You are about to embark on your In-Vitro Fertilisation (IVF) journey which is described as “a round of IVF treatment” or an “IVF cycle.” Let’s explore how to get pregnant when it comes to IVF.
If you are still having a monthly period your “cycle” will commence on that day, Day 1 of your cycle. IVF is however also common in women who may not have a regular cycle or are in menopause and have no monthly period. In such instances the IVF nurse/doctor will ensure that, with medication, a cycle is induced and can be predicted. Everyone’s body is different and as such exact treatment protocols will differ and you will be advised your the day 1 of your cycle.
You will commence taking medication which will stimulate your ovaries (where your eggs are contained) to produce more than 1 egg. In a normal cycle, without fertility intervention, your ovaries will usually produce 1 egg from 1 ovary and the following month, another egg from your other ovary. The stimulation medication however stimulates both ovaries to produce more than 1 egg in an effort to retrieve as many eggs as possible.
The medication is taken by injecting yourself with a very small needle (similar to a diabetic needle) in the fat of your abdomen. Every cycle differs slightly but you would usually inject yourself for about 7 to 12 days. It may initially sound like a daunting task but you will be shown how to inject yourself and after the first one it really is smooth sailing and easy (speaking from experience it is not painful AND I had a phobia about injecting myself!)
Your treating specialist will prescribe the medication and its dosage as each woman’s body reacts differently to the stimulation of the medication. The most common hormones used in the injections you will be taking are follicle-stimulating hormone (FSH) and luteinizing hormone (LH.) These are hormones which your body naturally produces.
It is important to understand that you are born with all your eggs your body will ever have (about 3 million eggs at birth!) and as such the hormones are only functioning to encourage or stimulate the body to mature and release more eggs than would normally be released from the ovaries. The medication cannot “make” the eggs as is sometimes presumed.
It is during this time, when you are administrating the medication that your doctor will be doing frequent internal scans (transvaginal scans) of your ovaries to check how the follicles (fluid sacks that contain the eggs) are growing and how many there are developing. Your Doctor may adjust your medication with an increase or decrease in dosage, depending on how your ovaries are responding to the medication. It is important that the ovaries are not over or under-stimulated.
During this time you may experience symptoms similar to pre-menstrual symptoms like bloating, abdominal discomfort and mood swings. This is very normal and usually quickly dissapates as soon as the medication is stopped.
On about day 12 (everyone is different) you will administer 1 last injection called a “trigger injection.” This medication is given at a very precise time and it signals the body to get the eggs ready for ovulation (the release of the eggs.)
It is at this time that your specialist will schedule the “egg retrieval day” which is usually on day 12 to day 14 of the cycle. The egg retrieval is also called the egg “pick up” or OPU (Ovum Pick Up) and is performed under an a general anaesthetic, you will be asleep and will not feel anything. The eggs are contained in fluid filled sacs called follicles and your specialist will use a special sonor to guide a “section needle,” via the vagina, in order to extract the eggs from the follicles in the ovaries. This process takes about 30 minutes. The number of eggs retrieved is usually between 8 and 15 but can vary. Not all the eggs collected at the egg retrieval will be “mature” and only the mature eggs will be used in the next fertilisation stage. Recovery takes about 30 minutes and you will need someone to drive you home after the procedure.
The next step is where the “how to get pregnant” starts. The sperm are added to the process. The sperm and eggs are placed in a dish and allowed to find each other as they would naturally do in your body. The laboratory experts often select the best sperm cells and may perform a process called ICSI (intracytoplasmic sperm injection.) This is when the best sperm is injected into the egg under a microscope to assist to fertlisation.
The sperm will be ready in the laboratory after your partner has provided a fresh sperm sample. Sperm may also have been frozen and at this stage is thawed for fertilisation of the eggs.
The next exciting (and anxious) stage is the daily monitoring of how many eggs fertilise into embryos. Unfortunately not all the eggs will fertilise and become embryos. The embryos are carefully monitored in the laboratory and you will receive a daily update on their development. Development in the laboratory usually lasts 3 to 5 days before an embryo/s are transferred to the uterus. When the embryos have divided into a few cells they are called blastocytes and the laboratory will be able to grade them according to the quality of the embryos. You really only need one good embryo which is what I always tell couples.
A 7 week old embryo
The day of embryo transfer (or ET as it is commonly referred to) is a simple procedure which takes a few minutes and you will be awake for this painless procedure. Your specialist will, under ultrasound guidance, “pick up” an embryo from the laboratory and insert it through your cervix and into your uterus. The hope is that the embryo will attach itself within a day or two. If you are prepared and healthy enough to carry a multiple pregnancy then more than one embryo may be transferred at this time. Some woman think that if they get up and walk around the embryo may fall out but this is a not the case! You can get up and walk around immediately without fear that an embryo may fall out.
Sometimes you may have additional embryos after transferring an embryo/s into your uterus. The clinic will have freezing and storage facilities and any additional embryos will be immediately frozen. This embryo/s can be used for a second attempt should your first attempt not be successful. The embryos/s may also be used for a sibling in the future. The success rate of thawing (or defrosting) embryos is generally good and embryos have been frozen for in excess of 25 years and are still capable of producing a pregnancy.
Approximately 12 days after the embryo transfer a blood test is performed to check whether you are pregnant! The blood test measures the presence of the hormone hCG (human cholionic gonadotropin.) This test may be repeated as the doctor will want to check that the levels of this hormone are increasing each day which means your embryo is growing well.
The entire IVF process from Day 1 until the pregnancy test is about 30 days and closely mimics, with the aid of science, the natural process of how to get pregnant.