IVF Treatment, Process and ConditionsFertility Treatment
What You Need to Know About In Vitro Fertilization
In vitro fertilization (IVF) is the most commonly known assisted reproductive technology for fertility treatment. This method involves retrieving eggs from a woman’s ovaries and fertilizing them with sperm in laboratory. IVF is considered one of the best assisted reproductive methods which increases the chance of fertilization between sperm and egg by contributing to proper function of male and female sex cells when they join each other in laboratory.
Having taken advantage of prominent physicians as well as infertility clinics and centers offering advanced fertility treatments, Iran is considered not only a leading country in the Middle East in terms of offering effective treatments but also a top country in the world.
When Is IVF Recommended?
The IVF method is often recommended in the case of occurring the following conditions:
- Women over 40 years old;
- Blockage or damage of the fallopian tubes;
- Poor ovarian function;
- Uterine fibroids;
- Low sperm count or sperm deformity;
- Existence of genetic disorders;
- Unexplained infertility;
- Secondary infertility;
- Recurrent miscarriages;
- Polycystic ovary syndrome (PCOS).
Depending on the situation of the infertile couple, IVF can be performed in the following ways:
- Use of the woman’s eggs and her partner’s sperm;
- Use of a donated egg and the male partner’s sperm;
- Use of a donated embryo.
However, the doctor may use surrogacy or uterus transplant in women with uterine insufficiency.
There are several steps you have to follow prior to IVF treatment; including:
- Perform an ovarian test as well as a blood test to determine the level of follicle-stimulating hormone and also obtain information about the size and quality of the egg;
- Perform a uterus scanning or vaginal ultrasonography using high-frequency sound waves to find the uterine condition and also to choose the best method of fertilization;
- Taking a semen sample of the male partner in order to evaluate the number, shape and size of sperm. The sperm is then injected directly into the egg by using ICSI method.
How long Does the IVF Process Take From Start To Finish?
In general, the IVF treatment process takes about 4 to 6 weeks. It takes a few weeks for the eggs to mature, and it will take about half a day for ovulation, taking a semen sample of man, and fertilization in the laboratory.
In the case the uterus condition is favorable, the resulting embryos are transferred into the uterus about 2 or 5 days later.
Most patients will not need to be hospitalized during the treatment process; but in rare cases, if the number of eggs extracted from the ovary is high, the doctor will prescribe an overnight stay in hospital after egg retrieval operation. It should be noted that the success rate of this method and a healthy delivery depends on various factors such as the couple’s age and the health of their reproductive organs.
Understanding the IVF Process Step-by-Step
In Vitro Fertilization, also known as IVF, is one of the most effective forms of assisted reproductive technology. In this method a mature egg is removed from a woman’s ovary and fertilized with sperm in a laboratory dish, and then, transferred into the uterus. The process takes about three weeks; however, in some cases, this cycle is divided into several stages and will take longer. Understanding the IVF process step-by-step can make the couple fully aware of IVF different stages, so that they will choose this technique with more confidence. In following, we are going to describe the IVF process timeline from its beginning to the end.
Step 1: Preliminary ultrasound evaluation
Prior to starting the IVF cycle, patients will usually require an ultrasound imaging. The preliminary ultrasound evaluation in IVF process is considered very important since it is used to look at the woman’s uterus and ovaries as well as to study the follicles count, the amount of blood flow to the ovaries and finally the uterine condition.
Step 2: Secondary ultrasound on the fifth day of menstruation
The patient is required to perform another ultrasound on the fifth day of the menstrual cycle. This testing allows the doctor to check the growth of follicles and the thickness of the endometrium. Follicle growth prepares the woman’s body for ovulation and estrogen production. At this time, two blood tests are performed to assess estrogen levels.
Step 3: Preparing for in vitro fertilization
Your doctor may prescribe birth control pills prior to the program. This will reduce ovarian cysts and prevent from ovarian hypersensitivity syndrome; however, there is disagreement between doctors about this issue.
If your menstrual cycle is irregular, your doctor will prescribe progesterone for you. After 6 days of taking progesterone, some doctors also prescribe injectable antagonists or agonists that will affect ovulation.
Step 4: Proceeding with IVF
An IVF treatment cycle begins on day 1 of your period. On the second day, blood tests and vaginal ultrasound are performed which respectively check the size of follicles and determine the level of estrogen and estradiol.
Step 5: Stimulation of the ovaries
In this stage, the patient receives injectable fertility drugs that stimulate the ovaries to produce multiple, viable eggs. They usually should be injected between one or four times a day (for 7 to 10 days). These drugs control the growth of the ovaries as well as oocytes that are actually immature egg cells.
Step 6: Oocyte maturation
At this stage, HCG injection is prescribed. With HCG injections, timing is an important factor. If the drug is taken early, the egg will not mature enough, and if it is taken too late, the egg will mature too much. This injection is usually given when the size of four follicles reaches to 18 to 20 mm and the estrogen level is up to 2000 pg/ml.
Step 7: Ovulation
Ovulation is usually done 34 to 36 hours after HCG injection. In this operation, the doctor uses local anesthesia and usually removes between 8 and 15 oocytes. The oocytes are sent to the laboratory where they are fertilized with the partner’s sperm.
A few days after the ovulation, the person may experience spotting as well as cramps in the lower abdomen which is normal and disappears after a few days.
Step 8: Egg fertilization
In laboratory, sperm is removed from the partner’s semen and then sent into the oocyte.
Step 9: Embryo transfer
The resulting fetus is transferred into the uterus usually 2 to 5 days after egg retrieval operation. This process is painless and without anesthesia. At this step, about 2 or 5 fetuses are often transferred to the uterus. After the embryo transferring process, a break of two to three hours is prescribed, after which the patient can return home.
Step 10: Pregnancy test
12 days after implantation, a pregnancy test is performed and the test result indicates whether the woman is pregnant or not.
What are the Risks and Side Effects of IVF?
Being time-consuming and expensive as well as having uncertain treatment outcome, IVF can be a stressful treatment process for infertile couples. Besides, in some cases we can see complications that come from ovarian stimulation drugs as well as egg retrieval or embryo transfer processes. It is recommended that you see your doctor if you notice any abnormal symptoms during IVF.
Although, most of the potential complications and risks related to IVF process rarely occur, you must be aware of some probable dangers in this regard. Some of these dangers include:
- Fetal weight loss and occurring preterm birth due to the possibility of multiple pregnancies because of the placement of multiple sperms in the uterus;
- Pregnancy loss or abortion;
- Ectopic pregnancy which occurs in 2 to 5% of IVF cases and leads to impossibility of continuing the pregnancy;
- Occurrence of ovarian hyperstimulation syndrome which leads to high accumulation of fluid in the chest and abdomen after swelling of the ovaries due to injection of human chorionic gonadotropin (HCG);
- Infection, bleeding, and in rare cases damage to the bladder or intestines;
- The possibility of nausea and vomiting;
- Flatulence and severe stomach pain;
- Significant weight gain in 3 to 5 days;
- Damage to internal organs and blood vessels because of using a needle to collect eggs;
- Occurrence of stress.
It should be noted that although some researchers believe that using IVF method causes problems such as birth defects as well as ovarian cancer, no credible research has confirmed such hypotheses.
What are the disadvantages of IVF?
- IVF is an invasive and expensive treatment;
- In every IVF cycle, about two and three embryos are transferred to the uterus at a time which increases the risk of multiple pregnancies;
- As same as other methods of assisted reproduction, there is a possibility of Ectopic Pregnancy in the IVF method;
- In some cases, fertility drugs can cause the ovaries to become overstimulated which leads them to swollen and become painful;
- Bleeding and infection are as likely to occur in the IVF method as in other invasive procedures.
Required care after IVF
- Avoid smoking, drinking coffee or alcohol, and taking drugs;
- Avoid strenuous activities;
- Avoid sports activities such as swimming, horseback riding and aerobics;
- Do not use sunbathing, hot sauna, hot tub and Jacuzzi;
- Avoid sexual intercourse for two months after embryo transfer.
How Long should I wait between two IVF cycles?
In order to reach a normal menstrual cycle, it is recommended to space between two IVF cycles for 2 or 3 months – after 2 menstrual cycles were passed. Of course, in order to restart the IVF process, it is not necessary to see a doctor exactly two months after the first treatment period; Instead, you can repeat the second IVF cycle whenever you are ready for.
It should be noted that some tests have a validity date of 6 months and they may need to be repeated in the case restarting treatment process takes longer time. However, those couples who have frozen fetus, have not to repeat the entire IVF procedure and only the embryo transfer stage will be repeated for them.
What factors determine IVF success rates?
The IVF success rates are not the same for everyone and depend on various factors and conditions, the knowledge of which can help to observe the related effective points. The most important factors influencing the IVF success rate include:
- Mother’s age
Younger women are more likely to have a successful pregnancy and give birth to a healthy baby. For mothers over the age of 41, using of donated eggs increase the chances of a successful pregnancy.
- Reproductive history
Women with a history of a successful pregnancy before starting the IVF process are more likely to succeed in their treatment. It should be said that in the case of repeated failure in IVF cycle, the chance of pregnancy decreases.
- Sperm condition
The chance of a successful pregnancy can usually be increased by transferring more mature sperm.
- Causes of infertility
Infertility problems occur due to various reasons. For example, the presence of a normal egg can increase the chance of a successful IVF, while having severe endometriosis can reduce the success rates.
- life style
The couple's daily behaviors and lifestyle - especially mother - play an important role in increasing the success of IVF treatment. For example, smoking, drinking alcohol and high caffeine drinks as well as consuming some special drugs should be avoided. Also, in case of severe obesity, you should first return to your normal weight.
Costs of Fertility Treatment in Iran
The presence of well-equipped medical centers and experienced doctors have made Iran one of the hubs of fertility treatment in the region and a favorable destination for many infertile couples from different countries. One of the main reasons that foreigners choose Iran to receive fertility treatment services is the much lower treatment cost compared to other countries by which they can save up to 50%.
In general, methods such as IUI are relatively inexpensive treatments that vary in price from one treatment center to another, while you have to pay more for other fertility treatments such as IVF or microinjection. It should be said that the low cost and at the same time the high-quality fertility treatment services in Iran, has made this country one of the hubs of IVF treatment.
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Frequently Asked Questions About IVF Treatment
1) What if ovulation occurs before the egg is removed?
Occurrence of ovulation before the egg is removed eliminates the possibility of egg retrieval and prevents further treatment. For this reason, careful and regular check-ups by the medical team are important to know the level of blood hormones and to determine the time of ovulation.
2) Is it normal to spotting after egg retrieval?
Yes. As mentioned before, after ovulation there is a possibility of minor bleeding or spotting which is often caused by a perforation of the vaginal wall with the needle. Spotting is normal within 42 to 84 hours after egg retrieval, but in case of more severe bleeding, you should see a doctor immediately. Other causes of spotting after embryo transfer include successful implantation, implantation of one embryo and separation of the other – if more than one embryo is transferred -, coming of menstrual cycle, and also maybe a sign of infertility.
3) How many times is it possible to repeat IVF cycle?
There are no restrictions on the recurrence of the IVF procedure, and this is up to the couple and the doctor.
4) Is it wrong to have intercourse between the onset of IVF and ovulation?
It is recommended that the man refrain from ejaculating for 84 hours before taking semen sample. Of course, it is better to ejaculate 5 to 6 days before semen sampling, which will result in the highest number of healthy and motile sperm in the day of sampling.