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 a laboratory. IVF is considered one of the best assisted reproductive methods.It increases the chance of fertilization between sperm and egg by contributing to the proper function of male and female sex cells when they join each other in the laboratory.
Having taken advantage of prominent physicians and infertility clinics and centers offering advanced fertility treatments, Iran is considered a leading country in the Middle East in terms of providing effective treatments and 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.
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 almost half a day for ovulation, a semen sample of man, and fertilization in the laboratory.
If 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. Still, in rare cases, if the number of eggs extracted from the ovary is high, the doctor will prescribe an overnight stay in the hospital after the egg retrieval operation. We should note 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.
There are several steps you have to follow before IVF treatment; including:
- Perform an ovarian test and 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;
- Take a semen sample of the male partner to evaluate the number, shape, and size of sperm. The sperm is injected directly into the egg using the ICSI method.
- Take an ovarian reserve test to evaluate the quantity and quality of eggs as well as the level of hormones such as estrogen, follicle-stimulating hormone (FSH), and anti-Müllerian hormone (AMH) in the blood;
- Take blood tests for diagnosing infectious diseases such as AIDS; and
- Take tests and ultrasounds to determine the depth of the uterus. Before starting the IVF procedure, doctors should determine the depth of the uterus with the help of Sonohysterography (also called saline infusion sonography or SIS).
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, 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's different stages so that they will choose this technique more confidently. The following will describe the IVF process timeline from its beginning to end.
Step 1: Preliminary ultrasound evaluation
Before starting the IVF cycle, patients will usually require ultrasound imaging. The preliminary ultrasound evaluation in the IVF process is considered very important since it is used to look at the woman’s uterus and ovaries and 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 must 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 before the program. These pills will reduce ovarian cysts and prevent ovarian hypersensitivity syndrome; however, there is a disagreement between doctors about this issue.
If your menstrual cycle is irregular, your doctor will prescribe progesterone for you. After six 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 and oocytes, which are immature egg cells.
Step 6: Oocyte maturation
At this stage, the doctor will prescribe an HCG injection. With HCG injections, timing is an essential factor. If the drug is taken early, the egg will not mature enough, and if it is taken too late, it will mature too much. This injection is usually given when the size of four follicles reaches 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. The doctor uses local anesthesia in this operation and usually removes between 8 and 15 oocytes. The oocytes are sent to the laboratory and fertilized with the partner’s sperm.
A few days after the ovulation, the person may experience spotting and cramps in the lower abdomen, which is normal and disappears after a few days.
Step 8: Egg fertilization
In the laboratory, sperm is removed from the partner’s semen and sent to the oocyte.
Step 9: Embryo transfer
The resulting fetus is transferred into the uterus usually 2 to 5 days after the 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 transfer, a break of two to three hours is prescribed, after which the patient can return home.
Step 10: Pregnancy test
Twelve days after implantation, a pregnancy test is performed, and the test result indicates whether the woman is pregnant or not.
Frozen Embryo Transfer in IVF
If a woman has a low ovarian reserve, cancer, or other health issues, the IVF specialist suggests the couple use frozen embryos for IVF. By using a frozen embryo, the couple can perform IVF at any time in the future, significantly when the mother's health issues are reduced.
During frozen embryo transfer (FET), the embryo is first defrosted and injected into the mother's uterus using a narrow plastic tube. Before FET, the doctor asks the mother to take several blood tests and perform physical examinations to ensure that her body and uterus are ready for implantation. In many cases, IVF with frozen embryos has a higher success rate because it lets the uterus return to its normal state after IVF medication.
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 the sunbathing, hot sauna, hot tub, and Jacuzzi;
- Avoid sexual intercourse for two months after embryo transfer.
Is IVF Painful?
IVF has multiple complications like any other fertility treatment and may cause mild or moderate pain. At first, some women may feel pain while injecting hormonal drugs, which is almost similar to the pain of injecting other drugs. The mild pain and irritation caused by the injections are not a big deal for most women. Later, when the ovulation induction drugs have affected, and the follicles are fully developed, you may experience bloating and mild abdominal pain due to the enlargement of the ovaries.
But the main stages of IVF are the egg retrieval process and embryo transfer which are relatively invasive. The good news is that since both of these procedures are done under local anesthesia, you don’t experience severe pain and discomfort during and after the operation. The only reason some women feel pain after IVF is that the doctor uses a speculum to keep the vagina open, which may hurt the vaginal opening.
Causes of IVF Failure
IVF may sometimes fail due to the following reasons:
- Failure in implantation: more than 95% of IVF failures are caused because the mother's body recognizes the embryo as a foreign object and rejects it. This rejection weakens the embryo and makes it unable to grow and implant.
- Poor quality of the embryo: in the IVF method, even if the embryo is of high quality in the laboratory environment, it may not have the necessary quality for implantation in the mother's uterus, which will cause IVF failure.
- Problems with hormones: sometimes, ovulation induction drugs cannot stimulate ovulation, or the body does not respond to them. For example, it is challenging to produce FSH hormone in women over 37 years old, and this causes IVF to fail.
- Chromosomal abnormalities: chromosomal abnormalities, especially from age 40 onwards, are the common causes of IVF failure because aging causes the cells not to divide correctly. Of course, sperm chromosomal disorder is less frequent than egg chromosomal disorder.
Also, other factors cause IVF failure, such as:
- Endometrial polyps;
- Thin uterine lining;
- Polycystic ovary syndrome (POS); and
What are the Risks and Side Effects of IVF?
Being time-consuming and expensive and having uncertain treatment outcomes, IVF can be a stressful treatment process for infertile couples. Besides, in some cases, we can see complications from ovarian stimulation drugs and egg retrieval or embryo transfer methods. You should see your doctor if you notice any abnormal symptoms during IVF.
Although most potential complications and risks related to the 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;
- An ectopic pregnancy occurs in 2 to 5% of IVF cases and leads to the 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.
We should note that although some researchers believe that using the IVF method causes problems such as congenital disabilities and ovarian cancer, no credible research has confirmed such hypotheses.
IVF Success Rate
Depending on several factors, such as the mother's age, her weight, and her lifestyle, the success rate of IVF is different. On average, the success rate of the IVF method is less than 50%, and according to the mother's age, it changes as follows:
- 13-18% for women over 40 years old;
- 23-27% for women between 38 and 40 years old;
- 33-36% for women between 35 and 37 years old;
- 41-43% for women under 35 years old;
As can be seen above, the success rate of IVF decreases significantly in women over the age of 40. In other words, women's fertility decreases by 9% annually from age 35 onwards. Moreover, genetic abnormalities are observed in most of the eggs after the age of 45. Note that, by performing preimplantation genetic diagnosis/screening (PGD/PGS), embryos without chromosomal defects can be selected for transfer. In addition to reducing the risk of miscarriage in elderly mothers, the chance of having successful IVF is increased by 10%.
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.
Side Effects of IVF Stimulation Drugs
- Ovarian hyperstimulation syndrome (OHSS);
- Mood swings;
- Hot flashes and bloating;
- Constipation and breast pain;
- Rapid weight gain within 3 to 5 days;
- Shortness of breath;
- Ovarian cancer.
The Risks of the Egg Retrieval
- Severe uterine bleeding;
- Pelvic pain;
- The presence of blood in the urine;
- A fever over 38° C;
- Damage to the intestines, bladder, or blood vessels.
What to do after the embryo transfer?
In most cases, women experience spotting and light bleeding after embryo transfer. The spotting can occur due to embryo implantation; however, using vaginal suppositories can also be another reason. In case of severe bleeding, you should see a doctor immediately.
In general, after the embryo transfer, you should consider the following:
- Take partial rest for three days;
- Avoid strenuous sports activities;
- Abstain from sexual intercourse for 17 days;
- Avoid moving heavy objects;
- Use a diet containing fresh vegetables and fruits as well as laxatives to prevent constipation;
- Do not use a vaginal douche or tampon;
- Do not use the bathtub, and also do not swim for 48 hours.
Sleeping or resting is allowed in any situation. See a doctor in case of severe bleeding, shortness of breath, nausea, or severe pain is recommended.
What factors determine IVF success rates?
The IVF success rates are not the same for everyone and depend on various factors and conditions, which can help 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 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. We should note that in the case of repeated failure in the 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, a regular egg can increase the chance of a successful IVF, while severe endometriosis can reduce the success rates.
The couple's daily behaviors and lifestyle - especially the mother - play an essential role in increasing the success of IVF treatment. For example, couples should avoid smoking, drinking alcohol and high caffeine, and consuming drugs. Also, in case of severe obesity, you should return to your average weight.
How Long Should I wait between two IVF cycles?
To Reach a regular menstrual cycle, doctors recommend space between two IVF cycles for 2 or 3 months – after two menstrual cycles were passed. Of course, to restart the IVF process, it is not necessary to see a doctor precisely two months after the first treatment period; Instead, you can repeat the second IVF cycle whenever you are ready.
We should note that some tests have a validity date of 6 months and may need to be repeated if restarting treatment takes longer. However, couples with frozen embryos do not have to repeat the entire IVF procedure. Doctors will only repeat the embryo transfer stage.
The following steps are taken to repeat the IVF Process:
- Use birth control pills on the third day of menstruation;
- Performing ultrasound scanning and prescribing diphtheria ampoules on the 17th day of menstruation;
- Re-examination and performing another ultrasound along with prescribing estradiol tablets on the second or third day of the next menstrual period;
- It evaluates the effect of estradiol within 6-7 days after its consumption and adjusts the intake amount to help the endometrial thickness reach 7-8 mm.
Based on the findings of IVF specialists, you don’t have to do anything special after IVF embryo transfer; however, there are some tips and recommendations that patients must follow to increase the chance of successful IVF:
- If you have experienced frequent miscarriages, severe bleeding, and placenta previa in the previous pregnancies, have enough or even absolute rest after embryo transfer;
- Avoid lifting heavy objects and doing strenuous activities;
- Avoid doing some sports such as swimming, horse riding, Pilates, and aerobics;
- Avoid sexual intercourse and orgasm for two months after embryo transfer;
- Avoid smoking and drinking alcohol;
- Do gentle exercises such as walking and yoga to reduce stress and anxiety and regulate your blood circulation;
- Avoid bathing with hot water, taking a sun bath, and using a hot sauna or hot tub until your doctor permits;
- Take omega-3 and folic acid supplements to have a healthy fetus;
- Sleep at least 8 to 9 hours every night in the dark to improve melanin production and, as a result, have healthy follicles; and
- Maintain a balanced BMI by having a low-fat, high-quality diet rich in iron, magnesium, potassium, calcium, and protein.
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 favorite destination for many infertile couples from different countries. One of the main reasons 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 inexpensive treatments that vary in price from one treatment center to another. At the same time, you have to pay more for other fertility treatments such as IVF or microinjection. We should say that the low cost and, at the same time, high-quality fertility treatment services in Iran have made this country one of the hubs of IVF treatment.
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Frequently Asked Questions About IVF Treatment
What if ovulation occurs before the egg is removed?
The occurrence of ovulation before the egg is removed the possibility of egg retrieval and prevents further treatment. For this reason, careful and regular check-ups by the medical team are essential to know the level of blood hormones and to determine the time of ovulation.
Is it normal to spot after egg retrieval?
Yes. As mentioned before, there is a possibility of minor bleeding or spotting after ovulation, 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 -the coming of the menstrual cycle may also be a sign of infertility.
How many times is it possible to repeat the IVF cycle?
There are no restrictions on the IVF procedure recurrence, which is up to the couple and the doctor.
Is it wrong to have intercourse between the onset of IVF and ovulation?
The man is recommended to refrain from ejaculating for 84 hours before taking a semen sample. Of course, it is better to ejaculate 5 to 6 days before semen sampling, resulting in the highest number of healthy and motile sperm on the sampling day.
When is a woman's pregnancy or non-pregnancy determined?
If the IVF is successful, the person will have symptoms like a normal pregnancy. The most accurate way is to perform a pregnancy test two weeks after the embryo transfer.
How many embryos are transferred to the uterus?
As mentioned above, in most cases, more than one embryo is transferred to the uterus to increase the chance of pregnancy. This depends on several factors such as the results of medical examinations, the couple's readiness for the possibility of having multiple children, the percentage of multiple pregnancies in the medical center, the mother's age, etc.
In most cases, a maximum of three embryos are transferred to the uterus; however, if the mother is older – for example, over 53 years – sometimes, transferring more than three embryos is permitted.
When can you start your daily activities after the embryo transfer?
It is usually best to take a complete 42-hour break after embryo transfer. It is also necessary to avoid strenuous exercise such as swimming, horseback riding, running, etc., about two weeks after the transfer until pregnancy is confirmed. However, daily light activities are not prohibited.
Is there a possibility of multiple births in IVF?
Yes. As usually a number of embryos are transferred to the uterus to increase the chance of implantation, the chance of having multiple children also increase.
It should be noted that in a natural pregnancy, the probability of having twins is about one in eighty while in IVF pregnancies this rate reaches to about 52%. However, the probability of having triplets in IVF is also about 2 to 3%.
When to have sexual intercourse after the embryo transfer?
It is not possible to pinpoint an exact time for sexual intercourse after IVF process, but doctors recommend that it is better to delay the sexual intercourse for at least two or three weeks. In fact, vaginal muscle contractions during orgasm may adversely affect the fetal implantation process.
However, it should be noted that according to doctors, having sex the night before the embryo transfer process will increase the chances of pregnancy.
What happens to remaining embryos in IVF?
At each egg retrieval process, more than one egg is usually extracted; so that, more than one embryo can be produced in the laboratory. A number of resulting embryos are transferred to the uterus while the rest are frozen to be used in further IVF cycle if the first one is not successful.
Furthermore, these frozen embryos can be used in a case the couple wishes to have children again in the coming years. Although the chances of a successful pregnancy with frozen embryos are slightly lower; but, its lower cost and the reduced risks and complications of re-egg retrieval make this method a very good option.