Stages of Artificial fertilization
1. Hormone therapy or stimulation:
Once the decision for treatment has been reached, our specialist will find you a suitable stimulation program. Stimulation means a hormonal therapy which helps to produce several follicles and eggs within the same menstrual cycle. The hormonal medications are nowadays easy and ready to use solutions daily injected either in the area of your stomach or thighs.
The duration of the hormonal therapy varies according to the stimulation program, method of treatment and the individual characteristics of the client. In IVF-treatment the stimulation lasts for about ten days and the development of the follicles are monitored through ultrasound scans.
Our IVF nurse will provide you all instruction on taking the injections and doctor will answer on any questions you might have about stimulation or your treatment.
2. Ultrasound scans:
The growth of the follicles during the hormone therapy is monitored through ultrasound scans. The number of scans varies from one to four depending on your type of treatment.
Based on these scans, changes will be made in the stimulation program, if necessary, in order to ensure optimal medication and the development of an appropriate number of follicles.
The check-ups during the treatment are brief but you are welcome to ask any questions that you might have concerning your treatment. All ultrasound scans are included into the treatment price.
3. Taking of Ovum:
The egg collection takes place in the morning. The operation is done after 34-36 hours from the last triggering injection. The triggering injection is hCG-hormone; it matures the eggs, releasing them to the follicular fluid.
The eggs withdrawn by removing follicular fluid from ovarian with the help of aspiration needle, the process being monitored by ultrasound. Just before this procedure you will receive a short-time anaesthesia.
The egg retrieval procedure most often is painless. The egg collection may take 10-20 minutes, depending on the number of follicles.
Once the egg collection procedure is complete, our nurse will take you to the recovery area to rest. Having rested and received further instructions for the doctor you will be ready to go home.
The sedatives might still affect your reflexes, so you are not allowed to drive that day. Sick leave can be prescribed for you for the day of the procedure if it is necessary.
In search for eggs our embryologist will examine the follicle fluid under a microscope. When eggs are found they are placed in a culture dish. The eggs are cultured in a culture medium and kept in an incubator with a controlled environment resembling that of the human body. The eggs are very sensitive to temperature and pH-changes, and therefore are promptly handled on warmed plates at the working place of embryologist.
4. Semen specimen:
During or shortly after the egg collection procedure, the male gives his semen for the eggs fertilization. Sometimes giving a sample in an unfamiliar environment under pressure may seem difficult or awkward on this important and exciting day. If you think there may be any problem in producing the semen, please consult our specialist or nurse well in advance.
You can produce your semen sample in a sterile container provided by the clinic at home too. In that case be sure to bring the sample to our clinic within an hour after production. It is also possible to freeze the semen prior to treatment. Sperm collected directly from the testicles or donated sperm can also be used in infertility treatments.
5. Fertilization:
The quality of the semen, its motility and number of sperm, determine whether an IVF or the ICSI method will be used to fertilize the eggs. The most active spermatozoids with normal structure are chosen for fertilization. The fertilization is carried out a few hours after the egg collection.
6. Checking of Fertilization and Growing of Embryos:
The fertilization of eggs is checked next morning after the collection of eggs in the IVF laboratory. There are two pronucelus in a fertilized egg, one from the sperm, and the other from the egg. After a few hours the two pronucelus become one and form the nucleus of the cell. The nucleus consists of the chromosomes which carry the genetic information in the form of DNA.
The fertilized eggs are further cultured in an incubator with a strictly controlled temperature and carbon dioxide concentration level. By the next morning the eggs have divided and now called embryos. The embryos are classified according to the number of cells and the quality of their structure. The best quality embryos are chosen for transfer to the uterus and the rest of high quality embryos can be frozen.
Sometimes the embryos’ culturing is prolonged for further 5 days. This method is called embryos’ culturing till the blastocyst stage. In some cases it allows to choose the most viable embryos to be transferred to the uterus. It is up to the doctor to decide whether to culture embryos till blastocyst stage.
7. Implantation of Embryo:
The embryos are normally transferred to the uterus on the second or third day after collection of the eggs. Not more than one or two embryos are transferred. A single embryo transfer is recommended in cases where the embryo is of high quality, the woman is into reproductive age or this is her first infertility treatment. By transferring two embryos, the likelihood of a successful pregnancy may be increased but it also involves a risk of a twin pregnancy.
The procedure of implantation is painless by itself and does not call for any further medical procedures.The embryo is transferred with the tiny plastic catheter though vagina to the uterus. Pregnancy begins if the embryo implants into the lining of the uterus in a couple of days after transfer into uterus.
Upon the implantation you may go home, as soon as you receive all instructions from your doctor according to you treatment plan. During a day or two after embryo has been transferred you will need to avoid physical activity while carrying on your normal daily life.
8. Time between transfer and test:
The results of the pregnancy test can not be reliable before a fortnight has passed after the embryo transfer. For many, this two-week wait is the most difficult part of the treatment and a good few refer to the wait as the days of agony. There is a lot to do and think about prior to the transfer; you have to take care of the hormone injections and ultrasound scans.
During and after your infertility treatment, hormone stimulation and procedures you will receive all necessary support from the personnel. You will be able to discuss any question with the staff and receive professional advice either visiting the clinic or by telephone. There is nothing you can do after the transfer other than wait and hope that the embryos will implant into the uterus and the pregnancy will begin.
Mood swings from high optimism to tormenting despair are common. Your infertility physician, our nurses and support team are ready to support you during this phase of the treatment as well.
9. Pregnancy test:
Pregnancy begins if either one or both of the embryos implant into the lining of the uterus. The implantation takes place within a few days from the embryo transfer. The pregnancy test is based on hCG-hormone that the embryo which is implanted onto the lining of the uterus starts to produce.
The test taken from a blood sample can be performed 12 days after the embryo transfer. A pregnancy test detecting hCG-hormone in the urine is reliable only two days later. Then blood test taken from blood detects the exact level of hCG hormone and the urine test tells whether the test is positive or negative.
The blood sample for the pregnancy test can be taken at the AVA Clinic or in any other laboratory in your local area. The IVF team of the AVA Clinic wants to know the result of the pregnancy test as eagerly as you, so kindly inform us of the result in any case.
10. Monitoring the pregnancy:
After a positive pregnancy test the pregnancy is verified with an ultrasound scan. The first ultra sound scan is usually conducted within 4-5 weeks from the embryo transfer. The location of the pregnancy, the number of embryo sacs and the heartbeat of the foetus can in most cases be monitored during the scan. In a normal pregnancy, the implantation takes place on the lining of the uterus, and the heart beats of the foetus or at least the embryo sac can already be detected in the first ultrasound scan.
If the embryo sac cannot be seen in the ultrasound scan, there has either been an early miscarriage or an incorrect implantation, e.g. to the fallopian tube. About 1% of pregnancies are extra uterine, and they either abort on their own or call for an operation.
Some pregnancies that have begun as a result of infertility treatments abort even before the first ultrasound scan. These so-called biochemical pregnancies occur in natural pregnancies as well, but the miscarriage takes place so early that the woman seldom even realizes that she was pregnant. You can book an appointment for your first ultrasound scan with your own physician at the AVA Clinic or with a local gynaecologist in your area.
After that, the monitoring of your pregnancy continues either at a communal or private maternity clinic of your choice. We at the AVA Clinic constantly monitor our operations by compiling statistics on the results. Therefore we kindly ask you to inform our clinic about the course of your pregnancy either by phone or email.
