The process of IVF or In Vitro Fertilization is a type of fertility treatment for couples who have tried other methods of assisted reproduction but have failed.

In IVF fertilization, the egg fertilization process takes place outside the uterus. Eggs are taken from the mother (or donor) and fertilized with sperm from the father (or donor) in a glass container.

Tests before starting Artificial Insemination procedures

First, in order to evaluate the quantity and quality of the eggs, a blood test is checked by the doctor on the first days of the menstrual cycle to determine the response rate of the treatment for the individual. They also check the state of ovarian reserve, ovarian follicles and uterus by ultrasound.

On the fifth day of the menstrual cycle, ultrasound is performed again. This ultrasound allows the doctor to check the growth of follicles and the thickness of the uterus endometrium. At this time, two blood tests are performed to evaluate the level of estrogen.

Also, tests are performed to check the quality and quantity of male sperms.

Natural pregnancy process

A woman’s menstrual cycle is about one month. During this time, an egg is released under the influence of sex hormones in a woman’s body.

The released egg enters the uterus, and if the released sperms reach it and fertilization, the pregnancy process begins.

But it is possible that sperms and eggs do not reach each other or fertilization does not take place due to several reasons.

In this case, assisted reproductive methods and IVF are considered as the most effective methods.

What are the stages of IVF?

The stages of IVF in order:

• Stimulation of the ovaries
• Egg collection
• Sperm collection
• Fertilization and embryo culture
• Embryo transfer

In general, IVF is done in 5 stages and is an excellent solution for treating infertility.

1. Ovarian stimulation stage

Before fertilization to obtain the egg, the ovulation induction drug is prescribed orally and by injection for one to two weeks at most. which causes multiple eggs to be produced in the ovaries.

2. Egg collection stage

After using the drugs, it is time to extract the eggs.

At this stage, a special needle is passed through the vagina and then through the pelvic area to the ovaries. This work is done under the control of vaginal ultrasound.

To eliminate the pain, generally, anesthetics, and sometimes painkillers and sedatives are used.

After the eggs are extracted, they are checked for the quality and maturity of the eggs, and according to that, the eggs are kept in the laboratory environment for the necessary time.

3. Sperm collection stage

On the same day of egg extraction, the wife must prepare the sperm sample in a sterilized plastic container and deliver it to the laboratory within 20 minutes. If necessary, sperm extraction from the testicles is done surgically.

In order to obtain a sample with the maximum number of sperm and quality, it is better for the person not to have intercourse within the last 3 days and at most 5 days

Usually, the sperm sample is washed twice in the laboratory and more stimulating and better quality sperms are used for fertilization.

4. The stage of fertilization and embryo culture

In the stage of embryo culture (IVF), sperms are added to eggs so that in vitro fertilization takes place.

The amount of sperm that is given to each egg is about 100 thousand sperm. About 12 to 18 hours after fertilization, the eggs are evaluated to ensure their fertility and proper condition.

All tests related to examining genetic defects or determining the sex of the fetus can be done at this stage.

5. Embryo transfer stage

About 2 to 5 days after extracting the embryo culture, the embryo has gone through the growth stages and becomes a ball of about 8 cells. The fetus is inserted into the mother’s uterus or surrogate through the cervix by means of a fine counter. This step is very quick and painless.

Two weeks after embryo transfer, pregnancy blood test is performed. If the pregnancy blood test is positive, two to three weeks later, an ultrasound will be performed to check the pregnancy status.

Embryo transfer can be done in two ways for infertile patients, which are:

• Fresh embryo transfer: In this transfer, the patient is ovulated 3-4 days before the embryo transfer and the embryo transfer is done within the same cycle.
• Embryo transfer in the form of freezing: egg freezing is done for patients who, in this transfer, the embryos are already ready. People who are married and don’t want to get pregnant for a while can apply for embryo freezing.

Also, frozen eggs can be used in IVF fertilization. Unmarried single women can freeze eggs to use high-quality eggs in future pregnancies.

People who have a hymen and do not want to damage their hymen should perform egg extraction through laparoscopy. In this way, first of all, ovarian stimulation drugs are prescribed for ovulation. Then they cut through the navel using laparoscopic method and remove the eggs and then freeze the eggs.

People who do not have a hymen can receive eggs through vaginal, which is much easier and there is a chance to get more eggs.

The frozen egg can be extended for 10 to 15 years.

What is Hatching?

Often failure in In vitro fertilization occurs due to the inability of embryos to implant in the uterus. Those who have had at least two unsuccessful IVF cycles, suggest hatching to help the embryos implant.

The hatching technique can help couples whose embryos do not have enough energy to break the shell and implant.

In order to continue growing and implanting in the uterine wall, the embryo must come out of the protein coating called zonaplacida. Some factors such as the age of the mother, the low quality of the embryo, the use of frozen embryos, or the high level of FSH (follicle stimulating hormone) in the mother’s blood may prevent the thinning of this shell and the chance of implantation decreases.

Hatching is a laboratory procedure in which the embryologist thins the zona pellucida shell of the embryo under a microscope using a laser or chemicals to help it implant in the uterus after transfer. Hatching is usually done on the fourth day of embryo development.

The hatching process is performed in the laboratory and before the transfer of the embryo, and there is no need for the presence of the mother.

What is the success rate of IVF?

The success rate of in vitro fertilization depends on the factors of parents’ age, ovarian reserve, level of health, parents’ lifestyle. But in general we can say:

• For women under 35 years old, between 40 and 50 percent
• For women aged 35 to 37, between 33 and 36 percent
• For women between 38 and 40 years old, between 23 and 27 percent
• For women over 40, between 13 and 18 percent

What are the main causes of infertility and the need for IVF?

1. Uterine tubes are blocked or damaged, or severe pelvic adhesions
2. The cause of male infertility is, for example, a decrease in sperm count or low sperm motility
3. Ovulation disorder, decrease in ovarian reserve and decrease in egg quality related to age
4. Genetic problems and abnormalities
5. Endometriosis or fibroid or uterine weakness
6. Presence of antibodies against egg and sperm
7. The inability of sperm to penetrate or survive in the cervical mucosa
8. Infertility with unknown causes

What are the causes of IVF failure?

Among the main factors affecting the failure of IVF, the following can be mentioned:

• Older age of the lady
• Poor embryo quality
• Bad egg or sperm quality
• Problems in the uterus or pelvis
• Ovarian failure to respond to IVF infertility treatments
• Chromosomal abnormality
• Implantation disorders
• Problems in embryo transfer technique

Determining the sex of the fetus with IVF (IVF)

Generally, there are two ways to determine gender

Determining the sex of the fetus through IUI

In this method, gynecologists and obstetricians first wash, sift and strengthen the sperm sample, and then insert it into the uterus. Through IUI, 70-75% of the desired gender is created.

Determining the sex of the fetus through IVF

To determine the gender of the embryo, only the desired gender can be cultured during the fertilization and embryo culture stage. Gender determination by IVF method is 99% certain.

But despite the selection of quality eggs and sperms, because the embryo enters the uterus from the outside, the probability of success is 30-40%.

Care after infertility treatment with IVF

Although there is no medical need for any special measures after the embryo transfer, and the patient can resume his daily activities immediately after the embryo transfer, it is usually better to take absolute rest within 42 hours after the embryo transfer.

What is recommended to the patient is that:

• Do not use hot water while bathing, it is also better to avoid swimming pools, saunas and jacuzzis.
• Avoid heavy activities.
• Being calm is very helpful.
• Have an extremely healthy and nutritious diet. and take supplements and folic acid.
• Continue taking the prescribed medications until the end of the doses. It is worth noting that continuous use of progesterone plays an important role in helping implantation and maintaining pregnancy in the early days.

Complications of IVF

• Fertility drugs can cause temporary side effects such as headaches, mood changes, mild abdominal cramps, abdominal pain, hot flashes, mild bloating, constipation, and breast tenderness. In some cases, fertility drugs will cause excessive stimulation of the ovaries and their swelling and pain.
• On the other hand, there is a possibility of ectopic pregnancy in the IVF method as well as other assisted reproductive methods.

How many embryos are transferred to the uterus?

As mentioned, in most cases, more than one embryo is transferred to the uterus, which increases the probability of pregnancy.

Usually, up to 2 embryos are transferred for women under 40 years of age and up to 3 embryos for women over 40 years of age.

But if the mother’s age is high – over 53 years – sometimes more than 3 embryos are allowed to be transferred.

In a natural pregnancy, the probability of twins is about one in eighty, and in a pregnancy with IVF, it is about 52%. This is while the probability of triplets in IVF is about 2-3%.

How many times can each person do IVF?

The total number of times a patient can enter an laboratory fertilization cycle and ovulate will be six times.

This means that each person can receive IVF injections a maximum of six times and can be punctured six times, but the number of transfers will be unlimited.

How long does IVF infertility treatment take?

The duration of the IVF infertility treatment process will be different depending on the ovarian reserve of each person. Sometimes, depending on the ovarian reserves of this protocol, this treatment process may last 15 days for one person and 45 days for another person.

Some protocols may require you to enter the cycle twice and ovulate from it. But what the patient should consider is that this treatment process will take three weeks to two months. Sometimes these steps are divided into different parts and the process can take longer.

The interval between two IVFs

In order to return to the normal menstrual cycle, it is recommended that people delay repeating laboratory fertilization for 2 to 3 months after 2 menstrual cycles. Of course, there is no need to go to the doctor exactly after two months to start this process; Rather, they can go to the doctor at any time when they are ready to repeat IVF.

However, it should be known that some of the previous tests have a validity date of 6 months, and if the time to repeat the treatment is longer, those tests must be repeated again.