In Vitro Fertilisation (IVF)
How is IVF done? → Ovarian stimulation → Ovulation → Fertilization → Fertilization → Embryo transfer
IVF is the joining of eggs and sperm in the laboratory – extracorporeally – in order to produce fertilised embryos for transfer to the uterus of the expectant mother.
The fertilisation of eggscan be carried out either by means of the conventional IVF method (IVF) or by means of the microfertilisation method (ICSI).
IVF with the couple’s own sperm is recommended in:
- Couples for whom simple methods, such as Intrauterine Insemination (IUI), have failed.
- Women with complete absence or damage to the fallopian tubes.
- Women suffering from advanced endometriosis, with possible complications in the fallopian tubes and egg quality.
- Situations where there is a limited number of eggs.
- Cases of severe male infertility.
IVF with donor sperm is recommended in:
- Severe cases of male infertility, with poor sperm quality.
- Previous failure to inseminate with sperm from the couple.
- Cases of poor embryo quality or repeated implantation failures, mainly due to the male factor.
- Male carriers of a genetic disease that cannot be studied in embryos.
- Women without a partner.

How is IVF done?
The woman is given medication to stimulate her ovaries and produce many ovarian follicles. Then, at the appropriate time, the woman is ovulated, followed by fertilisation of the eggs from the sperm sample in the laboratory by the embryologists.
The fertilised eggs are cultured in appropriate culture media and grow into embryos. The dishes containing the fertilised eggs (zygotes) are placed in an incubator for 2-5 days under special conditions to allow the embryos to go through the early stages of development.
The embryos are then transferred back to the woman’s uterus(embryo transfer) and 12 days after the embryo transfer, a pregnancy test is done to confirm the pregnancy.

Stimulation of the ovaries
Ovarian stimulation during IVF consists of daily injections that cause the ovaries, instead of producing just one follicle, to produce many more so that a larger number of eggs can be obtained.
Treatment lasts from 8 to 12 days, depending on the protocol used and the speed of each patient’s response. During the treatment, a series of 3 or 4 ultrasound scans and hormone measurements are performed to check that there is normal follicular growth.

Ovulation – What is it and how is it done?
Oocyte retrieval is the process of retrieving eggs from the ovaries . When we have evidence through ultrasound that the follicles have reached a satisfactory size and we consider that there is an appropriate number, oocyte retrieval is scheduled 36 hours after the administration of an injection of chorionic gonadotropin, which causes the eggs to mature in a similar way as in a natural cycle.
It is performed in the operating room under anesthesia, so that the woman does not feel any discomfort during the procedure , which lasts approximately 15 minutes.
Egg retrieval is performed transvaginally , under continuous ultrasound control. The follicles are punctured one by one through a needle that penetrates the vaginal wall. The contents of each follicle are aspirated into special tubes and immediately delivered to the embryology laboratory.
The embryologist locates the eggs, isolates them from the follicular fluid and places them in special small containers, called dishes, containing a special culture medium. The dishes are then placed in an incubator under the appropriate culture conditions.

Fertilization
After egg retrieval, sperm is collected from the partner and the eggs are fertilized. The fertilization process is carried out either through classic in vitro fertilization where a few thousand sperm are placed around an egg or through intracytoplasmic sperm injection ( ICSI ) where a live sperm is selected and inserted into the egg by the embryologist.
At this point, it should be mentioned that there are two more new methods that ensure the correct selection and use of the highest quality and functional sperm and improve success rates. These are IMSI and PICSI .
With the first method, IMSI (intracytoplasmic injection of morphologically selected sperm), the morphologically perfect sperm are selected with a special -high-resolution- microscope (which provides a magnification 6,000 times greater than that in the ICSI method) and are then placed inside the egg.
With the PICSI method, sperm is selected depending on whether or not it binds to the hyaluronan hydrogel substance, which covers the dish in which we place the sperm. Based on the fact that only normal sperm, with the correct number of chromosomes and a low rate of DNA fragmentation, binds to this substance, the embryologist easily selects the quality sperm and microfertilization follows.
The day after fertilization, the embryos are “graded” according to their morphological characteristics and their ability to divide. Some may not have developed and are rejected because they are considered non-viable. This correct morphology seems to be associated with spermatozoa that have the correct number of chromosomes and therefore with the creation of embryos that also have the correct number of chromosomes.

Embryo transfer
It is the process of transferring the embryos into the uterine cavity.
Embryo transfer is painless and short, no anaesthesia is required.
The best embryos are selected for transfer to the mother’s womb and the embryo transfer is performed with a special catheter.
The whole process is done with great care and thoroughness. The woman usually remains lying down for about an hour and then she can return home.
Read also
Poor responders to IVF cycles – Management & better protocols
The incidence rate of poor responders (PORs) to stimulation in IVF cycles currently ranges from 7 to 24%. This rate is even higher in patients aged 38 years and older.
What does a good number of eggs recovered for IVF mean – What to expect?
In almost all IVF cases, the initial stage involves the ovarian stimulation phase and the subsequent induction of ovulation.
What is ovarian hyperstimulation syndrome (OHSS)?
Ovarian hyperstimulation syndrome (OHSS) is a complication that can occur with assisted reproductive treatments. It is characterised by an abnormally high ovarian response to drugs given to stimulate the ovaries, especially in in vitro fertilisation (IVF).