In-Vitro Fertilization, abbreviated as IVF, is one of the most efficacious ways used in assisted reproductive technology. IVF treatment is a procedure that involves a series of steps from preparation of the women’s body to produce mature egg cells, collection of mature egg cells, receiving sperm sample, fertilization of egg and sperm in a petri dish, and implantation of the fertilized egg in the uterus or keeping the fertilized egg frozen (cryopreserved). Implantation can be done by the doctor to other woman’s uterus, known as a gestational carrier or a surrogate mother, who will conceive the baby for the couple.

In-vitro fertilisation is done for couples who have infertility problems or to avoid any genetic defects in the child. IVF fertility treatment can choose and use the couple’s eggs and sperm, your egg and donated sperm, donated eggs and your partner’s sperm, donated eggs and sperm, or donated embryos.

IVF treatment process is done due to various factors that limit a couple to achieve pregnancy. Here are some of the reasons who need in-vitro fertilisation:

• Absent, damage or blockage on the fallopian tubes: any damage or blockage in the fallopian tubes of women can hinder the egg to pass through to the uterus for fertilization, or the embryo to the uterus for implantation. Fallopian tubes may have been removed due to several reasons such as tubal ligation, tube rupture due to ectopic pregnancy.
• Male sperm production and sperm motility problems: decreased sperm count, weak sperm motility, and sperm abnormalities prevent the ability of the sperm to fertilize an egg.
• A woman with ovulation problems: approximately once a month, a mature egg is released from the ovary for fertilization. Irregular production or unavailability of egg poses a problem in fertilization.
• Couples with a genetic disorder: IVF fertility treatment are done to prevent the baby from getting genetic disorder or any disease that one or both of the couple have.
• Unexplained fertility: there are couples even after thorough fertility tests are done, a doctor may not be able to pinpoint the cause of infertility in one person or both partners.
• Fertility preservation: is done to preserve the egg, sperm or embryos for future use. One or both of the couple may not be ready yet to have a child or is about to undergo treatment that could affect fertility.
• Endometriosis: occurs when endometrial tissues grow outside of the pelvic organs, eventually leading to pain and damage on the fallopian tubes, ovaries, and uterus.

IVF fertility has opted because a couple may have tried for at least 2 years with unprotected sex but no success in getting pregnant. IVF treatment can also be done because previous attempts on other assisted reproductive technique have not worked for the couple. In some cases that by choice or by chance due to health-related issues that a woman cannot grow the embryo inside her womb; the couple may opt for a surrogate mother in the IVF process. A surrogate mother or a gestational carrier will conceive the baby for the couple.

Before a couple can be recommended with IVF, they will undergo screening and tests to ensure higher IVF success rate. For the males, the doctor will perform a physical assessment and analysis of the semen.  The semen will be tested for sperm count, sperm motility, quality of the sperm, seminal fluid amount.

Males will undergo one or more of the following tests:

• Semen analysis, hormone testing: To check testosterone level and other male hormones
• Genetic testing: To check infertility problems due to genetic defects
• Testicular biopsy: To recognize infertility problems or sperm retrieval for IVF
• Imaging studies: Such as transrectal ultrasound, scrotal ultrasound or vasography (x-ray of the vas deferens to check for any blockage or patency of the vas deferens and ejaculatory ducts).

Females also will have to undergo physical examination and screening test prior to the IVF treatment process. The tests will be done by the doctor to evaluate eggs, ovaries, fallopian tubes, and ovaries. Ovaries should produce mature eggs. Eggs should pass the fallopian freely to reach the uterus for fertilization and implantation of the fertilized egg. The doctor will check if any of these processes have interfered.

Female tests before IVF treatment include:

• Pelvic exam, blood tests: To determine hormone levels
• Pelvic ultrasound: To check the ovaries, fallopian tubes, and uterus
• Hysterosalpingography: Involves using a contrast dye and x-ray is taken to assess the patency in uterus to the fallopian tubes and check other problems
• Ovarian reserve testing: Counts activated follicles and estimate total ovarian reserve.

In rare cases, your gynecologist may perform hysteroscopy or laparoscopy.

• Hysteroscopy: Uses a thin lighted scope, known as a hysteroscope, and inserting it through the vagina to assess cervical and uterine problems.
• Gynecologic laparoscopy: Uses a thin lighted scope to assess organs in the pelvic area such as the ovaries, fallopian tubes, and uterus. It uses small incisions to access the pelvic area.

The IVF process involves various steps that take 2- 3 weeks in one cycle of IVF treatment. Here are the important steps in the IVF treatment process:

1. Stimulation: Normally, a woman produces one egg per month. In this step, women are given with injectable fertility drugs to stimulate the ovaries to produce multiple eggs. Fertility drugs contain follicle-stimulating hormone (FSH), a luteinizing hormone (LH), or a combination of these two hormones. Routine transvaginal ultrasound is done to monitor the production of eggs and blood tests to monitor hormonal levels.
2. Egg Retrieval: This step in the IVF process is usually done in the doctor’s clinic and involves using transvaginal ultrasound to collect eggs from the ovaries. Before the procedure starts, the woman will be given sedative and pain medications to minimize pain and discomfort. The ultrasound probe as a guide and a very thin needle will be inserted through the vagina until it reaches the ovary. Eggs and fluid will be collected through follicle aspiration using the needle that is connected to suction equipment. The same process will be done to the opposite ovary. Cramping after the procedure is expected but usually subsides within the day.
3. Sperm Retrieval: Men will collect fresh semen through masturbation and placed in a sterile container. It is usually collected the same day that the woman will undergo egg retrieval and will be submitted to the doctor’s clinic.
4. Insemination and Fertilization: The sperm or a donor sperm will be mixed with the eggs in a petri dish- known as insemination. After several hours, the union of egg and sperm (fertilization) takes place. If the doctor observed that there is less chance of fertilization, he may inject the sperm directly into the egg- intracytoplasmic sperm injection (ICSI).
5. Embryo Culture: The embryo will be monitored for 5 days in average, and by this time several cells that are continuously dividing will be observed from the embryo. There are couples who opt to do pre-implantation genetic diagnosis (PGD) to screen the embryo for possible genetic disorders.
6. Embryo Transfer: This IVF fertility step is done in the doctor’s clinic. The woman is awake and may feel cramping but tolerable. The doctor will make use of a thin catheter and insert through the vagina to reach the uterus, and embryos will be released. The embryo will adhere to the linings of the uterus approximately 6-10 days. Some couples may opt to keep the fertilized egg frozen (cryopreserved) for future use.

The woman should take a rest after the IVF birth procedure and may resume regular activities the following day. After the embryo transfer, women must take progesterone for about 8 to 12 weeks. This hormone stimulates blood vessel growth in the endometrial lining and activates endometrial glands to produce nutrients for the developing embryo. After 2 weeks of the embryo transfer, the woman can go back to the clinic to do a pregnancy test.

Although IVF success rate is high, in-vitro fertilisation still has risks and complications involved. It is important to know these IVF treatment complications so that in case a woman can experience any of these, she can immediately consult her doctor. Some of the IVF fertility risks and complications are the following:

• Ovarian Hyperstimulation Syndrome: is a result of too much hormonal medication in the body. The ovaries will become swollen and the woman will manifest mild to moderate abdominal pain, abdominal bloating, nausea, vomiting, diarrhea, rapid weight gain (10 lbs. for 3-5 days), and shortness of breath.
• Possible risks during egg retrieval include allergic reactions to anesthetic drugs, infection, bleeding, and damage to organs adjacent to the ovaries.
• Ectopic Pregnancy
• Birth defects
• Stress and depression
• Miscarriage
• Multiple births
• Premature birth and below 2500gms birth weight of the baby