IVF (In Vitro Fertilization): Procedure & How It Works

Overview

Following the laws of nature, conception is a natural process that occurs when a man and woman come together for reproduction. However, there are times when fertility issues are encountered and the process of conception requires artificial help. One of the most common medical processes employed for such is IVF.

In this article, we have compiled the most important facts you need to know about the procedure, answering your question “What is IVF”, as well as other important things you should know.

What is IVF

In Vitro Fertilization (IVF) is one of the ART processes of Fertilization by manually combining an egg and sperm in a laboratory dish, and then transferring the embryo to the uterus. Simply said it is a process by which an egg is fertilized by sperm outside the body.

For pregnancy to occur an egg has to be released from the ovary and unite with a sperm. Normally this union called fertilization occurs within the fallopian tube which joins the uterus (womb) to the ovary.

However, in IVF, the union occurs in a laboratory after eggs and sperm have been collected, after fertilization the embryos generated are then transferred to the uterus to continued growth. During an IVF procedure, mature eggs are collected from ovaries and fertilized by a sperm in the lab. Upon the success of the fertilization process, the resulting embryo is transferred to a uterus. A full cycle of IVF takes approximately three weeks. However, it could be more depending on the steps and parts involved in the IVF process depending on the peculiar condition.

IVF can be done using a couple’s eggs and sperm. Or it may involve eggs or sperm from a known or unknown donor.

Your chances of having a healthy baby using IVF depend on many factors, such as your age and the cause of infertility.

It is a very sensitive procedure that is time-sensitive, financially demanding, and invasive; therefore, you must speak to a specialist to understand how it works, the potential risks, and whether it’s right for your condition.

Candidates of IVF

Individuals and couples turn to IVF for various reasons, such as facing challenges with infertility or when one partner has a pre-existing medical condition that affects fertility. IVF often becomes the preferred option after other fertility treatments haven’t succeeded, or in cases where individuals are dealing with the implications of advanced maternal age.

Generally, candidates for IVF include but are not limited to women and men suffering from any of the issues listed below

• Advanced maternal age: a decline in age for women directly affects their ability to generate good quality eggs needed to achieve pregnancy, this is known as diminished ovarian reserve
• Women with damaged and blocked fallopian tubes: Women who have fallopian tubes that are blocked or damaged may struggle with natural conception since the pathway for sperm to meet the egg is compromised. IVF bypasses the fallopian tubes entirely, enabling fertilization to occur in a controlled laboratory setting.
• Anatomic defects of the reproductive tract preventing direct coitus: For individuals with physical abnormalities of the reproductive tract that prevent intercourse, IVF offers an alternative path to parenthood by allowing fertilization outside of the body.
• Psychologic dysfunction e.g. Vaginismus: Psychological conditions such as vaginismus, which can make intercourse painful or impossible, don’t have to impede the dream of starting a family. IVF circumvents the need for coitus, providing a solution for those affected by such conditions.
• Endometriosis: Endometriosis can hinder fertility by causing inflammation and scarring, which may affect the ovaries, fallopian tubes, and implantation of the embryo. IVF helps women with endometriosis by retrieving eggs directly from the ovaries and facilitating embryo implantation.
• Unexplained infertility: Couples who have unexplained infertility face challenges with conception despite having no identified issues with their reproductive health. IVF can offer these couples a higher chance of pregnancy.
• Cervical Failure: When the cervix is not functioning properly due to physical or hormonal factors, it can prevent sperm from reaching the egg. IVF circumvents the cervical factor by injecting the embryo directly into the uterus.
• Premature ovarian failure: Women with premature ovarian failure experience reduced egg quality and quantity at an early age. IVF can use donor eggs to provide a viable option for these women to conceive.
• Reduced Sperm Count and Motility: Men with low sperm count or poor motility may find it difficult to achieve natural conception. IVF, often combined with intracytoplasmic sperm injection (ICSI), can enhance the chances of fertilization by injecting a single sperm directly into an egg.
• Impotency: Impotency, or erectile dysfunction, can prevent natural conception. IVF allows couples to bypass the need for an erection by directly utilizing sperm for fertilization.
• Immunological failure: Sometimes, immunological issues can cause the body to reject sperm as foreign invaders. IVF helps by minimizing the immune system’s role in the early stages of fertilization and pregnancy.
• Retrograde ejaculation: This condition causes sperm to enter the bladder instead of exiting through the penis during ejaculation. IVF can use sperm retrieved from urine or directly from the testicles to enable conception.

IVF Treatment Process

The fertility treatment process involves a series of steps/ protocols to achieve the desired result through IVF.

5 major steps for fertility treatment include…

• Ovarian Stimulation
• Egg Retrieval
• Sperm Retrieval
• Fertilization
• Embryo Transfer and follow-up.

Each step has its timeframe before moving to another. The steps usually involve

1) Consultation: This is where you meet the gynaecologist and other teams of fertility specialists who will attend to your case. Here, a series of patient information which includes age, weight, past and current medical history, physical examination etc. are taken, and the patients are referred to the routine laboratory and medical imaging unit for investigation.

It is essential at this stage that intending fertility treatment couples can pay attention to questions being asked, cooperate fully, provide needed answers, and ask the right questions, taking time to think things through so that you and your partner will understand the entire process and make the right choice.

2) Preliminary investigation (Pre-ART): This is usually done on the first day of consultation. Both partners will be referred to the routine laboratory to carry out blood tests and a medical imaging unit for the woman.

Investigation for wife:

The first day of bleeding is considered cycle day (CD) 1. On CD 3, specific hormonal tests are conducted on the woman; including:

 Anti Mullerrian Hormone(AMH):-

1: Follicle Stimulating Hormones (FSH): – An assessment of the ovarian reserve. Its function is to stimulate female egg maturation.

2: Luteinizing Hormones (LH): – to assess whether you are ovulating. LH stimulates ovulation.

3: Prolactin: – stimulates milk production in the beast after childbirth.

4: Ultrasound Scan: A transvaginal scan is done to assess the ovaries for the presence of follicles, cysts, and any other issues that may be preventing its proper functioning, the uterus(presence of endometrial lining and thickness, presence of cysts, fibroids, and any other relevant information) surrounding areas for

Other investigations may include HSG, diagnostic hysteroscopy, and chlamydia testing.

Read Also: 6 Important Factors To Consider When Choosing A Fertility Clinic

Investigation for husband:

1. Seminal fluid analysis (SFA): – This test assesses the fertility status of the male partner and indicates the quality and quantity of his semen. The male partner will be required to abstain from sexual intercourse for a minimum of 3 days and a maximum of 7 days before producing the sample into a sterile container for evaluation at the laboratory.
2. Semen culture: – This is done with the same semen sample provided for analysis to the laboratory staff. It is carried out to determine if the male partner has an infection.

General investigation: 

Routine tests for Blood group, Genotype, Hepatitis B, Hepatitis C, Syphilis, HIV I, and II will be carried out on both partners involved at the Laboratory

3) Counseling Consent and Confidentiality: Counseling is an important part of your fertility treatment journey. The counselling team works closely with the gynaecologist specializing in fertility treatment and clinical embryologist to provide you with evidence-based information regarding the procedure.

• The various protocols involved in the procedure and the financial considerations will be explained in detail to you and your partner during this process.
• It is also expected at this time that other treatment programs/procedures that may be needed for your treatment be explained to you, programs like Egg donor program, Semen donor program, Semen/ Embryo freezing, Surrogacy, Testicular Biopsy, etc.
• Following your counselling session, you will be presented with consent forms, which are a legal requirement for most of the processes you will undergo during your IVF treatment journey.
• You must understand the procedures before consenting to any. This is where the counselling becomes very vital for both partners.
• You and your partners are advised to ask questions so you understand what your treatment involves and all the likely outcomes. You will require time to reflect on your decision before signing the consent forms.
• Part of the counselling session is also the issue of confidentiality. You want to be sure you’re your privacy and any data related to you and your partner are secured and that your treatment is handled with utmost care, and in a confidential manner at all times and this is expected from every standard IVF treatment clinic.

4) Fertility drugs: These are medications given to aid in a successful fertility treatment cycle: these include: downregulation drugs, Ovarian stimulation drugs, endometrial thickness build-up drugs, supplements, and luteal support drugs. All the above drugs play a vital role in the process and it is important that the intake is accordingly and appropriate

Now let’s look at each step in detail

5). Ovarian Stimulation/ Induction: The beginning of an IVF cycle starts with ovarian stimulation or induction. In this process, exogenous hormones are used to stimulate the ovaries to produce several eggs instead of the single egg that typically develops and is released each month. Multiple eggs are required because some eggs won’t develop normally after fertilization or may not even fertilize at all.

The other steps in the Ovarian stimulation process include

1: Monitoring: Throughout this stage, the patient’s response to the drugs is closely monitored through blood tests and ultrasound scans. These tests measure the growth and development of follicles (which contain the eggs) and hormone levels, ensuring that the ovaries are responding correctly.

2: Dosage Adjustments: Depending on the monitoring results, dosages of the drugs may be adjusted to optimize egg production while minimizing the risk of Ovarian Hyperstimulation Syndrome (OHSS), a potential side effect of fertility medications.

3: Trigger Shot: Once the follicles have reached the appropriate size, indicating that the eggs are mature, a final hormone injection, often referred to as the “trigger shot,” is given. This shot, usually containing human chorionic gonadotropin (HCG) or a GnRH agonist, triggers the final maturation and loosening of the eggs from the follicle walls.

Possible Drug Side Effects: As much as there is in every other prescribed drug, there are expected side effects in taking fertility drugs. However, they are temporal and do not require major attention. Some possible side effects are:

• Headaches
• Nausea
• Ovarian hyper-stimulation syndrome (OHSS)
• Restlessness
• Fatigue
• Mood-swings
• Irritation at the site of your injection
• Discomfort around the ovaries etc

 6). Egg Retrieval: After stimulation what follows is the monitoring of the cycle, through a series of ultrasound scans.to determine the right time for egg removal. The aim of monitoring the cycle is to check the development of the follicles and the lining of the uterus to adjust the dose of the drugs and to time the HCG Injection.

The egg is usually retrieved between 34 to 36 hours after the final injection and before ovulation occurs.

Normally, the woman is sedated and given pain medication after which transvaginal ultrasound aspiration is used to retrieve the eggs. In this procedure, an ultrasound probe is inserted into the vagina to identify follicles after which a thin needle is inserted into an ultrasound guide through the vagina and into the follicles to retrieve the released eggs.

An abdominal ultrasound method may also be used when the ovaries are not assessable through the transvaginal ultrasound method. After removal, mature eggs are placed in a nutritive liquid or culture medium and then incubated. Healthy and mature eggs are then mixed with sperm in an attempt to create embryos.

 7). Sperm Retrieval: The sperm retrieval process follows after the egg is retrieved. The partner/ sperm donor needs to provide a semen sample to the clinic on the morning of the egg retrieval day. Normally, the sample is obtained through masturbation, however, coitus interruptus (interrupted ejaculation), and sperm-friendly condoms can be used when masturbation is difficult or impossible.

Read Also: 16 Essential IVF Success Tips: Maximizing Your IVF Treatment Chances

8). Treatment and fertilization

Sperm is collected and prepared using any sperm preparation technique that will result in the retrieval of a good number of motile sperm from the semen. This is determined by the Embryologist after accessing the semen collected. The prepared sperm are then introduced into the dish containing the already washed eggs and kept in the incubator for a few hours(5-12hrs) to allow sperm-egg interaction.

After a few hours, the eggs are stripped of any extra cells surrounding them and assessed for the presence of 2 pronuclie( that of the sperm and egg) and 2 polar bodies, this is what determines fertilization, any other observation is either no fertilization or abnormal fertilization and such zygotes are removed from the other normal fertilized eggs

The zygotes are then transferred to a fresh new dish with no sperm to continue development.

9). Embryo Development and Transfer

• The embryo remains in the incubators for a few days following fertilization to undergo further development, normal development is seen in the synchronization of division on the specific days( day1- zygotes- 2cells, day2: 4cells-8cell day3: 8cell- 32 cells day4; 32-maorula, day5- blastocyst) and the synchrony in the sizes of the cells present.
• The good quality embryos are selected for transfer: transfer can be done on any of the 5day of development following observation and a collective decision between the embryologist and the doctors to determine the transfer day that will lead to a highly probable successful outcome for the patient, the patient endometrial build up is also placed in consideration
• Embryo transfer involves placing selected numbers of the best embryo(s) into the uterus to achieve conception. Embryos are majorly transferred on the third or fifth day after the follicular puncture. Unlike the egg retrieval procedure, this procedure is usually painless and does not require the use of any anaesthetic.
• The embryos are aspirated in a small amount of fluid (culture medium) inside the catheter and are passed through the cervix to the uterus with the aid of ultrasound guidance in a manner that ensures that the embryo(s) is placed on the lining of the uterus.
• The physician gently introduces the flexible catheter through the woman’s cervix into the uterine cavity under ultrasound guidance. When the catheter is in place, the embryologist carefully injects the embryos into the uterus, and the physician slowly withdraws the catheter.
• The catheter is immediately returned to the laboratory, where it is examined under the microscope to make sure that all the embryos have been deposited in the uterus. Any residual embryos would be re-incubated, and the transfer process would usually be repeated to deliver the remaining embryos.
• The number of embryos transferred depends on the number of good quality embryo(s) available, individual patient requests, and the age of the patient.
• This decision is reached collectively by the patient, the gynaecologists, and the embryologist. Typically, two to three embryos are transferred in one treatment cycle. If you have extra embryos that are suitable for cryopreservation (to be frozen), they will be cryopreserved on written consent and payment. Rarely, a transfer may be cancelled if no eggs are fertilized or the embryos formed after fertilization is of poor quality.
• After the transfer, we advise that you wait and rest in the clinic bed for a minimum of 30 minutes before going home. You may resume normal but not strenuous activities immediately after the transfer. Continue with the supportive drugs given to you until instructed otherwise.
• A pregnancy test date will be scheduled for you at the clinic laboratory (or a laboratory around you if you stay far from town), 14 days following the embryo transfer.

General Advice After Embryo Transfer

• Take it easy for a few days to avoid any strenuous exercises such as aerobic exercises and horse riding.
• Eat healthy and avoid meals that might cause diarrhoea symptoms and constipation
• Avoid caffeinated drinks and beverages
• Continue taking folic acid tablets.
• Avoid intercourse for two weeks.
• Do not stop luteal phase support until the pregnancy test results.

10). Pregnancy Test & Confirmation

For many couples, the period between the embryo transfer and pregnancy test is the most emotional.

The pregnancy test is the detection of a significant amount of HCG in the blood of a pregnant woman using a pregnancy test strip. If the result is positive (chemical pregnancy), we will give you an appointment on the next date of visitation for the confirmation of a living baby in your womb. If otherwise, you will be counselled by the gynaecologists on the way forward.

When Should One Go for Fertility Treatment Using IVF?

As soon as possible, as the success rate of IVF declines with age, one should seek a solution early usually after 12 months of uninterrupted intercourse and, when you have undergone other treatment methods( ovulation induction, timed intercourse, IUI), also when age has declined significantly before trying to achieve conception.

How To Prepare for IVF Treatment

Starting your IVF treatment involves a lot of processes some of which are psychological to get you ready for what lies ahead including having a thorough medical exam and fertility tests for both you and your partner. Some of the preparations you’ll go through include:

• Initial Consultation: Discussing medical history and fertility goals with a specialist.
• Fertility & Other Testing: Comprehensive assessments for both partners to evaluate fertility status including Uterine exam, up-to-date Pap test and mammogram (if over 40), Semen analysis, Screening for sexually transmitted infections (STIs) and other infectious diseases, Ovarian reserve testing, and blood and urine tests etc
• Lifestyle Adjustments: Adopting a healthy diet, quitting smoking, reducing alcohol intake, and managing stress.
• Financial Planning: Understanding the costs involved and preparing for them.
• Emotional Readiness: Seeking support through counselling or support groups to navigate the emotional challenges of IVF.

What To Expect After IVF Treatment

These are some things you should expect after IVF Treatment

• Waiting Period: The two-week wait after embryo transfer is often full of anticipation and anxiety, culminating in a pregnancy test.
• Physical Symptoms: Some may experience mild cramping or spotting.
• Monitoring: Regular check-ups to monitor hormone levels and pregnancy progression.
• Follow-Up Procedures: Depending on the outcome, you might have a follow-up consultation to discuss the next steps.

Risk, Benefits, and Side Effects of IVF

Potential risks of IVF treatment include

• Multiple Births: If more than one embryo is transferred, there’s a risk of multiple pregnancies.
• Ovarian Hyperstimulation Syndrome (OHSS): Rarely, the ovaries can swell and become painful
• Ectopic Pregnancy: Where an embryo implants outside the uterus.

Common side effects include:

• Mild Bruising: From injections.
• Mood Swings: Due to hormone treatments.
• Abdominal Discomfort: Following egg retrieval or embryo transfer.
• Physical: Bloating, breast tenderness, mood swings, and headaches due to hormonal changes.
• Emotional: Feelings of anxiety, depression, or stress during the demanding process.

Managing these risks and side effects is a critical part of the IVF journey, necessitating close communication with your medical team throughout the process.

IVF Centres in Nigeria

Lily Fertility Center (LFC) is one of the leading IVF Centers in Nigeria and the leading IVF Centre in Warri and Benin South-South Nigeria.

Established in 2008, to date, we’ve had over 1,500 live births with an average of 40-50% success rate which is comparable with the global benchmark for IVF success rates.

Conclusion

IVF is an Assisted Reproductive Technique ( ART ), that has been used over the years to rescue couples plagued with infertility, it has allowed what seems impossible by natural standards to become possible and achievable, However, it is important that you only undergo the procedure in a standard fertility center or hospital, and get a proper diagnosis from a reproductive specialist on the best means to go about it.

Get answers to your questions and more by booking a session with our fertility experts today!

OTHER IMPORTANT THINGS TO KNOW

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When selecting an IVF centre in Nigeria, consider:

• Accreditation: Ensure the clinic is accredited by relevant health organizations.
• Success Rates: Review the centre’s success rates for IVF procedures.
• Specialist Expertise: The qualifications and experience of the reproductive specialists.

IVF Cost

IVF treatment cost is usually affected by the following

• Number of Cycles: More cycles mean higher costs.
• Medication: The type and dosage of fertility drugs required.
• Additional Procedures: Any extra procedures like ICSI or PGT testing.

IVF Success Rate

Most times success rates depend on:

• Age: Younger patients typically see higher success rates.
• Clinic: The experience and techniques of the clinic can impact success.
• Underlying Conditions: The nature of infertility affects the likelihood of success.

Can I Select My Preferred Gender?

Yes, gender selection is possible through PGT: Preimplantation genetic testing can identify the sex of embryos before transfer.

Is there any way I can increase my chances of getting pregnant through fertility treatment

Some of the things you need to consider that could enhance your chances include

• Nutrition: A balanced diet can improve fertility.
• Stress Management: Reducing stress through techniques like meditation or counselling.

Does Age Matter and What Is the Best Age…

Age plays an important role in the success of fertility treatment ….

• Egg Quality: Egg quality diminishes with age, impacting success rates.
• Ideal Age: The ‘best’ age for IVF is generally under 35.

Are there Options for me to Conceive later; in case I choose not to do so now?

• Egg Freezing: Storing eggs at a younger age for future use.
• Embryo Freezing: Freezing embryos for later implantation.

IVF vs IUI

• Procedure Complexity: IVF is more complex and involves egg and sperm manipulation outside the body.
• Cost: IVF is typically more expensive than IUI.
• Success Rates: IVF generally has higher success rates, particularly for certain infertility diagnoses.