What are the Steps of IVF?
The Fertility Clinic is a state-of-the-art facility accredited by the Department of Health. We offer many assisted reproductive technologies (ART) to help couples achieve a successful pregnancy. One of the most popular procedures is in vitro fertilization (IVF). Learn more about the steps of the IVF procedure.
Step 1: Controlled Ovarian Hyperstimulation (COH)
The first step of in vitro fertilization is controlled ovarian hyperstimulation. COH can be achieved using different means. The most common method is the long GnRH-agonist (Lupron) protocol. This involves suppression of gonadotropin hormone secretion in order to prevent premature ovulation. Once suppression is achieved, the woman receives daily injections of gonadotropins. Hormone assessments and ultrasound imaging are used to monitor follicular development. When the follicles have reached appropriate size, human chorionic gonadotropin (hCG) is given, and egg retrieval is done within 34 hours of the injection.
Step 2: Egg Retrieval
Egg retrieval is done in a procedure room using intravenous sedation. The ovarian follicles are aspirated under guided transvaginal ultrasound. Once removed using a tiny needle, the follicular fluids are scanned by the embryologist in order to locate the available eggs. After retrieval, the eggs are placed in a special medium and cultured using an incubator.
Step 3: Fertilization
Normal, motile sperm are transferred into a dish that contains the eggs (a process called standard insemination). If sperm parameters are not normal, the ICSI technique is used, which involves injecting the egg with a sperm using a high-powered microscope. The embryologist selects a single sperm using a microneedle, and injects it directly into the cytoplasm of the egg. This increases the chance of fertilization. Fertilization will occur within 18 hours after insemination.
Step 4: Embryo Culture
The fertilized eggs are now zygotes, and they are cultured in a special formulated medium to support growth. On the second or third day after egg retrieval, the zygotes are assessed to see if growth and development are normal. Blastocyst culture gives the embryos a higher potential for implantation. To reduce the chance of multiple pregnancies, fewer embryos are transferred. Embryo transfer is recommended on day three for cycles with low numbers or poor egg quality.
Step 5: Embryo Quality
To assess the quality of an embryo, there are several criteria to follow. This is crucial for deciding which embryos are right for the transfer process. On the day of the scheduled transfer, the embryologist photographs and evaluates the embryos. The fertility specialist and embryologist decide which ones to transfer based on the appearance and rate of development. Usually, the embryos are transferred when the cleavage stage occurs (day three after egg retrieval), or at the blastocyst stage (day five following egg retrieval). The laboratory uses a special grading system to evaluate embryo quality.
Step 6: Embryo Transfer
When the embryos are in the cleavage stage, they have around 4-8 cells. The embryologist examines the number of cells and assesses them for symmetry. Fragmentation occurs when the cells divide unevenly, which results in crowding. The laboratory prefers that there are no fragmentation due to this. Day five embryos are blastocysts, which are increased in size and more developed. The more expanded the embryo is, the better the quality. With embryo transfer, the embryos are loaded into a tiny, soft catheter and then positioned inside the uterine cavity via the cervix.