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In Vitro Fertilisation (IVF)

In Vitro Fertilisation (IVF)

Conventional IVF involves the removal of the human oocytes from the ovaries and the fertilization process which is accomplished by “letting” motile spermatozoa to fertilise the oocytes into a special culture medium. Once embryos form, they are then transferred into the uterine cavity through a process called Embryo Transfer. IVF essentially attempted to mimic the biological processes in vivo.

IVF is used for women who have blocked or damaged fallopian tubes thus preventing the egg and sperm from meeting naturally. IVF may also help couples whose infertility is unexplained and/or the male partner has a low sperm count. Other factors like age, endometriosis, immunology, obesity and psychology may lead a couple to infertility and consequently, to IVF treatment.


The 4 stages of IVF:
1. Follicular development and monitoring 
2. Oocyte recovery
3. Fertilization of oocytes 
4. Embryo transfer


1. Follicular Development and monitoring

In a normal menstrual cycle, LH and FSH are the hormones that the body uses to stimulate development and maturation of a single oocyte.  In order to optimize pregnancy rates during IVF, it is important to have more than one mature oocyte available for fertilisation, embryo development and transfer into the uterus. The ovaries are therefore stimulated using higher levels of the stimulating hormone that naturally exist in the body. (This is achieved using Gonadotrophin injections). Many different stimulation regimes exist at the moment and the physician chooses the one best suited to the biological system of the particular patient in order to achieve a good number of high quality oocytes. Close monitoring of the follicles (the sacs that contain the growing oocytes in the ovaries) is required and is achieved with frequent ultra-sound in order to determine their size and their numbers. At the appropriate timing, an additional hormone will be administered that will aid with the final maturation of the oocytes. Based on all the available feedback and laboratory findings, the most suitable time for the recovery is determined. Alternatively, the Natural cycle-In Vitro Fertilisation (NC-IVF) can be followed with the absence of hormone therapy where IVF is performed using the single follicle that grows naturally.

2. Oocyte Recovery
This is the procedure with which the doctor collects the oocytes. The procedure requires anaesthesia (intravenous sedation).  A small needle is advanced under ultrasound guidance through the upper portion of the vagina into the follicles within the ovary. The fluid that is aspirated is taken to the laboratory and the oocytes are identified and transferred into culture media inside an incubator at 37oC to continue the maturation process for a few more hours. 


3. Fertilisation of Oocytes
Your partner will have to give his sample of sperm on the day of the oocyte recovery (or beforehand if that is deemed necessary by the specialists, of which will be preserved until needed). The sperm is carefully prepared with a special procedure, and the healthy spermatozoa are separated. Approximately 100,000 motile spermatozoa are added per oocyte, 4-6 hours after oocyte recovery, so that fertilisation can take place the following 12-18 hours in the incubator. The insemination process usually leads to the fertilisation of the oocytes and the resulting embryos are transferred to different culture media and are observed closely over the next 48 hours.                          


4. Embryo Transfer
On the basis of their rate of growth and morphology, usually 2-3 embryos are chosen and are transferred through the neck of the womb using a small catheter (fine tube). The number of embryos that will be transferred is decided according to the age and medical history of the woman, together with the number and quality of the embryos that have been released during each therapy cycle. Furthermore, the couple has to deal with the possibility of a multiple pregnancy. Embryo transfer is a painless procedure, much like having a cervical smear, and takes only a few minutes.  A short resting period in the recovery room following the transfer and restrictive activities for the rest of the day is recommended. The day after oocyte retrieval, progesterone and other supplements will be prescribed to ensure that the lining of the uterus receives sufficient stimulation and sustains the implantation of the embryos. Quantitative pregnancy test with blood needs to be done 13 days after embryo transfer.



Natural cycle-In Vitro Fertilisation (NC-IVF) can be followed with the absence of hormone therapy where IVF is performed using the single follicle that grows naturally.




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