IVF, IVM, ICSI & Frozen Embryo Transfer

IVF, IVF with ICSI, IVM and Frozen Embryo Transfer
updated Feb 12, 2009

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IVF - In Vitro Fertilization is a last resort for many couples. Most couples starting IVF have already been through long months of trying to conceive naturally, failed IUI - Intra Uterine Insemination - cycles, multiple tests, a lot of frustration and disappointment.

This article discusses the following topics:

What is IVF?
What is the process of IVF?
What is IVM - in vitro maturation?
What happens if there are 'left over' embryos - information about Frozen Embryo Transfer

What is IVF?
In Vitro Fertilization (literally, fertilization in glass) is a procedure during which the egg, instead of being fertilized in the woman's fallopian tube, is fertilized in a test tube or petri dish. When minimal sperm is available, frequently ICSI - intracytoplasmic sperm injection - is performed.

How is IVF performed - what's the process?

Step 1 - Preparation
Both partners go through a variety of tests. These vary from one medical center to another, but often include hormone tests for the woman, AIDS and other tests for both partners and a sperm analysis for the man.

The medical center decides on a treatment plan -- how the egg production will be stimulated in the woman and when it will begin (on what day of the woman's cycle). This is what is referred to as your IVF protocol.

Frequently Lupron (also known as decapeptyl) is used to help the doctors take full charge of your hormones. It depresses your natural hormones, making the medication the sole source of ovarian stimulation.

Egg production is stimulated using hormones (e.g. Pergonal, Repronex, Fertinex, Follistim, Gonal F, Novarel, Ovidrel, Pregnyl, Profasi, and Menogon and Puregon), with the goal being to produce a "good" number of eggs to help increase the chances of having several viable embryos. (Good is defined differently in different medical centers). When too many follicles begin to ripen simultaneously, it raises the risk for OHSS (ovarian hyperstimulation syndrome).

The stimulation of egg production takes anywhere from several days to close to two weeks. During this time the woman is monitored closely using ultrasound and blood tests. It is very common to make changes to the IVF protocol during the stimulation process.

What you feel: You may feel swollen or bloated from the multiple follicles that are growing. You may feel irritable or have other symptoms as a result of the hormone injections and you may feel anxious about the egg retrieval process and the success of your cycle. Many clinics now offer support groups for their patients.

Step 2 - Ova or Egg Aspiration / Retrieval
Once the eggs are ready, they are aspirated or retrieved using a needle that goes through the vaginal wall and into each follicle.

This procedure is generally performed using light general anesthesia. It usually takes less than an hour from the beginning of the preparation until the woman wakes up from the anesthesia.

What you feel: After the procedure, you may feel some discomfort and you may continue to feel bloated. If you feel any significant pain or change in your general feeling, it is important to report them to your doctor or medical center.

The man is asked to give a sperm sample. He may be asked to come in with it in the morning or may be ushered to a private room... (see information about giving a sperm sample)

Step 3 - Fertilization
The lab evaluates the ova and the sperm and decides how to proceed. The end result is hopefully embryos.

Depending on the local policy, you may have information about the number of embryos as early as the following morning.

If the protocol calls for ICSI - Intracytoplasmic Sperm Injection - it is perfomed at this time. ICSI is generally used in cases where the sperm quality is very poor and fertilization would not occur naturally, such as in cases of poor (or lack of) motility. An individual sperm is selected and injected into the egg.

The initial fertilization rate is not always the number of embryos that will be available for transfer. Some eggs fertilize and then do not continue to divide properly. Depending on the decisions made at your particular medical center, only embryos of a certain quality level are recommended for transfer.

Step 4 - Embryo Transfer
Once the embryos are formed and have started to grow, it's time to put them where they belong - in the uterus.

One or more embryos are transferred to the woman's uterus using a catheter. The process is similar to IUI (intra-uterine insemination) and is usually painless. You may be asked to empty your bladder before embryo transfer. You may also be offered photos of your embryos.

Step 5 - Waiting
Maybe one of the hardest parts of the whole process. The two-week wait. It might only be two weeks, but it seems like at least 2 months.

Support in the form of progesterone suppositories or injections may be given. This helps keep the progesterone levels high, to increase the chance of a pregnancy being established.

See early pregnancy signs and symptoms for more information.

Related stories:
Rachel's story - IVF, Frozen Embryo Transfer
Natalie's story - IVF, ICSI
Elaine's story - IVF
Beth's story - IVF
Janah's story - IVF
Helen's story - IVF, ICSI, Frozen Embryo Transfer
Kelly's story - IUI, IVF
Jackie's story - IVF, Frozen Embryo Transfer
Lynn's story - IVF after breast cancer
Mandy's story - 6 failed IVF cycles
Pauline's story - IVF with aspirated sperm
Lia's story - IVF, Frozen Embryo Transfer to surrogate
Fiona's story - IVF, Frozen Embryo Transfer, IVIG
Maya's story - IUI, IVF
Mia's story - IUI, IVF
Cassidy's story - IVF, adoption
Dawn's story - IVF, FET
Sarah's story - IVF, FET
Amanda's story - IVF, FET
Kristina's story - IVF
Bethanne's story - IVF, FET
Dina's story - IVF
Shah's story - IVF

IVM - In Vitro Egg Maturation

A variation of IVF in which the procedure of stimulating egg production is reduced to approximately three days. The ova are harvested when they are not yet matured & are then matured in a laboratory.

This method is not widely accepted and is recommended particularly for women who suffer from PCOS - polycystic ovarian syndrome - and are at higher risk for OHSS - ovarian hyperstimulation syndrome.

Also see my blog entry about IVM.

Frozen Embryo Transfer

When excess embryos are not transferred, they can be frozen for future cycles.

In a Frozen Embryo Transfer cycle, the uterine lining may be prepared using hormones or the transfer may be performed using a natural cycle.

The embryo(s) is/are thawed and transferred to the uterus in the same process as step 4 above.

It is said that frozen embryos are less successful than fresh embryos, however some women who have been successful with frozen embryos feel that some factors actually make it more likely to succeed:

The preparation stage, which is emotionally draining, is much simpler
There is no egg retrieval process -- another high-stress point

Related Stories:
Rachel's story - IVF, Frozen Embryo Transfer
Helen's story - IVF, ICSI, Frozen Embryo Transfer
Jackie's story - IVF, Frozen Embryo Transfer

More information about IVF - BabyCenter - Fertility treatment: In vitro fertilization

Disclaimer: Information on this page is provided as a service to Fertility Stories visitors and is not to be viewed as medical advice.