At present, In Vitro Fertilization (IVF) is the foundation of most infertility treatments. The impact female fertility assistance of the first success of IVF by Sir Robert Edwards in 1978 and its global significance earned Sir Robert Edwards the Nobel Prize in Physiology & Medicine in 2010. In 1992 the method of intracytoplasmic sperm injection (ICSI) was added to the array of techniques used in assisted reproduction. With this advent most infertile men could also be offered an effective treatment. To increase the pregnancy rate further we combine IVF and ICSI with modern blastocyst transfer. We follow the highest international standards in our IVF and ICSI treatments and incorporate the latest valuable research findings through our collaborations with world-leading IVF clinics in Europe, USA, Japan and Australia.
The steps of an IVF cycle
IVF (in vitro fertilization) treatment is a technique used in couples with infertility due to many different reasons. The treatment lets us control and assist the natural process of fertilization that normally occurs within the human body. To help you understand the treatment process we have written a simplified explanation of the steps of an IVF treatment:
1. Fertility work-up
In order to know if IVF treatment is a suitable treatment option for you, each couple undergoes a thorough fertility investigation. In some cases, we do not find any specific cause of your infertility, so-called “unexplained infertility”. This is however also effectively treated by IVF in most cases. If you and your partner have already had an infertility work-up done at a different clinic, it is important that we are provided with all relevant medical records and laboratory results.
2. Ovarian stimulation
Follicle stimulating hormone (FSH) is a naturally occurring hormone that stimulates the growth of the follicles that surround the egg cells in the ovary. In a normal ovulatory cycle, FSH is released by the pituitary gland in the brain in amounts that stimulate maturation of only one follicle with an oocyte at a time. In modern IVF treatment, we use injections with slightly higher doses of FSH to stimulate the maturation of a larger number of follicles containing oocytes. Furthermore, we suppress the natural FSH secretion from the pituitary gland to be able to control precise and optimal levels of FSH in the blood circulation. This is done by giving another naturally, occurring hormone, so-called “Gonadotropin Releasing Hormone (GnRH)” some weeks before FSH stimulation or alternatively an antagonist to GnRH for a shorter time during stimulation. In most cases, the FSH stimulation is done over a time period of approximately 10-14 days. Throughout this period we monitor your follicle development within the ovaries closely using ultrasound imaging.
Several large oocyte-containing follicles within the ovary at the end of hormone stimulation
3. Egg retrieval
By using different doses of hormones and by ultrasound monitoring of the ovaries, we are able to chose the best time to retrieve the mature egg cells. When we measure the size of the largest follicles to about 2 cm we know that the egg cells are approaching full maturation. This is the time for us to induce ovulation by injecting a bolus dose of yet another naturally occurring human hormone, luteinizing hormone (LH). Thirty hours later several mature egg cells will be ready for retrieval (oocyte pick up) using a transvaginal ultrasound guided needle. At the oocyte retrieval we treat all our patients with local anaesthetics, which in the vast majority of cases helps us avoid any discomfort. Simultaneously with the egg retrieval, the male counterpart provides a sperm sample that we use to find the best and most viable sperm cells to fertilize the oocytes.
4. Fertilization and the development of an embryo
After retrieval of the oocytes, each of them is normally placed in separate culture dishes with several thousand sperm cells to simulate normal fertilization. If there are signs of a low amount or quality of sperm we fertilize the oocytes by ICSI (Intra Cytoplasmic Sperm Injection) techniques, where the sperm cell of highest quality is selected for manual injection into the oocyte for fertilization. The day after, it is time for the embryologists to check if fertilization has occurred. In general terms approximately 70% of all oocytes are fertilized but there are wide variations between couples. When fertilization occurs, the 23 paternal and 23 maternal chromosomes unite into one 46-chromosome cell. This cell will soon divide into new cells and your developing embryo has started its 9 months long journey towards becoming your future child.
In an ICSI procedure the sperm cell is injected into the oocyte
5. Embryo transfer
After 24 hours, the fertilized egg has divided into an embryo of 4-cells and on day 3 after oocyte pick up it is an 8-cell embryo. The embryo may at this stage be placed inside the uterus using a fine, ultrasound-guided catheter. Alternatively we may wait another two days and transfer a more developed embryo, a so-called blastocyst (Fig. blastocyst). Our experienced doctors and embryologists make this decision together after taking many factors such as embryo quality, age and other medical data into consideration. The major goal in this decision is of course to maximize your chance of having a healthy baby. Once the embryo or blastocysts chosen for transfer have been selected they will be transferred into the uterus using a fine catheter. All embryos that have not been transferred will be frozen and stored for later use.
6. Continuation of pregnancy
Oocyte fertilization and later embryo or blastocyst transfer into the uterus is not a guarantee alone of pregnancy. The endometrium in the uterus also has to accept the embryo during implantation and allow for formation of a placenta that will nurture the growing foetus. To increase the chances of for healthy development you will be prescribed vaginal suppository pills of progesterone, which is another naturally occurring female sex hormone produced by the ovaries that stimulates the uterine endometrium to accept an embryo. Missing the predicted period within 3 weeks after oocyte retrieval is usually the first sign of successful IVF-treatment. Pregnancy can be confirmed with a urine pregnancy test, and if this turns out to indicate pregnancy we perform a follow-up ultrasound examination to make sure your fetus is growing normally at the correct position inside the uterus All subsequent visits during your pregnancy will be taken care of by the antenatal care service, just as a normal pregnancy.
If the first embryo transfer doesn’t result in pregnancy you don’t have to go through the entire IVF cycle again, instead we can use your cryopreserved embryos in frozen embryo transfer.
Last updated: 2016-02-15