Looking into starting IVF treatment and feeling overwhelmed by the information out there? Dr. Prati Sharma, a reproductive endocrinologist and fertility specialist at CReAte Fertility Centre in Toronto, Canada breaks down the entire IVF process and what you should expect.
IVF or in vitro fertilization is a type of fertility treatment where developing eggs, called oocytes, from a person's ovary are stimulated using gonadotropins (a type of injectable medication). The eggs are then retrieved and fertilized in a laboratory to create embryos with sperm. The embryos are grown for 3 to 5 days in the laboratory, and transferred into the uterus or frozen to be transferred at a later time.
These embryos can also be tested pre-transfer for genetic abnormalities. This is the same process that is used for fertility preservation or egg freezing but the difference being that eggs are frozen after they are retrieved from an ovary and frozen without injecting sperm into them to create embryos. This way, the eggs can be used later once you are ready to create embryos and conceive.
The process of IVF involves taking medication, in the form of injections which mimics the normal hormones that fluctuate during a menstrual cycle, namely follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These injections allow for the development of multiple follicles (where eggs are stored in the ovary) to develop during one menstrual cycle rather than a single follicle or egg that normally develops in a natural cycle. By stimulating multiple follicles to grow, there is a potential to retrieve multiple eggs during one IVF cycle and create multiple embryos.
During an IVF cycle, a person takes injections typically once a day (up to 2-3 injections per day of medication) and is monitored for their response every 2-3 days with ultrasound (transvaginal) and bloodwork to see how their ovaries are responding to the medication. The dosage of medication can then be adjusted accordingly. Typical IVF stimulation lasts approximately 10-12 days followed by an egg retrieval around day 12-14 of stimulation. Varying cycles will differ in timing, length of stimulation and start date but a standard cycle will start on day 2 or 3 following a natural or hormonally induced period and the cycle lasts about two weeks.
Egg retrieval or the ovum pick-up is performed in a fertility clinic under conscious sedation by your fertility doctor. Using an ultrasound probe as a guide to visualize the stimulated ovaries, a small needle is inserted into the ovaries and the eggs are retrieved through the vagina. This process takes 20-30 minutes and is a day-procedure.
Recovery is fairly quick with a low complication rate. You may need to do more than one IVF cycle to retrieve an appropriate number of eggs and create multiple embryos depending on your personal clinical parameters, age and other fertility evaluations.
The embryo transfer will take place during the middle of your menstrual cycle. An embryo transfer is generally performed without sedation by your fertility doctor. It requires a full bladder to straighten out the uterus and make it easier to transfer an embryo to the correct place in the uterus. Embryo transfers take place under ultrasound guidance to enhance proper placement (1-2 cm from the top of the uterus). Using a small catheter, the embryologist in the laboratory will load the catheter with the embryo, and the doctor goes through the vagina and cervical opening to place the embryo in the uterus. This process is not painful. The transfer happens in under 5 minutes! You can empty your bladder right after the transfer takes place.
In general, IVF is not painful. Ovarian stimulation with fertility medication can cause mild symptoms such as bloating, mild mood changes, nausea and breast tenderness due to the elevation in estrogen levels that occurs during the cycle as the ovarian follicles develop. However, these symptoms can last even after egg retrieval until the next period when your hormones are back to normal levels.
Egg retrieval occurs under conscious sedation (IV sedation) so it should not be painful, but it is normal to experience mild cramps for a few days after the egg retrieval procedure. For example, if a person makes more than 20 eggs, they may develop ovarian hyperstimulation syndrome (OHSS) which can cause the prolongation of symptoms post egg retrieval. While the complication rate of IVF and egg retrieval is low (~1%), if complications such as infection, bleeding or damage to any nearby organs like the bowel or bladder occur, symptoms can be more pronounced and will require further intervention.
Embryo transfers are not painful and generally, do not require sedation. With a full bladder, the doctor places a speculum in the vagina and then passes the embryo which is in a small "straw" or embryo transfer catheter into the cervix and then uterus in order to place the embryo in a location in the uterus for optimal implantation. While you may experience some discomfort from the full bladder and pressure from the abdominal ultrasound, the procedure itself is typically painless.
Success rates for IVF, number of cycles needed, and time to conceive are all dependent on many things including a person’s age, ovarian reserve parameters, infertility diagnosis, anatomical concerns such as uterine defects like fibroids, polyps or congenital uterine anomalies, and sperm quality. In addition, any concomitant medical issues such as diabetes, or other chronic medical conditions can affect success rates.
These issues are all evaluated during the initial fertility consult and diagnostic testing can give a better picture of IVF success rates prior to initiating treatment. It is always best to speak to your fertility doctor after testing has been done to determine the optimal fertility treatment plan and if IVF is the plan, what the success rates are for your situation. Often when one or more IVF cycles are done, embryos are genetically tested and subsequently, a frozen embryo transfer occurs. Sometimes patients will undergo endometrial receptivity testing or a mock cycle prior to proceeding with a frozen embryo transfer. This process can take anywhere between 2-6 months. Patients may also begin with less invasive treatments like intrauterine insemination (IUI) for a few cycles before moving on to IVF which can add to the time to conception.
Dr. Prati Sharma
Reproductive Endocrinologist and Fertility Specialist