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:
- 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.
- 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.
- 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.
- 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).
- 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.
- 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.