In vitro fertilisation (IVF) is the most common and effective form of assisted reproductive technology. It is used to help couples that have struggled with conception due to problems such as blocked fallopian tubes, endometriosis, low sperm count, and other fertility problems. It is also an often expensive procedure that has prompted many to consider IVF treatment in Bangkok, as the cost is more affordable yet the quality of healthcare remains high.
The process facilitates the extraction of an egg from the woman’s ovaries and sperm from the man, which are combined in a lab setting to create a healthy fertilised egg or embryo. The embryo is thereafter transferred to the woman’s uterus in hopes it will implant and develop. Where there may be a problem with the woman’s eggs or man’s sperm, donors may be used. If there is a challenge in having the woman carry the pregnancy term, surrogacy may also be considered.
Preparing for IVF
The IVF process involves 5 stages. However, before getting to this, evaluations must be done to ensure the couple are good candidates for the procedure. The NHS recommends IVF only be considered for women that are less than the age of 43 years who have unsuccessfully been trying to conceive through regular and unprotected sex for at least 2 years. It also recommends the same if a woman has unsuccessfully attempted artificial insemination over 12 cycles. In many other countries, just 1 year of trial can be enough to qualify one for consideration for IVF.
Those that meet this standard are put through multiple screenings to determine their physical health and any conditions that could be contributing to the failure to conceive. These screening can include:
- Semen analysis
- Ovarian reserve testing
- Uterine exam
- STI testing
The IVF Process
1. Egg Production
Normally, a woman will produce one egg during each menstrual cycle. To boost the chances of conception, your doctor will seek to stimulate the production of multiple eggs that can be fertilised and implanted. This is accomplished by having the woman first take medication to suppress the natural menstrual cycle.
Thereafter she will be prescribed fertility drugs that stimulate superovulation. These drugs contain follicle-stimulating hormone (FSH) and are usually self-administered as an injection or nasal spray. The more eggs that are realised from this process, the better the chances of successful treatment.
Ultrasound scans and blood tests are typically used to monitor the development of the follicles in a woman’s ovaries and measure responses to the drugs taken. They will also help determine when to schedule egg removal. Certain situations may cause your doctor to cancel this removal. This includes when there has been premature ovulation and when an inadequate number of follicles have developed. A repeat of this stage may be scheduled in a later cycle with some adjustment to the type of drugs and dosage to improve the outcome.
2. Egg Retrieval
Just a day or two before the eggs are scheduled to be retrieved, the woman is given an injection to help speed up their maturation. A procedure called follicular aspiration is then carried out to retrieve the eggs from the ovaries before they are released. This is an outpatient procedure that can be done at your doctor’s office.
Once the woman is sedated, the doctor will use an ultrasound-guided needle through the vagina to reach each of the ovaries and suction out the eggs. This minor procedure should be painless and take less than half an hour. Some cramping and minor bleeding may be experienced later, but this should quickly pass.
Where a transvaginal ultrasound may not work well in identifying the position of the ovaries, an abdominal ultrasound may be used to instead guide the needle.
Once the eggs are extracted, they are placed in a culture medium and incubated. They are evaluated to ensure they are healthy and mature before they can be fertilised. The woman is given another injection to start preparing her uterine lining to receive the embryos after fertilisation.
3. Sperm Collection
This can be done the same day as when the eggs are being retrieved at the doctor’s office. IVF clinics typically prefer to work with fresh sperm versus frozen sperm. Masturbation is the normal mode for collecting a semen sample.
Where the man may have certain conditions, like azoospermia where there is no sperm in their ejaculate, testicular aspiration may be used. Similar to follicular aspiration, it involves collecting sperm directly from the testicle through a minor surgical procedure that is completed within 10 minutes. It is similarly done by administering local anaesthesia and using a small needle attached to a syringe to aspirate.
Thereafter, the sample is taken to the IVF lab where it is processed to separate the sperm from the semen fluid. The healthiest sperm are also identified to be used in the fertilisation process.
This is the stage at which the best eggs are combined with the best sperm. The process is called insemination and takes just a few hours for the sperm to fertilise the egg. It can be done in one of two ways.
- Conventional insemination – the healthy eggs and sperm are mixed and incubated
- Intracytoplasmic sperm injection (ICSI) – a single healthy sperm is selected and directly injected into each mature and healthy egg. This option is usually used where there are few healthy sperms or if there have been previous failed IVF attempts.
5. Embryo Transfer
2 to 5 days after egg retrieval, the woman will return to the doctor's office for embryo transfer to be performed. At this stage, the fertilised eggs or embryos are placed inside the uterus with the expectation they will implant in the uterine lining.
The woman is given a mild sedative to help ease any discomfort. The doctor inserts a long thin tube or catheter into the uterus through the vagina. The catheter is attached to a syringe that carries the embryos. The embryos are then transferred into the uterus. Multiple embryos are typically transferred with the expectation that at least one will successfully implant. It is also the reason that multiples are common for couples that go through the IVF process.
The success of this process is proven about 12 days to 2 weeks later when the doctor puts the woman through a pregnancy test.