1. What is IVF?
The medical terminology of IVF is: in vitro fertilization – embryo transfer. The process is that the female partner first uses drugs to promote ovulation, then removes the eggs from the ovaries, and the male partner removes the sperm and cultures the combination of sperm and eggs into embryos in the laboratory, and then transfers the embryos to the uterine cavity for implantation and pregnancy.
2. Under what circumstances do infertile couples need IVF?
Tubal blockage infertility; ovulation disorders; immune infertility; endometriosis; mild oligospermia in men; obstructive azoospermia; unexplained long-term infertility.
3. Steps of IVF procedure:
1. controlled ovulation 2. follicle monitoring 3. egg retrieval 4. sperm retrieval 5. in vitro fertilization 6. embryo in vitro culture 7. embryo transfer 8. progesterone supplementation after embryo transfer 9. morning urine test on the 14th day after embryo transfer to determine whether pregnancy is controlled ovulation:
Since the length of natural menstrual cycle varies from person to person and varies from cycle to cycle in the same patient, it is not easy to schedule egg retrieval. Moreover, only one dominant follicle develops in the natural cycle and only one embryo can be formed after fertilization, and the pregnancy rate of transferring one embryo is very low. Therefore, controlled ovulation is needed to enhance and improve ovarian function in order to obtain multiple healthy eggs without the limitations of the natural cycle. Controlled ovulation is the use of ovulation-promoting drugs to obtain a sufficient number of eggs in a menstrual cycle to obtain multiple embryos for transfer. There are two protocols that are commonly used in our clinic: the long protocol, in which pituitary gland regulation is started on day 20-21 of the menstrual cycle and ovulatory drugs are started on day 3 of the menstrual cycle, with the dosage determined by the physician on a case-by-case basis; and the short protocol, in which pituitary gland regulation is started on day 2 of the menstrual cycle along with ovulatory treatment. The decision to use the long or short regimen is made by the physician, depending on the individual case.
Follicle monitoring:
To evaluate the effectiveness of ovarian stimulation and to determine the timing of egg retrieval, a vaginal ultrasound is used to monitor the size of the follicles, along with a blood test for serum hormones and to adjust the dosage of medication. When two to three or more follicles are larger than 1.8 cm in diameter and the number of follicles above 1.4 cm is comparable to the serum estrogen level, human chorionic gonadotropin (hCG) can be injected to promote follicle maturation. Eggs are retrieved 34-36 hours after hCG injection.
Egg retrieval:
The most commonly used method of egg retrieval is under local anesthesia, guided by vaginal ultrasound, the needle is passed through the vaginal vault to the ovaries and the eggs are immediately transferred under a microscope to a Petri dish containing embryo culture medium and incubated in a 37 °C incubator.
Sperm retrieval:
Sperm retrieval is performed on the same day as the egg retrieval. Hands are washed before sperm retrieval and semen is retained by the masturbation method. The small cup given is sterile and the rim and the inside of the cup should not be touched during the retention. The extracted semen is processed by the upstream method or Percoll density gradient centrifugation.
In vitro fertilization:
The treated sperm and eggs are placed in the same Petri dish 4-5 hours after egg retrieval and co-cultured for 18 hours before fertilization can be observed under a microscope. If the sperm quality is too poor to allow natural fertilization, the eggs must be fertilized by microinjection (refer to intracytoplasmic single sperm microinsemination).
Embryo transfer:
The fertilized egg is cultured in vitro for 48-72 hours to develop into an 8-16 cell stage embryo. At this time, 2-3 embryos of the best quality are selected for transfer back into the uterine cavity, depending on the patient’s age, previous pregnancy and quality of embryos, and the excess embryos can be frozen for preservation. Embryo transfer usually does not require anesthesia. Our clinic uses 3-5 days after fertilization for embryo transfer. Postponing embryo transfer requires higher conditions for in vitro culture, but postponing the transfer time is more in line with pregnancy physiology and can also eliminate poor quality embryos through natural screening, which can improve pregnancy rate and reduce multiple birth rate.
4. Hormone supplementation after embryo transfer:
Currently we mostly use injections to give progesterone to support the corpus luteum. If pregnancy is confirmed, hCG is used instead to continue supplementation until 10 weeks of pregnancy.
The pregnancy can be determined by urine test or blood sampling 14 days after embryo transfer. 4. How to reduce ectopic pregnancy in IVF?
The chance of ectopic pregnancy is about 3% in IVF. Although the incidence is very low, while the embryo is placed in the uterus at the time of transfer, it is not 100% certain that the embryo will remain in situ. There is no good medical method to avoid this phenomenon, except for doing bilateral tubal ligation.
5. Do I have to have a cesarean section during IVF delivery?
Generally speaking, pregnant women who have successful IVF pregnancies often choose to have a cesarean section when choosing the delivery method because their children are not easy to come by. On the one hand, cesarean delivery can shorten the delivery process compared to normal delivery, and on the other hand, the twin rate of IVF is higher than normal pregnancy, and twin deliveries tend to choose cesarean delivery, so in general, IVF deliveries have a significantly higher cesarean delivery rate than normal pregnancy deliveries. However, it does not mean that IVF necessarily requires a cesarean delivery.
The rate of miscarriage after IVF pregnancy is slightly higher than that of normal pregnancy, so care should be taken during the first trimester to recuperate and not to exercise easily. In the second trimester, moderate exercise activities such as walking are appropriate.