1. What do we mean by "in vitro fertilisation"?
The term in vitro fertilisation (IVF) refers to one of the methods by which we may help an infertile couple start a family. The correct term is Assisted Reproduction Techniques (ART) and covers a wide range of "therapies", including intra-uterine insemination (IUI), ovulation induction, and obviously IVF itself. In vitro fertilisation means that the egg is fertilized by sperm in the artificial environment of a laboratory, and not inside the woman's body, namely in the Fallopian tube, as happens during natural conception.
2. When does a couple have to ask for help from a gynecologist, specializing in infertility issues?
Under normal circumstances, a couple who are consciously trying to conceive should succeed in doing so within 12 to 18 months. This range is still subject to international scientific discussion, and there is some disagreement between, say, the American school and the British school. In any case, "conscious effort" means that both partners know at what frequency and especially at which point of the woman's cycle they should make love without protection.
3. What does fertility screening of both partners include?
First of all, the physician takes a detailed history and should proceeds with a full physical examination of both partners. Of essence for the woman are an ultrasound scan of her internal genitalia, a reproductive hormone profile, as well as a check of tubal patency. Depending on the problem detected, and his own judgment, the gynecologist may recommend performing laparoscopy and / or hysteroscopy. It also important to check the male partner for semen quality.
4. How does a treatment start?
Once all necessary information is collected, and the specialist decides that IVF must be applied, a so-called treatment protocol is established. Thus, on a specific day of the cycle, treatment starts with one or more hormones, with the goal of stimulating the ovaries to produce several follicles, instead of the one that they would normally produce in a natural cycle. The same hormones prepare the endometrium to receive the future embryos.
5. How is the patient monitored?
Typically, the "patient" (who is obviously not "sick", by the way), is monitored every 2 days by ultrasound, in order to record the number and size of growing follicles and the thickness of the endometrial lining. Usually, blood is drawn at each visit, to monitor hormonal response. If necessary, adjustments are made to the hormone doses.
6. When are the ovaries ready?
The follicles containing the eggs are expected to reach a certain critical size and number (typically, within 10-12 days). When specific criteria are met, the eggs are deemed mature and ready for egg collection. At the same time, the thickness of the endometrium is checked to make sure that it is adequate for embryo transfer. Then, a hormone is administered, which triggers final egg maturation and follicular fluid release.
7. When is egg collection performed?
Egg collection is scheduled approximately 36 hours after the final trigger injection of chorionic gonadotropin. It is important that the patient follows the timetable meticulously; an error of 2-3 hours may cause spontaneous rupture of the follicles (ovulation), which in most cases means failure of the next stages of the attempt.
8. How is egg collection performed?
Egg collection is performed under aseptic conditions and ultrasound guidance. The patient is given appropriate sedative drugs, leading to analgesia (incapacity of feeling pain). In some IVF units, a full general anesthesia is administered for egg collection. The follicular fluid is aspirated from each follicle, by means of a needle; this fluid is handed over to the embryologist, who identifies and isolates the eggs under a microscope.
9. How is fertilization performed?
On the same day, the husband/partner is asked to produce a semen sample, to be handed over to the embryologist. Eggs and sperm are placed in a specific liquid culture medium and incubated for 24 hours in special incubators. The following morning eggs are checked to assess fertilization. Embryo quality is scored 24 hours later.
10. Do all eggs get fertilized?
Eggs are fertilized at a rate of approximately 60-66%. Any fertilization rate near or above this figure is considered satisfactory. Of course, sperm and obviously egg quality play an important role in fertilization.
11. When are embryos trasferred to the uterus?
Embryo transfer is typically performed on day 2 or day 3 of culture. The procedure is quite simple and does not require sedation. However, it is a delicate moment for both the patient and the practitioners, because embryos and the endometrium are very fragile. A method that is gaining increasing support within the scientific community is culturing embryos to the blastocyst stage; in this procedure, embryos are transferred to the uterus on the 5th or 6th day of culture.
12. How many embryos are transferred?
Usually 2-3 embryos are transferred into the uterus, or less, according to their quality. In exceptional cases and always after agreement of both the couple and the physician, a higher number of embryos may be transferred. There is a general tendency in reducing the number of embryos transferred, in order to minimize the risk of multiple pregnancy.
13. What happens to the remaining embryos?
If the quality of the supernumerary embryos is very good, they may be frozen and cryopreserved; the couple may use them in a future attempt, obviously avoiding another ovarian stimulation and another egg collection.
14. When is the pregnancy test scheduled?
A simple urine pregnancy test is performed fifteen (15) days after embryo transfer. It is also possible to take a blood pregnancy test, 2-3 days before the urine test. If the result is positive, an ultrasound check is performed two weeks later, to confirm the pregnancy.
15. What are the success rates?
Obviously, this is the most important question for couples. Success rates vary from one IVF Unit to the other. Very important factors are the age of the female partner, her hormone levels, and, of course, the semen parameters. It is acceptable to say that success rates may reach 30-40% or a little bit more for women under 38 years of age.