In vitro fertilization consists of 5 phases. The first phase of in vitro fertilization includes initial interview and examination at Day 2 or 3 of menstruation and workup that is planned in the light of examinations and interviews. The initial examination and assessment are associated with an ultrasound scan. If ultrasound imaging shows no ovarian or uterine problem, which would, otherwise, contraindicate therapy, hormone profile of the patient is analyzed. When it is decided that it is the right time for beginning the in vitro fertilization treatment, personalized treatment is selected with reference to age of female subject, etiology of infertility, blood test results and ovarian characteristic, and time to start controlled ovarian stimulation is planned. In this end, the woman starts taking pills regularly. Ultrasound is scanned and serum hormone profile is analyzed at pre-determined intervals in order to evaluate response to treatment and the maturation of egg, after medicines are used.
Maturation of Egg
As diameters of follicles are measured in ultrasound scans at particular intervals and serum estrogen values reach particular level, significant details are obtained about the maturation of eggs. The time of hatching injection is determined according to maturation status of ova. Medicines are used approximately for 8 to 14 days. However, this period shows interpersonal variations. Egg pickup (OPU) is started 32 to 36 hours after the hatching medicine is injected.
Oocyte Pick-up (OPU)
For in vitro fertilization, OPU (oocyte pick-up) is done under sedation anesthesia (a status of sleep) in order to ensure comfort and suppress pain. The fluid inside the follicles are harvested into a tube under transvaginal ultrasound guidance and immediately transferred to the embryology laboratory. Oocyte is searched in this fluid under microscope. The existing oocytes are picked up from the follicular fluid. The patient is allowed to rest for 1 to 2 hours and discharged to home after the procedure.
Fertilization Procedure
Mature oocytes that can be fertilized (metaphase 2 oocyte) are selected. They are fertilized with sperms of male subject in oocyte pick-up day at laboratory settings. Fertilization is performed in two ways. First one is conventional IVF, where sperm and oocyte are left in the same environment and spontaneous fertilization is waited. The other is the microinjection method (ICSI - intracytoplasmic sperm injection). Best sperms are selected with specific methods under microscope and they are injected into the oocyte. Maturation is followed up at daily intervals to ensure growth of the embryo. Embryo(s) with best growth are monitored in a specific culture environment until they are transferred to the womb.
Embryo Transfer
Embryo transfer is pain-free procedure, which does not require anesthesia. Embryo(s) is/are drawn into a thin catheter and transferred to the womb with abdominal ultrasound guidance. Patients are allowed to rest for 1 to 2 hours after the transfer, before they are discharged to home. If the patient has rest embryo with good quality, they are frozen for long-term storage.
Waiting Period
Serum pregnancy test is analyzed two weeks after embryo(s) is/are transferred to the womb of the mother. The expectant mothers should be ready for a challenging and stressful period. Successful outcome is not always the case following such as a long and exhausting treatment. It is very important to be prepared in advance. Many research have shown that the highest success rate is obtained in the second and the third attempts.
The In Vitro Fertilization implies fertilizing a human oocyte with a human sperm at the laboratory settings and transferring the resultant embryo into the womb.
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