM! Fingers crossed for good results!