Starting the In Vitro Fertilization (IVF) treatment process can be an exciting and nerve-wracking experience. Usually, you may have been trying to conceive for months or, more likely, for years and years. But this is not always the case. Sometimes, IVF is the very first treatment tried.
For example, IVF may be the first option if a gestational carrier is required, an egg donor is being used or the fallopian tubes are blocked, among others. Even in these cases, IVF may come after years of trying to get pregnant and several fertility tests. But you do not need to worry because the more you understand the process, the more in control you’ll feel. One clinic’s protocol may be slightly different from another and treatments are based on individual needs.
Usually, IVF involves taking many eggs retrieved via a transvaginal ultrasound-guided needle, and placing them in a petri dish with specially prepared sperm cells. If all goes well, some of the retrieved eggs will become fertilized by the sperm cells and become embryos. One or two of those healthy embryos will be transferred to your uterus.
In some cases, the sperm cells need extra help with the fertilization process. An assisted reproductive technology known as intracytoplasmic sperm injection (ICSI) involves injecting a single sperm cell into an egg may be used. This may be done in cases of severe male infertility, or if past IVF cycles have failed at the fertilization stage, among others.
Before eggs can be retrieved, the ovaries must be stimulated. Without the help of fertility drugs, your body will typically only mature one (or maybe two) eggs each month. The process of IVF is appreciably successful. Your best odds for success may come from repeated treatment cycles, at least 2-3 are recommended. One good outcome is that IVF is generally safe if carried out by professionals in certified centers. It’s important to discuss with your doctor what your personal outcomes are likely to be.
The first official day of your treatment cycle is the day you get your period. On the second day of your period, your doctor will likely order blood work and an ultrasound. These first-day ultrasounds and blood work are referred to as your baseline blood work and your baseline ultrasound. Usually, these tests will be fine. If everything looks OK, treatment moves on.
During ovarian stimulation, your doctor will monitor the growth and development of the follicles. Monitoring the cycle is very important. While not common, a cycle may also be canceled if ovulation occurs before retrieval can take place. Once the eggs ovulate on their own, they can’t be retrieved. Your doctor will likely tell you to refrain from sexual intercourse.
Before the retrieval, a light sedative is used to make you “sleep” through the procedure. While you’re recovering from the retrieval, the follicles that were aspirated will be searched for oocytes or eggs. Fertilization of the oocytes must happen within 12 to 24 hours.
Once the semen sample is ready, it’ll be put through a special washing process, and the “best-looking sperm,” is placed in each culture dish with an oocyte and kept in a special incubator. After 12 to 24 hours, they are inspected for signs of fertilization.
About three to five days after the retrieval, an embryologist will identify the healthiest looking embryos visually with a microscope, but in some cases, genetic screening is performed. This is known as preimplantation genetic diagnosis (PGD) or preimplantation genetic screening (PGS). For PGD, day five embryos are preferred.
Sometimes, with PGD/PGS, the embryos are frozen and transfer is delayed until the next cycle. During the embryo transfer, a thin tube, or catheter, will be passed through your cervix through the catheter, they will transfer the embryos, along with a small amount of fluid.
The number of embryos transferred will depend on the quality of the embryos and the discussion with your doctor. Transferring two embryos is the most common option. On or after the day of your retrieval, and before the embryo transfer, you’ll start giving yourself progesterone supplements as progesterone in oil, or as a pill, vaginal gel, or vaginal suppository.
There is a two-week wait after the transfer. If you have questions ask your doctor, but you need to wait to see if pregnancy takes place. About a week to 12 days after the embryo transfer, a pregnancy test is done. If the test is positive, you may need to keep taking the progesterone supplementation for several weeks, following up with occasional blood work and ultrasounds to monitor the pregnancy.
If the pregnancy test is negative 12 to 14 days post-transfer, your doctor will ask you to stop taking the progesterone. Then, you’ll wait for your period to start. If this was your first cycle, another cycle may be recommended. Remember that your best chances for success are after doing several cycles.
The bottom line is that having a failed treatment cycle fail is never easy. Although heartbreaking, it’s important, however, to keep in mind that having one cycle fail doesn’t mean you won’t be successful if you try again. And when you try again, ensure that you take the right steps that you can take after a treatment cycle fail.