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IVF - In Verto Fertilisation
IVF is a fertility treatment where eggs and sperm are combined in a lab to create embryos, which are then transferred to the uterus to increase the chance of pregnancy.
IVF works by using a combination of medicines and surgical procedures to help sperm fertilise an egg and help the fertilised egg implant in your uterus.
The IVF process involves several steps:
Step 1: Ovarian Stimulation
The stimulation phase begins on Day 1. In a natural monthly cycle, your ovaries would typically produce one egg. With an IVF cycle, you’ll take medication for eight to 14 days to encourage the follicles in your ovaries (where the eggs grow) to produce more eggs.
Your specialist will prescribe medication specific to your body and treatment plan. This medication usually takes the form of injections. These injections can vary from one to two for the entire cycle, to one to two per day.
The idea of injecting yourself can feel daunting at first – we completely understand this. That’s why your fertility nurse will take you through the process step-by-step, showing you exactly how and where to give the injections. It’s a great idea to get your partner or a support person involved as well. That way, you can watch and learn together. Also, take comfort in knowing that we have additional resources online to guide you when you’re at home.
Trust us – what seems daunting at first quickly becomes a habit. You’ll be an expert in no time.
The most common hormones contained in the injections are:
- Follicle-stimulating hormone (FSH)
- Luteinising hormone (LH)
Throughout your cycle, your specialist and fertility nursing team keep a close eye on your ovaries and how the follicles are developing with blood tests and ultrasounds. They’ll adjust your medication if needed. It’s common to have some transvaginal ultrasounds, where a probe is inserted internally to view the ovaries and developing follicles to help fine-tune your treatment during the stimulation phase. Our team is there to support you and make you as comfortable as possible.
We’ll monitor you more frequently towards the end of the stimulation phase to time the ‘trigger injection’ perfectly.
The trigger injection is a crucial step in the process. It prepares the eggs for ovulation – the natural process in which your eggs are released. Your fertility nurse will tell you exactly when to give the trigger injection. The timing is critical, as your fertility specialist needs to perform the egg retrieval before you ovulate.
Step 2: Egg Retrieval/Pick Up/Collection
- Egg retrieval, also known as egg pick-up or collection, is a key step in In Vitro Fertilisation (IVF). It allows doctors to collect mature eggs from the ovaries, which are then fertilised in a lab to create embryos, increasing the chances of a healthy pregnancy.
- The procedure typically takes place 36 hours after a trigger injection.
- It is a day procedure performed under short general anaesthesia and usually takes 20-30 minutes.
- Under ultrasound guidance, fluid is removed from follicles vaginally.
- An average of 8 to 14 eggs is collected during the procedure.
- After the procedure, you will wake up feeling warm and comfortable within 30 to 60 minutes. You will need someone to drive you home.
- In-house admission facilities with additional charges are available at Nandini IVF if you wish to stay.
Egg retrieval plays a vital role in IVF, maximising the chances of conception and a successful, healthy pregnancy.
- Essential for IVF Success: Egg retrieval is crucial as it provides the necessary eggs for fertilisation and embryo development, which are vital for achieving a successful pregnancy through IVF.
- Increases Pregnancy Chances: By retrieving multiple eggs, the chances of successful fertilisation and embryo transfer are significantly improved, boosting the likelihood of implantation and pregnancy.
- Helps Overcome Infertility: For women facing challenges like blocked fallopian tubes, ovulation disorders, or low ovarian reserve, egg retrieval enables them to conceive by bypassing natural reproductive barriers.
- Supports Male Infertility Treatment: In cases of male infertility, where sperm quality may be compromised, egg retrieval allows for fertilisation through ICSI, helping overcome issues such as low sperm count or motility.
- Allows Genetic Screening: The retrieval process allows for genetic screening of embryos, ensuring that only the healthiest embryos are selected, thus reducing the risks of genetic disorders and miscarriage in the pregnancy.
Step 3: Sperm Collection
Sperm collection is an essential step in assisted reproductive processes, such as IVF (In Vitro Fertilisation). Expert scientists in the lab will combine and culture the eggs to create the maximum number of embryos. We have made significant progress in producing more embryos. It involves obtaining a semen sample, which contains sperm, to be used for fertilising an egg.
- Timing: In most cases, sperm is collected on the day of egg retrieval to ensure its freshness and compatibility for fertilisation. However, frozen sperm may also be used if necessary.
- Laboratory Handling: Once collected, the sample is sent to a laboratory where it is carefully prepared and processed. The healthiest and most motile sperm are selected to maximise the chances of successful fertilisation.
- Donor Sperm: If required, donor sperm can be used. This is typically pre-frozen and ready for use when needed.
- Quality Assurance: The process ensures that only the best-quality sperm is used, as this is critical for achieving the desired outcome in assisted reproduction.
This step is critical for the success of fertility treatments, and laboratories play a vital role in ensuring the sample is handled with care and precision.
Options For Sperm Collection
Fresh Sperm
Collected on the morning of egg retrieval.
- Typically performed on the same day as egg retrieval.
- The male partner provides a semen sample through ejaculation, usually collected in a sterile container.
- It is essential for the sample to be collected after 2–5 days of sexual abstinence to ensure optimal sperm quality.
Frozen Sperm or Donor Sperm
Our scientists will have it ready.
The lab will prepare the semen samples with great care and select the ‘ideal sperm’ which performs the best. Being able to identify such a sperm is a skill which our scientists have developed after years of work.
Step 4: Fertilisation
Fertilisation is the process where a sperm cell fuses with an egg cell to form a zygote, marking the beginning of life. It involves the merging of genetic material from both parents, creating a single-cell organism with 46 chromosomes. After a sperm successfully penetrates the egg, the egg undergoes a reaction to block other sperm from entering, ensuring only one sperm fertilises it. The zygote then begins to divide and develop into an embryo. In assisted reproduction like IVF, fertilisation occurs in a lab, either by placing sperm and eggs together or through Intracytoplasmic Sperm Injection (ICSI), where a single sperm is directly injected into the egg. If an egg is fertilised, it is cultured in the lab for up to 5 days until it reaches the blastocyst stage, which is considered ideal for implantation into the uterus, marking the first step toward developing new life.
Preparing sperm
Once collected, the sperm sample undergoes a meticulous preparation process in the laboratory. This involves washing and processing the semen to separate the most motile and healthy sperm. These are then concentrated and selected to maximise the chances of successful fertilisation. In cases where sperm motility or quality is compromised, advanced techniques like Intracytoplasmic Sperm Injection (ICSI) are used, where a single, high-quality sperm is chosen for direct injection into the egg.
Preparing eggs
The fertility specialist collects the liquid in the follicles, and under our state-of-the-art microscope, eggs are observed.
Once the gametes are available, we culture the eggs in an ideal environment. There are two ways to fertilise:
Standard IVF Insemination
Where the eggs and sperm are placed together in a culture dish to fertilise naturally.
Intracytoplasmic Sperm Injection (ICSI)
This is another method where scientists will hand-select a single ‘ideal sperm’ to inject directly into each egg.Dr. Shipra Bahuguna Gaur will discuss your situation and suggest the best option for you to increase your chances of pregnancy in each cycle.
Step 5: Embryo Development
After 17 hours of insemination, fertilisation occurs. Not all grow into embryos, as eggs might be immature or sperm may be weak. Our team will keep you well-informed. We hope to see:
- A 2-to-4 cell embryo on Day 2.
- A 6-to-8-cell embryo on Day 3 (Cleavage Stage).
- An approximately 100-cell embryo stage (Blastocyst) on Day 5.
Transferring robust, well-developed embryos increases the chances of successful conception.
Our approachable team will make sure you understand the process throughout your treatment and that you have the information and support you need.Embryo Development: A Key Stage in IVF
Embryo development is a crucial stage in the IVF process, where a fertilised egg undergoes continuous cell division, transforming into a viable embryo for implantation. The process begins with fertilisation, where the sperm successfully merges with the egg to form a single-cell zygote. Within hours, this zygote starts dividing, marking the beginning of embryonic growth. Over the next few days, the embryo progresses through different stages, each playing a vital role in its viability for implantation and pregnancy. By the third day, the embryo reaches the cleavage stage, consisting of 6 to 8 cells. It then advances to the morula stage on the fourth day before transforming into a blastocyst by day five or six. The blastocyst contains two key components: the inner cell mass (ICM), which develops into the fetus, and the trophectoderm, which forms the placenta. Not all embryos reach the blastocyst stage, and their growth depends on genetic and environmental factors. Key aspects of embryo development:
Day 1: Fertilisation occurs, forming a single-cell zygote.
Days 2-3: The embryo divides into multiple cells (cleavage stage).
Day 4: The morula stage begins, with cells compacting for further growth.
Days 5-6: The embryo reaches the blastocyst stage, making it ready for implantation.
Embryo Grading: Specialists assess embryo quality based on cell division, shape, and development rate.
Freezing Option: Healthy embryos that are not transferred can be cryopreserved for future use. Selecting a well-developed embryo significantly enhances the chances of successful implantation and pregnancy. IVF specialists carefully monitor this process, ensuring that only the healthiest embryos are chosen for transfer. With advanced techniques, such as embryo grading and freezing, fertility experts can improve the success rates, offering hopeful parents the best opportunity to conceive.
Step 6: Embryo Transfer
Embryo Transfer is a quick and straightforward procedure where the specialist carefully places the selected embryo(s) into the uterus using a soft catheter, guided by ultrasound for precision. It usually takes about 5 minutes, is painless, and doesn’t require anaesthesia, allowing the patient to remain awake and watch the process on the ultrasound monitor. The best embryo(s) are chosen beforehand based on their development, and the uterine lining is prepared for implantation. After the transfer, patients are advised to rest briefly before resuming light activities, and they are provided with post-transfer care instructions to maximise the chances of success.
The specialist places the embryo into the womb with a special catheter. Embryo transfer is a simple procedure that usually doesn’t require anaesthesia and lasts about 5 minutes. You are awake and can watch it as the procedure is ultrasound-guided
What Happens During Embryo Transfer?
- Preparation:
- Before the procedure, the specialist ensures that the best embryo(s) are selected based on their development and quality, often on Days 3 or 5.
- The patient may be given medication to prepare the uterine lining for implantation.
- The Procedure:
- The patient lies on a table, and the specialist uses a speculum to open the cervix gently.
- A soft, flexible catheter is loaded with the selected embryo(s) and carefully guided through the cervix into the uterus.
- The entire procedure is guided by ultrasound to ensure accuracy.
- Time and Comfort:
- The procedure is quick, typically lasting around 5 minutes.
- It is painless and doesn’t usually require anaesthesia, though some women might feel mild discomfort.
- Patients remain awake during the process and can watch it on the ultrasound monitor.
- Post-Procedure:
- After the transfer, patients are advised to rest for a brief period. However, they can resume light activities shortly after.
- The specialist will provide guidance on post-transfer care to optimise the chances of implantation.
- Preparation:
Step 7: Pregnancy Test
The pregnancy blood test is a crucial milestone in the IVF process, providing the first confirmation of whether the embryo has successfully implanted in the uterus. Typically conducted around two weeks after the embryo transfer, the test measures the levels of human chorionic gonadotropin (hcg), a hormone produced after implantation. High levels of hcg in the blood indicate a positive pregnancy result, while lower or absent levels may suggest the need for further evaluation. This test is more accurate than a home pregnancy test as it provides precise hormone levels, offering clearer insights into the success of the procedure. Patients are often advised to stay calm during this waiting period, as stress can impact overall well-being. Regardless of the outcome, your medical team will provide personalised guidance, whether it’s the next steps for a healthy pregnancy or additional support for another cycle. Further monitoring and follow-ups are detailed in the “Early Pregnancy Monitoring” protocol to ensure comprehensive care during this critical time.
What to Expect After the Pregnancy Blood Test
Once you’ve undergone the pregnancy blood test, you will typically receive the results within a few days. If the result is positive, it means that implantation has occurred, and you are pregnant. In some cases, the hcg levels might be lower than expected, which can indicate that further monitoring is necessary. In the case of a negative result, your doctor may recommend additional steps or discuss plans based on your health and previous cycles. Understanding what to expect after the test can help ease your anxiety and prepare you for the next steps in your journey.
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Fertility Journey
Starting a family may sometimes require some help that is why the team at Nandini IVF & research centre dehradun is here to suppot you along the way