How does IVF work?

IVF cycles involve seven steps, including ovarian stimulation, follicular development monitoring, egg retrieval, sperm sample retrieval, insemination (by IVF or ICSI), embryo transfer, and finally, the two-week wait. In this section, we take a closer look at what each of these steps entail.

Step 1: Ovarian stimulation

Ovarian stimulation is an essential part of the IVF treatment process. It involves the administration of medications to stimulate the development of multiple eggs in the ovaries. This is done to increase the chances of success in IVF. The ovaries naturally produce one egg per menstrual cycle, but in IVF, it is desired to retrieve multiple eggs to increase the chances of fertilization and implantation.

During ovarian stimulation, a combination of hormones is used to stimulate the ovaries to produce more eggs. These hormones can be administered through injections or in the form of oral medications. The dosage and duration of the medication are carefully monitored to ensure the ovaries are stimulated adequately without any risks or complications. Close monitoring is important because each woman responds differently to the medications, and the dosage may need to be adjusted accordingly.

During ovarian stimulation, the female partner injects herself with fertility medication in order to stimulate the growth of multiple follicles and prevent early ovulation.

A short protocol, is a better option for women who have high FSH levels, or have responded poorly to previous ovarian stimulation. If you’re adhering to a short protocol, you’ll administer lower doses of injections starting on the first day of your period to block out your own ovarian function, and follow this up with injections to stimulate your follicles in the next few days. When you’re undergoing ovarian stimulation, drink plenty of water, and get as much rest as you need. If you have a stringent workout routine, we recommend easing off temporarily. In particular, don’t undergo any aerobic training or exercise, which will redirect blood flow away from your follicles.

Ovarian stimulation is crucial in IVF treatment because it allows for multiple eggs to be retrieved for fertilization. In natural conception, only one egg is released and has the potential to be fertilized. However, in IVF, the chances of success are increased by retrieving multiple eggs, which are then fertilized in the laboratory. Having multiple embryos to choose from gives the embryologist and fertility specialist more options for selecting the healthiest and most viable embryos for transfer, increasing the chances of a successful pregnancy.

There are different protocols for ovarian stimulation, but in this lesson, we will focus on the short protocol and the medication used in this protocol.

The short protocol involves stimulating the ovaries for a shorter duration compared to other protocols. The medications used in this protocol aim to suppress the natural hormonal activity in the ovaries, followed by stimulating the ovaries to produce multiple follicles. The first medication used is called a GnRH agonist, which suppresses the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. This medication is typically administered as a nasal spray or an injection. By suppressing the natural hormonal activity, it helps to prevent premature ovulation and allows for better control over the ovarian stimulation process.

After the suppression phase, the second medication used is gonadotropins. These are synthetic forms of FSH and LH, which are administered via injections. Gonadotropins stimulate the development and growth of multiple follicles in the ovaries. This process usually takes around 8 to 12 days, during which regular monitoring through blood tests and ultrasounds is done to adjust the medication dosage and monitor the response. Once a sufficient number of follicles reach the desired size, a final injection of human chorionic gonadotropin (hCG) is given to trigger final maturation and prepare the follicles for egg retrieval. The eggs are then retrieved through a minor surgical procedure, usually performed under sedation.