Step-by-step IVF process

During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs (embryos) are transferred to the uterus. One full cycle of IVF takes about three weeks. Sometimes these steps are split into different parts and the process can take longer.

Stage 1: Ovulation induction

Typically, in women, an egg grows, matures, and hatches once a month. When using ovarian stimulants in IVF, a higher number of eggs are tried to be obtained. Treatment is started according to the results of the vaginal ultrasonography and blood hormone results on the second day of menstruation. When starting treatment, medication doses are determined according to the person's body mass index (kg/m2), if IVF has been previously applied to the ovarian reserve, the doses are determined according to the doses used in previous treatments and the number of eggs collected. Medication doses and treatment protocols are specifically determined for each patient and customized treatment protocols are applicable.

Several different medications may be needed as follows:

• Medications used for ovarian stimulation: they allow more than one egg to develop at a time.
• Medication used for oocyte maturation: they help the eggs mature.
• Medication used to prevent premature ovulation: These medications prevent the body to release the developing eggs too early.
• Medications used to prepare the inner surface of the uterus: progesterone supplementation is recommended for your uterus's inner surface to be more receptive and ready for implantation.

The stimulation process of the ovaries varies from person to person, it takes about 10-12 days. During this period, vaginal ultrasonography is performed at intervals of 2-3 days to monitor the development of follicles in the ovaries. Additionally, hormone levels in the blood are checked to measure your response to medications. When the follicles in the ovaries reach a certain size, rhCG or GnRH analogue is made, enabling the eggs to mature. Approximately 36 hours after this last injection, the egg collection process is started.

Stage 2: Eggs collection

The expectant mother is given a mild sedative or anesthetic, thus she will not feel pain or discomfort during egg collection. The doctor aspirates an egg from the woman's ovaries using an ultrasound vaginal probe with a thin hollow needle attached. This process takes nearly 12-30 minutes. These samples are delivered to the laboratory without any delay. Where the ovaries are not accessible by transvaginal ultrasound, an abdominal ultrasound can be used to guide the needle. The eggs are removed from the follicles by a needle attached to a suction device. Potential mothers may experience cramps and a feeling of satiety or pressure after egg collection.

Stage 3: Sperm collection

On the same day as the egg collection, a sperm sample is requested from the father candidate. Sperm obtained by masturbation is immediately sent to the laboratory. Semen can surgically be removed from the ovaries of prospective fathers who do not have sperm in their semen content. The sperm are taken from the semen at the laboratory.

Stage 4: Egg and sperm are mixed to enable fertilization

In the past, sperm and eggs were used to be mixed in a petri dish in classical IVF treatment and then gathered in a culture medium prepared at the laboratory and expected to be fertilized. During this period, your physician would check for signs of fertilization and monitor the growth of the embryos. Today, the microinjection method is currently applied in all IVF treatments. In the microinjection technique (ICSI), the sperm is injected into the egg.

Stage 5: Embryo transfer/ Fertilized eggs are placed in the uterus

After fertilization, embryo development is followed and the transfer process is performed on the appropriate day. However, the transfer days vary according to the strategies of IVF centers, the number of eggs obtained from the couple, and the developing embryo quality. The number of embryos to be transferred is selected according to the quality and period of the developing embryos, taking into account the female age and previous failed IVF trials, and the country's laws. After embryo transfer into the female’s uterus, daily application of progesterone or HCG is recommended to strengthen and support the uterine membrane and increase the likelihood of implantation. Most women may feel minimal pain and discomfort with hormone injections. After the transfer, a half-hour rest is sufficient: bed rest for more than half an hour does not increase the chance of pregnancy.

Typical side effects after the embryo transfer are as follows:

• A small amount of clear or bloody liquid comes in shortly after the procedure. (Due to cervical rubbing prior to embryo transfer)
• Breast sensitivity due to high estrogen levels
• Mild bloating sensation
• Mild cramping
• Constipation
• Low back and groin pain similar to menstrual pain

The expectant mothers should not have sexual intercourse, should not smoke until the pregnancy test, and should not use any medication without consulting a doctor. (Painkillers should not be used unless absolutely necessary.) In this period, expectant mothers can cook, climb up and down stairs, and walk. However, after the embryo transfer, activities such as sports, heavy work, and heavy lifting should not be performed until the pregnancy test results are obtained.

On the other hand, expectant mothers can go to the toilet and take a bath. The inside of the vagina should not be washed off when cleansing. Because this procedure causes infections as it will cause changes in the normal physiological environment of the vaginal canal.

Note: If you feel moderate or severe pain after embryo transfer, you should consult your doctor. Your doctor will have an assessment for complications such as infection, ovarian bending (ovarian torsion), and severe ovarian hyper-stimulation syndrome.

Stage 6: Performance of pregnancy test

A pregnancy test is applied to determine whether pregnancy occurs an average of two weeks after the embryo transfer. If the results of the test are positive, ultrasound control is performed approximately 10 days later to see the condition of the gestational sac.

Prepared by the Medical Editorial Board. Our health library contents have been prepared for informational purposes only and with the scientific content on the registration date. For all your questions, concerns, diagnosis or treatment about your health, please consult your doctor or health institution.