IVF Step By Step - Step One

In-vitro fertilisation (IVF) is generally the last resort in fertility treatment for couples who are struggling to get pregnant. The treatment is quite physically demanding for women and for both women and men, it's emotionally stressful. If done privately, IVF is also expensive. For many infertile couples, however, an intense desire for children outweighs the disadvantages of this treatment.

IVF treatment comes in cycles and the chance of pregnancy resulting from any one cycle is approximately 15 %. In the course of the treatment, your ovaries are stimulated into producing eggs, the eggs are then removed from your body and fertilised in a laboratory, and the resulting embryos are inserted back into your uterus, where, hopefully, one of them will implant and develop into a healthy baby. Because more than one embryo is usually transferred back into your uterus, your chances of a multiple pregnancy, which is riskier than a normal pregnancy, are increased.

The First Phase

IVF treatment is all about hormones. The first step in the IVF process involves suppressing your normal hormonal (menstrual) cycle and then stimulating your ovaries into producing as many eggs as possible.

The Suppression Phase

It's important to make sure that your normal ovulation cycle does not interfere with the artificially induced cycle of IVF. Your fertility doctors will therefore give you drugs to block your normal hormone production and put your body into an artificial state of menopause. You may experience some menopausal symptoms.

The suppression drugs themselves prevent the pituitary gland in the brain from stimulating the production of luteinising hormone (LH) and follicle stimulating hormone (FSH). FSH causes follicles to grow on the ovaries, these follicles contain eggs. When one of the eggs develops to maturity, a surge of LH is produced, which prompts the follicle to release the egg. This is what is meant by ‘ovulation'. The egg then travels down the fallopian tubes, where it may be fertilised, before arriving in the uterus. If the egg is not fertilised, it will be flushed out when you have your period.

Treatment with these suppressant drugs normally starts on around day 21 of your natural cycle and is administered daily via an injection or a nasal spray. You will probably be allowed to inject yourself. The course of drugs generally lasts for around two weeks but may be continued into the stimulation phase.

The Stimulation Phase

Yet more hormonal drugs are used in the stimulation phase. You may receive artificial FSH in the form of the drug Clomid, which is generally taken as a pill. However, because IVF is usually offered only to couples who have already tried Clomid and failed to get pregnant, it's more likely that powerful injections of gonadotropins would be used. These hormone injections are normally given every day for about 10 days. During this time, many follicles will develop in your ovaries. The difference between this and normal ovulation is that, if the treatment works, these follicles will produce more than just one mature egg. This means that more eggs are available for fertilisation and your chances of pregnancy are therefore higher.

This stage of the IVF process can be very draining for a woman. You will probably need to attend your IVF clinic on a daily basis for injections, blood tests and vaginal ultrasound exams to check on the progress of your follicle growth. You will be closely monitored for any signs of hyper ovarian stimulation syndrome (OHSS). Once your follicles have grown to between 16 and 20 millimetres, your eggs are probably ready for harvesting. Here begins the next step in the process...

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