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In vitro fertilization (IVF)

WHAT IS IVF?

In vitro fertilization is a method of assisted reproduction. This method has been proven to be particularly effective, and has helped with bringing thousands of healthy children to the world, for the past three decades.

During IVF, mature eggs are fertilized outside the woman’s body, after being collected from the woman’s ovaries. The embryos (fertilized eggs) are then left to grow in a laboratory and then are transferred back to the woman’s uterus.. An IVF fertility cycle lasts about 14 days.

Trying less invasive treatmeant options before IVF is recommended, since IVF is not usually the first step to treat infertility.

HOW SUCCESSFUL IS IVF?

The success rates of IVF treatments vary. They can depend on many factors, such as the cause of infertility and the woman’s age. It is very important to understand that the birth success rates are not the same as the pregnancy success rates. Approximately 15 – 45% of pregnancies achieved by IVF lead to births.

WHY TO CHOOSE IVF?

In vitro fertilization is appropriate if you or your partner have:
• Male infertility: Low sperm count, low mobility of sperm or poor quality sperm which reduces the chance of fertilization.
• Damaged or blocked fallopian tubes in women which can lead to prevention of the sperm reaching the egg.
• Endometriosis, which can cause the abnormal function of the ovaries, uterus and fallopian tubes
• Uterine fibroids. Such fibroids can cause infertility by interfering with the uterus cavity by locking the fallopian tubes or altering the position of the cervix and so prevent the sperm from reaching the uterus.
• Previous fallopian tube removal or sterilization

• Ovulation disorders (female)

• Premature menopause (under 40s)

• Advanced reproductive age

• Unexplained infertility

• A genetic disorder
If there’s a genetic disorder, a process, which includes IVF, called Pre-implantation Genetic Diagnosis can be applied. It includes genetic analysis of a living fetus in order to determine the absence, presence, or change of a particular gene or chromosome before transferring the embryo to the uterus.

• Retention of fertility in women with cancer or other health problems
Women can freeze their eggs for future use, or freeze their embryos for future use. Women who have no functional uterus or the pregnancy poses a serious risk to their health can choose IVF pregnancy with another woman (surrogate mother).

THE IVF PROCEDURE

IVF includes a number of different stages. The stages involved in this process are:

FOLLICULAR STIMULATION
A combination of hormones and medication is usually given to the woman in order to stimulate her ovaries to recruit and mature many follicles, to take more than one egg per cycle.This happens enable the collection of multiple oocytes, and so to increase the probability of a successful IVF. In both cases there is the possibility some of the eggs collected will not be fertilized or will not develop normally after fertilization. To ensure that their collection will be done at the right time, the development of eggs is monitored by blood tests and transvaginal ultrasound.

EGG COLLECTION
A relatively easy process that takes place in the presence of an anesthesiologist, in a sterile room. It is required not to eat anything from the night before and to avoid water, candy or gum the morning of the egg retrieval. During the egg collection, using vaginal ultrasound, the position of follicles is successfully ascertained. A needle is inserted through the vagina and it aspirates the content of the follicles. The follicular fluid is delivered directly to the embryologist, where the eggs are identified, isolated from the liquid and transferred to a suitable temperature.

SPERM COLLECTION
When the day of the egg collection arrives, is required for the husband to give his sperm. Semen collection is done by masturbation into a sterile urine collection box. The collection of semen on a specific day can be difficult and stressful, the husband can provide the sample from his home earlier or a few days earlier. Fresh samples are preffered.

FERTILIZATION
The fertilization takes place after the egg collection and the sperm preparation.To begin the process the eggs are placed in a petri dish, which contains a specific growth medium for a few hours. The sperm is placed with the eggs and incubated together at 37oC, for 16 to 20 hours. The next morning, the embryologist before composing a detailed briefing on the outcome will examine the oocytes to see which ones are fertilized. Fertilized eggs become embryos and are incubated in special laboratory conditions for a few days, depending on the embryonic-transfer-stage. The fertilization rate is usualy 80 – 100%.

EMBRYO-TRANSFER
The embryo-transfer is a very simple procedure and it requires no anesthesia.Two to five days after the eggs are fertilized, the healthiest ones, are selected with specific criteria for placement in the woman’s uterus. The selected embryos are aspirated into a catheter and guided into the woman’s uterus. According to the age and medical history of the woman, the transfer of one to three embryos is possible.
A 2-day rest is highly recommended after the procedure. The embryos that are not transferred can be frozen and used in a next cycle of in vitro fertilization. It is also, always recommended to be accompanied from the clinic to the house. It is not uncommon to see vaginal fluids with blood before the pregnancy test. Approximately 50% of patients, have reportedly seen a little blood before the pregnancy test or even afterwards.