In Vitro Fertilization (IVF)

IVF (in vitro fertilization) is the most common method of medically assisted reproduction. It was first applied successfully to humans in 1978. In 1978 the first successful IVF procedure was performed without the use of drugs. This technique was abandoned due to low success rates in subsequent attempts. In vitro fertilization, as the word says, is the fertilization that is taking place out of the body: the ovum is not fertilized from the sperm into its natural environment, the woman’s fallopian tube, but instead, it is fertilized in the laboratory.

IVF Protocols Stimulation

Several protocols were designed for IVF procedure; the most common are the “Long Protocol” the “Short Protocol» while the rest are modified by these two. There are two types of medication that characterize these two categories. The one prevents the ovulation and the other stimulates the development of more follicles. The difference between the two protocols is lying mainly in the duration of the administration of the drug that prevents the ovulation. The main difference between these two protocols relies upon the duration of the medication given despite the fact that they have the same components with different appellation.

The choice of the protocol and the optimal dose is adapted to each woman ideally, according to her age, hormonal profile, the ovarian response in a previous effort as well as the number and progression of previous efforts. Once the protocols has been chosen, during the ovarian stimulation, the woman is closely monitored by performing recurrent transvaginal ultrasounds and giving blood samples in order her doctor to check her hormonal levels. Subsequently, when follicles reach the appropriate size with the necessary level of hormones and uterine lining with the right thickness, then one last injection is given to promote their maturation.

The procedure of Oocyte Retrieval 

Egg Collection

The next step, after the stimulation of the follicles, is the oocyte retrieval that is performed by transvaginal monitoring of the follicles under continuous ultrasound check. The doctor using a puncture needle removes the eggs from the follicles. The follicular fluid is quickly delivered to embryologists who search for the eggs with the help of a microscope. Finally, embryologists inform about the number of oocytes that have been collected. Retrieval, although it is a short process, it is carried out with mild sedation (analgesia). Consequently, for safety reasons, women who are about to perform this procedure, should be completely fast since midnight on the previous day.

Collection and processing of the semen

On the day of the egg selection, the semen is collected and processed. For better sperm quality, abstinence from sexual intercourse is recommended 2-3 days before the oocyte retrieval. The semen is, then, subjected to a special treatment in order to isolate the sperm with the highest mobility in small volumes. This process activates the sperm cells and enables them to fertilize the eggs. It should be noted that the sperm collection, the planned day, often causes anxiety in men; a situation that usually creates difficulty in its collection. In order to avoid such a case, the wife can be present and the sample can be collected from his home or, in special circumstances, even freeze his semen a few days before the procedure. In cases of azoospermia (no sperm in ejaculation), it is possible to take the sperm directly from the testis by biopsy on the day of the egg collection or use donor’s sperm.

In vitro fertilization

Some hours after the egg retrieval and proper sperm processing, the ova and the sperm come in contact. This can be performed in two ways. In simple IVF, the ova are simply placed in a high concentration of spermatozoa. One of these will fertilize the egg by penetrating its outer membrane, and a follow-up test is done the next day. In cases where sperm quality is not good, micro-fertilization (ICSI) is performed. During micro-fertilization, a sperm is placed in an egg with a microtropic microscope. The eggs are then placed in special dishes in lab. The next morning, fertilization is controlled by embryologists. The existence of two pronuclei (small round formations) at the center of the ovum indicate the achievement of the normal fertilization. The fertilization rate in the laboratory ranges from 50% to 100%. The status of oocytes (degree of maturity, cytoplasm nature), sperm fertilization capacity, egg and sperm quality, as well as the way the laboratory manages and cultivates the biological material, are some of the responsible factors for the fluctuation of the above percentage .