Yazd Madar Gynecology and Obstetrics (OB / GYN) Single-Specialty Hospital
Look at the In Vitro Fertilization (IVF) Process
Ø Preface
Scientists’ research shows that one out of every 8 couples does not get pregnant easily, but they can use assisted reproductive technologies such as IVF. In the process of IVF, one of the procedures to treat infertility, the female ovum and male sperm are fertilized in the laboratory environment and an embryo is formed. The embryo resulting from IVF can be placed inside the uterus or frozen and transferred in subsequent cycle according to the attending physician’s opinion.
There are various concerns such as the success rate of IVF, the cost of doing it and so on; therefore in this manual tried to provide the readers with necessary information in a concise and understandable procedure.
Ø What is IVF?
The term IVF means In Vitro Fertilization or, in other words, fertilization of ova in a laboratory environment. In this process, fertilization does not occur naturally inside the woman’s body, but inside a glass container in the laboratory.
Ø Who are chosen to do IVF?
1- Women with blocked or damaged fallopian tubes
2- Women with a history of Tubectomy and demanding for refertilize
3- Women with severe endometriosis
4- Women with unknown causes of infertility
5- Male infertility (sperm disorders including low count (oligozoospermia), low motility (Asthenozoospermia) and abnormal morphology )
6- Patients with a history of multiple unsuccessful treatments such as ovarian stimulation drugs, IUI, etc.
Ø In Vitro Fertilization (IVF)
Initial measures and evaluations are done before doing IVF, and according to be the attending physician’s opinion, sometimes it is necessary to perform several tests, which include:
1- Counseling with the couple and getting their history and essential information
2- Sperm analysis
3- Performing uterine Sonographies to determine the health status of the uterus
4- Performing hormonal test (Ovarian Reserve Test, etc.)
Ø Step-by-Step Descriptions of the IVF Procedures
Step 1: Ovulation Induction
Ovulation stimulation drugs are prescribed to obtain more ova and subsequently to form multiple embryos and increase the chances of fertility. These drugs are usually prescribed from the second day of menstruction after performing Sonography and ensuring that the uterus and ovaries are healthy. The growth process of the ova is followed by successive Sonographies, therefore, the patient may undergo Sonography several times at intervals of two to three days until the desired condition is reached and control of the treatment steps is done mainly through vaginal Sonographies and blood tests. When the size of the follicles reaches 18-20 mm in the Sonography images, the Human Chorionic Gonadotrophin (HCG) ampoule is prescribed for the final maturation of the ova.
Step 2: Ova Collection
Puncture, or popularly called ovulation, is performed with the help of Sonography observations through the vagina. In this procedure, by drilling the follicles, their contents including ova and follicular fluid, are removed from the vaginal route.
Ø Necessary Cares before Performing Puncture Procedure
1-Eating a light dinner at 7 pm and fasting from 12 pm until the time of surgery
2- Bathing and removing body hair, the night before the operation
3-Not using cosmetics and nail polish
4-Not having sexual intercourse for two weeks before the operation
5-Takin blood pressure, thyroid or heart disease medications as usual
Step 3: Sperm Preparation
On the day of ova collection, semen is prepared from the patient’s husband and after washing and preparation, healthy and very active sperms are isolated, and a number of these alive and active sperms are placed in a laboratory culture environment next to a mature ovum cell, then it is placed in labeled containers inside the incubator until fertilization takes place (IVF).
In the Intra Cytoplasmic Spermatozoal Injection (ICSI), a healthy and alive sperm is selected and injected directly into the cytoplasm of the mature ovum cell by a special needle. This procedure is recommended in cases where IVF is not successful or infertility problems related to the patient’s husband, and the probability of fertility increases.
Ø Necessary cares after performing puncture procedure
1- Spotting after ovulation is due to the wound caused by removing the vaginal lining by the follicle removal needle. If the spotting is so much that it can fill the sanitary napkin with blood, patient must definitely inform the treatment staff.
2- After removing the ovum, the patient is recommended to use Progesterone Supplements medicines in the form of injections or suppositories. It is very important that these drugs are used exactly as prescribed by the specialist for the patient, because it plays an important role in preparing the uterus for implantation.
3- Abdominal pain and discomfort is normal; in case of mild pain, it should be improved using Acetaminophen tablets, but in case of severs pain, the patient must inform the ward nurse.
Step 4: Fertilization and Embryo Growth in the Laboratory Environment
The fertilized ovum is placed in a CO2 incubator with a temperature 37ºc; an environment that has the same conditions as the mother’s womb. Usually, on the third or fifth day after the discharge of ova, the embryos are ready to be transferred to the mother’s uterus. The formation of embryos, their number and quality will depend on the number and quality of ovum and sperm.