Millions of couples and individuals who have been diagnosed with infertility rebuild their hopes of becoming pregnant through IVF. Every year, more than 2.5 million IVF cycles are being performed around the world, resulting in an annual tally of more than 500,000 births.¹

The demand for IVF is currently rising, especially in Europe where IVF is more accessible and affordable. For instance, a lot of patients choose to undergo fertility treatments in Northern Cyprus where there are a number of established IVF clinics with high success rates. The high demand for IVF in Europe has translated to improved rates of conception. According to the latest reports, IVF now accounts for over 5% of all births in European countries.²

If you are experiencing difficulties conceiving, IVF could be your top procedure of choice to become pregnant. But what exactly is IVF, how does it work, and how can it help you have the family you’ve always wanted? These questions are very common among patients like you. Knowing the answers can help you prepare for IVF and make informed choices about your IVF cycle.

What is IVF?

IVF is the most commonly performed method of assisted reproduction technology (ART). With its high success rates globally, IVF is now considered as the most effective treatment to infertility. But what does IVF mean?

IVF stands for in vitro fertilization. The term “in vitro” means “outside the body in an artificial environment”. The “artificial environment” refers to the laboratory of fertility clinics wherein eggs, sperm, and embryos are kept and nurtured for IVF cycles.³ Fertilization is the scientific term that refers to the union of the egg and sperm. In natural circumstances, fertilization occurs inside the woman’s body, particularly in the fallopian tubes.

Simply put, in vitro fertilization is a process that combines the egg and sperm in a petri dish in the laboratory. Currently, most clinics perform IVF through a process known as intracytoplasmic insemination (ICSI). Through ICSI, the sperm cell is injected directly into the egg cell. The embryos that are formed after fertilization are then transferred into the uterus of the woman who will carry the pregnancy to term.

Who can benefit most from IVF?

IVF was originally developed to help couples, particularly women with damaged fallopian tubes, to become pregnant. With the advancements in medicine and technology, the applications of IVF have expanded to genetic diagnosis and treatment.⁴

• Couples and individuals with infertility problems

Infertility problems affect up to 10% of couples around the world. Different circumstances can cause infertility in men and women. You may consider IVF if you or your partner have any of the following health conditions:³

1. Blocked or damaged fallopian tubes
2. Pelvic inflammatory disease
3. Polycystic ovarian syndrome
4. Endometriosis
5. Fibroids in the uterus
6. Previous ligation or removal of fallopian tubes
7. Diminished ovarian reserve
8. Poor sperm quality
9. Low sperm count or absent sperm production (azoospermia)
10. Unexplained infertility

• Couples and single women who would like to choose the gender of their baby

Gender selection, now known as sex selection, is a process that allows couples and individuals to choose the biological sex of their baby. Gender selection is done through a series of procedures that include IVF, testing for the genetic makeup of the embryo to determine its sex, and transfer of the desired embryo into the uterus.

Couples and individuals may want to choose the sex of their embryo due to medical or non-medical reasons. Medical reasons mainly include preventing the birth of a child with a sex-linked disorder. If you or your partner has a known family history of sex-linked disorders such as Duchenne muscular dystrophy or hemophilia, you may opt to have a baby girl to avoid giving birth to a male baby affected by such disorders.⁵

Meanwhile, there are a number of non-medical reasons for gender selection, such as family balancing or personal reasons. A couple may want to have an equal number of male and female children. A single woman may want to have a daughter or a father may want to have a son. These are all valid reasons to use gender selection for conception.⁵

• Lesbian couples who want to have a shared motherhood

Recently, there have been a significant increase in the number of lesbian couples seeking fertility procedures to build their own family. In most cases, the couple makes the decision on which partner shall carry the pregnancy. The decision can be based on medical reasons or personal circumstances. The couple may also decide which partner will provide the egg for the IVF cycle. It is possible that the egg will come from partner A while partner B is the one who will become pregnant and deliver the baby.

• Gay couples who want to build their own family

IVF and its associated fertility procedures also benefit gay men who want to build a family. Fertility specialists will guide gay couples on the details of choosing an egg donor and surrogate who will carry the pregnancy. The couple will then decide which partner will provide the sperm. Some couples decide that each partner would provide sperm to fertilize half of the oocytes. The couple can then choose which embryo will be transferred into the uterus.

• Patients who want to preserve their fertility

Individuals who are about to begin chemotherapy or radiation therapy for cancer may also benefit from IVF. Cancer treatment has been proven to damage eggs and sperm. Eggs could be harvested and fertilized via IVF. The resulting embryos could then be preserved through cryopreservation for future IVF cycles.^3,4

Women in their reproductive years who want to become pregnant at later age can also benefit from IVF. This process, known as social egg freezing, is becoming more popular as more women choose to delay childbearing for different social reasons. Social egg freezing, also known as elective egg freezing, is suitable for healthy women until 35 years old. Women who would opt to freeze their eggs would need to undergo ovarian stimulation, retrieval of eggs, and cryopreservation of your viable eggs. These eggs can then be used for IVF cycles once you are ready to conceive.⁶

• Individuals with increased risk for genetic disorders

If you or your partner is at risk of transmitting a genetic disease to your offspring, you may benefit from preimplantation genetic diagnosis (PGD). PGD is a prenatal diagnostic test performed on embryos that have been created via IVF. With PGD, it is now possible to detect if an embryo contains genetic disorders. This allows embryologists to select the most suitable embryo for implantation.⁷

How to Prepare for IVF

Before you begin your IVF cycle, you and your partner will most likely undergo several tests and procedures. As the success of IVF depends on different factors, the screening tests prior to your cycle will help evaluate your odds of becoming pregnant. The results of these tests will help your doctor on recommending the most appropriate treatment approach for your case.⁸

The screening tests and procedures that you might need to take include the following:

• Ultrasound imaging and evaluation of your hormone levels to determine if you have adequate ovarian reserve
• A series of blood tests which include blood typing, hormone tests, and screening for infectious diseases
• Blood typing and identification of Rh blood group
• Hormone tests
• Anti-Mullerian Hormone (AMH)
• Follicle-stimulating Hormone (FSH)
• Luteinizing Hormone (LH)
• Estradiol
• Thyroid-stimulating Hormone (TSH), T3, T4
• Prolactin
• Screening for infectious diseases and immunity against diseases
• Tests for hepatitis B and C which include HBsAg and anti-Hbs
• Tests for HIV and syphilis (VDRL)
• Detection of immunity to varicella (chickenpox) and rubella (German measles)
• Semen analysis to determine the sperm quality
• The volume, number, mobility, morphology, and progression of the sperm are tested through the spermiogram.
• Mock embryo transfer to estimate the depth of your uterine cavity
• Uterine examination which includes a sonohysterography, ultrasound imaging, and hysteroscopy

How Does IVF work? 5 Steps You Should Know About

IVF is composed of a series of procedures that will help you become pregnant. The basic steps in an IVF cycle includes:³

1. Ovarian stimulation

The first step in the IVF cycle is ovarian stimulation. The goal of this procedure is to induce the ovaries to produce an egg that will be used in fertilization. Hormones and medications will be administered daily to help you produce eggs. The growth of the eggs in your ovaries will be monitored through a transvaginal ultrasound. The response of your body to the protocol will be monitored by measuring the levels of estrogen in your blood.

Once eggs have been produced, they will be nourished and allowed to grow to a size of 18 mm. At this point, a hormone known as human chorionic gonadotropin (hCG) is injected to promote oocyte maturation. It is possible to retrieve up to 20 eggs, but in women with low oocyte reserve, particularly those who are over 35-40 years old, there can only be few eggs left. For these women, only up to 5 eggs may be harvested during oocyte retrieval.

2. Retrieval of eggs

Mature oocytes can be retrieved 34 to 36 hours after the injection of hCG. Most clinics perform egg retrieval under general anesthesia. During the process, you will get a general anesthesia and a transvaginal ultrasound-guided aspiration of eggs will be performed. In this procedure, an ultrasound probe is inserted into your vagina. A needle guide is attached to the probe and this will help the doctor to accurately place the needle into the ovaries and aspirate the egg.

3. Sperm collection

Meanwhile, your partner or sperm donor should provide a semen sample on the day of egg retrieval. In most cases, sperm collection is done through masturbation. Nevertheless, alternative ways to collect sperm have been developed for specific male populations. You can learn about the other methods of sperm collection here.

4. Fertilization

The traditional procedure for fertilization involves the isolation of sperm from the semen sample through a process known as density centrifugation. The sperm is then washed with protein-containing liquid formulation to prepare the sperm for fertilization. Up to 100,000 sperm cells are then mixed and incubated with an egg cell in a petri dish for 12-18 hours. This procedure allows fertilization of the egg.

Now, the more common method used in most IVF clinics is ICSI. The ICSI technique allows the direct injection of the sperm cell into the egg cell. ICSI is highly beneficial for men with low sperm count as this method ensures that the retrieved sperm fertilizes the egg cell. Another benefit of ICS is that it prevents the fertilization of many egg cells, hence preventing the formation of many embryos. According to recent reports, ICSI has resulted in the birth of more than 2,000,000 babies worldwide.⁹

5. Embryo transfer

After fertilization, the formed embryos are allowed to grow in the laboratory until they reach the cleavage stage (day 3 after fertilization) or the blastocyst stage (day 5 after fertilization). When the embryos reach the cleavage or the blastocyst stage, they are then transferred into the uterus of the woman who will carry the pregnancy.

To improve the chances of a successful pregnancy, a hormone known as progesterone may be given on the day of egg retrieval or embryo transfer. It is mandatory that you take progesterone for 2 weeks. Embryos that were not transferred can be cryopreserved for future IVF cycles.

What to Expect After Your IVF Cycle

To check whether IVF has led to pregnancy, your doctor will perform a blood test about 12 to 14 days after egg retrieval.

If you are pregnant, your doctor will advise you to see an obstetrician or a pregnancy specialist to guide you on prenatal care.

If you are not pregnant, your progesterone supplementation will be stopped. You should then expect your period within a week. Contact your doctor if you don’t have your period after a week or if you experience any unusual bleeding.

Your IVF Support

The IVF journey could be very confusing and overwhelming for aspiring parents. If you are thinking of going through IVF but do not know which IVF clinic you should go to, you can consult a trusted fertility consultant who will help you find the best IVF clinics in terms of technology, success rates, and affordability. Your fertility consultant can also provide online courses to help you understand the procedures, avoid common mistakes during IVF treatments, and optimize your fertility options. Contact a fertility consultant today and learn more about the IVF process, the best IVF clinics, and other assisted reproductive techniques.

References

• Fauser, B. (2019). Towards the global coverage of a unified registry of IVF outcomes. Reproductive BioMedicine Online, 38(2).
• European IVF-monitoring consortium for the European society of human reproduction and embryology, Wyns, C., & Bergh, C. (2020). ART in Europe, 2016: results generated from European registries by ESHRE. Human Reproduction Open, 2020(3), hoaa032.
• Choe, J., Archer, J., & Shanks, A. (2022). In Vitro Fertilization. In StatPearls. StatPearls Publishing.
• Kushnir, V., Smith, G., & Adashi, E. (2022). The Future of IVF: The New Normal In Human Reproduction. Reproductive Sciences, 29, 849–856.
• De Wert, G., & Dondorp, W. (2010). Preconception sex selection for non-medical and intermediate reasons: ethical reflections. Facts, Views & Vision in ObGyn, 2(4), 267–277.
• Varlas, V., Bors, R., Albu, D., Penes, O., Nasui, B., Mehedintu, C., & Pop, A. (2021). Social Freezing: Pressing Pause on Fertility. Int J Environ Res Public Health, 18(15), 8088.
• Stern, H. (2014). Preimplantation genetic diagnosis: prenatal testing for embryos finally achieving its potential. Journal of Clinical Medicine, 3, 280–309.
• Mayo Clinic. (2022). In vitro fertilization (IVF). Patient Care & Health Information. https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716
• Palermo, G., O’Neill, C., Chow, S., Cheung, S., Parrella, A., Pereira, N., & Rosenwaks, Z. (2017). Intracytoplasmic sperm injection: state of the art in humans. Reproduction, 154(6), F93–F110.