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IVF – Diagnosis

Before proceeding with IVF, the fertility specialist may need to do multiple tests to determine the problem. If the couple is planning for IVF or if the fertility doctor thinks IVF can help a couple, he or she would want both the male and female to undergo the following tests.

In the case of males, the IVF doctor may recommend the following tests:

• Semen analysis – The IVF specialist may need to evaluate the sperm and the semen samples of the male. The man can produce the semen by masturbating semen is generally collected in the lab in a clean container. The semen is then sent to the lab for analysis which helps the doctor evaluate the quality, quantity, and motility of the sperm.
• Hormone testing – The doctor may recommend doing a blood test to evaluate the level of testosterone and other male hormones in his body.
• Vasography– Vasography is an imaging test that is done to check for any damage or blockage in the vas deferens, which is a long tube in males that connects the pelvic cavity to the epididymis.
• Imaging tests– The male may also be suggested to undergo imaging tests such as ultrasound or MRI of his genitals to confirm if there is a presence of any abnormalities.
• Genetic testing– Genetic test determines whether there’s a genetic defect that might contribute to infertility-related problems in a male.

In the case of the female, the IVF specialist may recommend the following tests:

• Imaging tests – Imaging tests like pelvic ultrasound are mostly recommended to identify if there is any abnormality in the uterus or the ovaries of the women.
• Ovulation testing – Ovulation testing is done through a blood test that can help determine whether you are ovulating or not.
• Test for ovarian reserve – Ovarian testing helps the doctor determine the number of eggs available in the ovaries. To evaluate your ovarian reserve, the IVF specialist may require testing your hormones at the beginning of your menstrual cycle.
• Hysteroscopy – In hysteroscopy, the doctor inserts a flexible, thin lighted medical instrument through the cervix of the woman to view inside her uterus and check if any abnormality is present that is preventing her from getting pregnant.

IVF Treatment explained step by step

• Step 1: Beginning of IVF treatment: The IVF treatment journey begins with the doctor determining the best time during your menstrual cycle. IVF treatment requires several eggs to mature.
• Step 2: Ovarian stimulation: Ovarian stimulation is the first and the most important step of the process where the doctor stimulates the ovaries to promote the growth of the follicles that contain the eggs. The common hormones that are used to stimulate the follicles are Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). Once injected, the IVF doctor along with the team monitors how the ovaries respond to the medications.
• Step 3: Trigger Injections: Once the doctor sees that the egg follicles in the ovaries are enough, the doctor will stop the LH and FSH injections and will recommend the time when you need to administer trigger injections. The trigger injection includes injecting human chorionic gonadotropin (hCG) to mature the eggs and help them get released from the ovarian follicle wall.
• Step 4: Egg retrieval: Egg retrieval or ‘egg picking stage’ is a daycare procedure done under general anesthesia. During the procedure, the doctor inserts a fine needle with an ultrasound-guided probe through the vaginal canal of the woman to retrieve her mature eggs. The procedure generally does not take more than 30 minutes. On average, 8-15 eggs are collected during this process. Once the eggs are retrieved, the patient is allowed to go home and rest. It is best if the patient is accompanied by her partner or someone else who can help her drive and reach home safely.
• Step 5: Sperm collection: After retrieving/ collecting the eggs, the IVF doctor will need to collect the sperm from the male partner. At this stage, the male partner will be asked to produce his semen specimen. Every IVF lab will have a dedicated room where the male can masturbate and give his sperm/ semen specimen. The male partner can produce his semen specimen at home or at the clinic where the semen specimen would be stored. In case the couple wants to use donor sperm or frozen sperm, the IVF team will get it ready in the lab.The collected sperm sample is washed with medicine under a microscope to get rid of all sorts of dirt and debris. This cleansing is done to find out the healthiest sperm that can fertilize the eggs. A perfect healthy sperm is one that is not very long and not too short either, not too fat or not too thin.
• Step 6: Fertilization: Once the sperm is washed and concentrated, it is placed in an incubator along with the eggs for fertilization. The process is very similar to that of natural fertilization where ‘sperm meets eggs’ inside a human body.
• Step 7: Embryo development: The eggs that would be fertilized by the egg would then turn into an embryo. The IVF specialist will collect the embryo, place it in a special incubator and monitor its growth for the next 4-6 days. The developed embryo would be mixed with amino acids to its growth. If the growth of the embryo is consistent, it is likely to turn into a 4-8 cell embryo by the 4th day.
• Step 8: Embryo transfer: Embryo transfer refers is a process where the developed embryo is transferred from the incubator and implanted in the uterine wall. This process is quick, does not take more than 20 minutes, and can be done at the clinic of the doctor. During the process, the woman would be asked to lie down on her back and spread her legs. The doctor will collect the embryo with a very soft, flexible, and thin catheter. Using a speculum, the doctor will open the cervix and insert the catheter through the cervix into the uterus to plant the embryo. An abdominal ultrasound is conducted to make sure that the tip of the catheter places the embryo at the best location for the embryo implantation. After the embryo transplant is over, the woman is allowed to head home.
• Step 9: Pregnancy check: The woman would be called to the clinic after 2 weeks for a blood test. If the blood test shows the presence of hCG in it, the pregnancy is successful. If the results are positive, the doctor would suggest the best pregnancy care tips to the woman and encourage her to limit strenuous physical activities. If the blood test does not show the presence of hCG, it indicates that the pregnancy is not successful. In that case, the doctor may either repeat the entire process once again or may determine another line of treatment.

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