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A Simple, Step-by-Step Guide to the IVF Process

In a previous article, we learned about IVF (In Vitro Fertilization), the most popular assisted reproduction option, including  what is IVF, when IVF should be used, how safe is IVF, and how it is done (read our introductory article of IVF here). In this article, we will walk you through the whole procedures once again, but with more essential details to help you understand and better prepare for your visit to our clinic. Can’t wait to start? Let’s begin.

1. Starting Phase

When: Whenever you can get an appointment

How long: 45 – 60 minutes

Starting the procedure, you will have to undergo extensive fertility testing, including an evaluation of your uterus and fallopian tubes, a hormonal evaluation, as well as other tests as may be necessary. The check-up will help your physician better understand your overall physical condition and recommend a treatment plan that most suits you.

In this stage, you will also be informed about everything you need to know about your treatment cycle, shown how to administer your daily injections of hormones at home, and be given instructions about any other medications (patches or pills) you may need during your ovarian stimulation phase.

2. Ovarian Stimulation Phase

When: Day 2 or 3 of your period 

How long: 10 – 12 days

After you have learned and understood what you need to do during your whole IVF cycle, and you have decided to proceed, you will begin the first step of IVF, which is to stimulate your ovaries to produce as many follicles as possible through self-administering hormonal drugs starting on day 2 or day 3 of your period, and proceeding for a further 9-12 days.

Your ovaries can have hundreds-of-thousands of ovarian follicles, with each follicle containing an oocyte (an immature egg). During your menstrual cycle, some of these follicles will begin to develop further and the egg in them become a mature egg. The goal, therefore, is for your ovaries to produce as many follicles as possible, since the more follicles, the higher chance you will be able to find and retrieve high-quality mature eggs.

During this phase, you’ll be asked to come into the clinic every few days for around 10 to 12 days, for more blood tests and ultrasound scans, to monitor how your ovaries are responding to the hormonal drugs. Once the testing shows that your eggs have completed their growth and development, your doctor will administer a “trigger shot”, a hormone (usually either human chorionic gonadotropin; hCG, or leuprolide acetate; Lupron) to help complete the egg maturation process, releasing them from the wall of the follicles, so we can begin the egg retrieval process.

3. Egg Retrieval and Semen Collection

When: 36 hours after the “trigger shot”

How long: 1 – 2 hours

36 hours after your trigger shot, your eggs will be retrieved through a minor surgical procedure to aspirate your follicles. The doctor will use ultrasound imaging to guide a thin needle through your pelvic cavity to remove or retrieve your eggs. The procedure will be done under general anesthesia to keep the process comfortable and painless. The whole process usually takes only 15-20 minutes.

On the same day that your eggs are being retrieved, your partner’s semen will also be collected. Usually, your physician will prefer your male partner to collect his semen fresh at the clinic, but if he cannot come to the clinic on that day, he may collect the semen sample on a day prior to the egg retrieval and have the washed sperm frozen.

Semen collection by masturbation is recommended to avoid contact with any body fluid from the male or the female partner (i.e. saliva, vaginal fluids). These fluids may contain bacteria which could contaminate the fertilization or culture media. After he collects his sample, the male partner will return the sample through a window to a specialist waiting in the Andrology Laboratory which is situated next to the collection room.

The collected semen will be left for about 30 minutes to liquefy, and then washed to remove debris, immobile sperm, and other substances in the semen, before being thoroughly examined for its quality in a process called semen analysis. This semen analysis is important as it will help your physician to best decide if your eggs and your partner’s sperm are to be fertilized by a standard fertilization IVF or an advanced fertilization ICSI method. If the semen sample is normal, the standard fertilization IVF is chosen.  But if the semen analysis results are lower than average, your physician may advise you to choose the second alternative fertilization ICSI technique, as it increases the chance that fertilization will occur. 

For the IVF technique, the eggs and sperm are mixed together and allowed to fertilize on their own in a laboratory dish, whereas for ICSI technique, , a single healthy sperm is specially selected and injected directly into a mature egg to achieve fertilization. ICSI normally takes a longer time and requires an experienced fertility scientist.

Once fertilization occurs, the fertilized eggs are considered as embryos.

4. How Embryo Culture 

When: After fertilization (via standard IVF or ICSI)

How long: 5-6 days

After the eggs and sperm are fertilized and become embryos, they will be cultured for 5 – 6 days in the laboratory until they develop and grow to the blastocyst stage, ready to be transferred into and implant in the lining of your uterus. Embryos which cannot reach the blastocyst stage are basically considered too weak and incompetent, and will not be transferred back to your uterine cavity.

The embryo culture process is very sensitive, and requires expertise and experience from embryologists who know how to both manage environmental conditions and operate advanced technical equipment to maintain a stable environment within the laboratory so that the embryos can grow properly. 

At Superior A.R.T., we use the Geri incubator, the newest generation of time lapse incubator technology available, with a single high quality microscope camera system dedicated to each culture chamber, thus allowing detailed tracking of embryo development without the plate or the embryos having to move. Each chamber is independently controlled and monitored, providing individualized, optimal culture conditions. The use of mini incubators increased the pregnancy rates as embryos had more stable conditions in which to develop.

To learn more about our Blastocyst Culture Technology here.

5. Embryo Transfer

When: After the culture process

How long: 2 to 4 hours

Finally, a selected blastocyst(s) can be transferred to your uterus through a simple and painless procedure where your blastocyst(s) will be loaded in a soft catheter, placed through the cervix and into your uterus under ultrasound guidance, and the blastocyst placed in your uterine cavity. The blastocyst(s) will implant into the uterine wall (endometrium) and begin to develop and grow.

About 7-10 days after the embryo transfer, you can take a blood pregnancy test to find out if you are pregnant. An ultrasound can be performed about 2 weeks after to confirm your pregnancy.

6. Embryo Freezing

When: After the embryo transfer process

How long: 1 to 2 hours

Any good embryos excess to transfer requirements can be frozen using a process called Vitrification, a technique in which your embryos will be frozen ultra-rapidly, so that the water molecules don’t have time to form ice crystals, and then held in deep frozen storage. This results in a long-lasting, high-quality preservation of your embryos indefinitely, if held in a high-quality and, well-maintained laboratory with consistent, regular quality control and monitoring of the amount of the liquid nitrogen and the integrity of the equipment.

These frozen embryos can be used at a later time if you wish to get pregnant again.

AAbout Superior A.R.T.

Superior A.R.T. offers comprehensive fertility and genetic services in state-of-the-art Assisted Reproduction Technology (A.R.T.) Laboratories in Bangkok Thailand. Superior A.R.T. was founded in 2007 by a group of leading Thai Infertility specialists in collaboration with Australian world leading fertility and A.R.T. treatment providers, Superior A.R.T is a renowned fertility clinic offering comprehensive fertility and genetic services by a team of experienced treatment providers and researchers specifically specializing in Assisted Reproduction Technology – A.R.T. Superior A.R.T. is committed to making your dream of having a healthy baby come true. 



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