IVF Procedure Summarised

The primary objective of IVF or in vitro fertilisation is to achieve the fertilisation of an egg outside a woman's womb by using artificial means. The embryo is then put into the womb for further maturation. IVF procedure is very complicated and primarily involves 5 stages namely ovarian stimulation, egg retrieval, fertilisation, selection and egg transfer. The IVF procedure essentially begins with initial check-ups which are done to analyse the condition of health of the would-be-mother, arrive at concise dates for the menstruation cycle and also ascertain whether the patient is not allergic to any medicine or injection which will be administered during the process of treatment.

The first stage of the IVF procedure is ovarian stimulation. In this process, after the dates of the menstruation cycle are established, treatment is started on the third day of menstruation. The medicines given during this stage help in triggering the growth of multiple follicles in the ovary. Usually ganadotropins are injected in the patient and the results are closely monitored. Monitoring also includes gynaecologic ultrasonography which keeps a tab on the follicular growth. The estradiol levels in the body are also kept in check. The aim of this process is also to stop spontaneous ovulation and this is done by administering GnRH antagonists. The egg retrieval stage is begun by first checking the progress of follicular growth. If the growth is found to be satisfactory an injection containing human chorionic ganadotropin is given which starts ovulation after 42 hours. The eggs are removed just before ovulation by using a transvaginal technique where the follicles are aspirated and the fluid is recovered.

Fertilisation is the next step. The surrounding cells are first separated from the eggs. The semen is also separated from other inactive cells and the seminal fluid. The resultants sperms and eggs are then incubated together. The ratio of egg to sperm is usually 1:75000. This takes place in the culture media and the procedure might take up to 18 hours. However, in cases where the sperm is from someone with a low sperm count it is directly injected into the egg. After fertilisation the egg is subjected to a growth medium where it grows to reach the 6-8 cell stage.

Selection of the eggs is subject to various conditions like evenness of growth and level of fragmentation. Typically eggs are transferred three days after retrieval. In countries like U.S. and Australia however, the eggs are put through a blastocyst stage to boost the chances of pregnancy.

Generally multiple embryos are transferred to minimise the risk of pregnancy and also to increase the chances of implantation. Transfers also depend on the number of eggs that are available, the woman's age and the result of various diagnoses. Older women always have an upper limit on the number. The best ones are transferred by using a catheter which is routed via the vagina and the cervix.

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