How long is the IVF process from start to finish?
In general, an IVF treatment includes two major parts. The first part involves the stimulation of the ovaries. This lasts approximately 12 days and is completed with the egg-retrieval. The next part is the creation of the embryos in the laboratory, their growth and the final embryo transfer. This phase will last approximately 5-7 days. An average number of 18-20 days is needed to complete a full round of IVF. However, this does not mean that you need to stay this long when travelling for treatment. With flexible, personalized protocols, a woman can start her treatment in her home country and only travel to abroad when she is ready for the next step of the treatment. This can reduce the amount of time that you stay abroad, to 10 days.
Do I need to take a lot of time off from work during this process? If yes, what for?
Most women will continue their normal, daily routine throughout their IVF treatment. During the monitoring phase of treatment, medical appointments can be scheduled in a way where they do not interfere with work or other activities. However, you will need to take some time off work for the egg-retrieval procedure as well as the embryo transfer. Moreover, most women prefer to stay home for a couple of days after the embryo transfer.
What are the chances of IVF working the first time around?
IVF is a medically-assisted technique of reproduction and, as any medical procedure, it cannot guarantee success. IVF success rates vary between age-groups and depend on individual characteristics of the couple as well as accompanying fertility problems. In general, women below 35 have the highest success rates overall.
What are the potential side effects of undergoing IVF?
IVF is a safe and effective medical procedure. Women who undergo IVF will need to receive medication for ovarian stimulation but also luteal support. This type of medication may cause potential short-term side effects, including bloating, bruising from injections, breast tenderness, nausea, mood swings and/or mild pelvic pain. These symptoms are temporary and subside after the completion of your treatment. Remember that so far there is no evidence that IVF treatment is associated with long-term health effects.
Is there anything I can do to enhance my chances of a successful cycle?
All couples will invest their time, emotions and financial resources on IVF and its success. As all investments, you should be prepared and organised. Simple advice before you start your journey with IVF is improve daily routine and lifestyle. Maintain a healthy weight by improving diet and exercising regularly, quit smoking and reduce stress-levels. Optimize sleeping time and look into specialized supplements. Finally, find guidance from a specialized fertility clinic and be persistent.
How many eggs are you trying to produce through stimulation?
The main target of ovarian stimulation is to recruit and retrieve a cohort of oocytes. Collecting an adequate number of eggs will maximize success rates and will increase the pool of available embryos. A normal response will vary between 8-14 eggs per cycle of stimulation. For women below 35, this number will offer the optimal live-birth rate per transfer. However, for women above 40, the number of eggs required may increase due to age-related factors.
What does Day 3/5/7 transfer mean?
During the laboratory phase of an IVF cycle we perform a daily monitor of the embryo quality. We consider as Day 0 the day of the oocyte pick up and the day that we apply the insemination method (conventional IVF or ICSI).
On day 1 the laboratory staff checks for the morphological signs of fertilization and the proof of the creation of an embryo. The following days we expect these embryos to develop through continuous cell divisions. On day 2 we observer the first cleavages and embryos have an average of 4 cells (these cells are called blastomeres). Accordingly, on day 3 we see embryos with approximately 8 cells, on day 4 an embryo called Morula and finally on day 5 or day 6 we expect to see the famous Blastocyst, an embryo with almost 200 cells and a cavity that pumps over time.
At some point the IVF lab, the IVF clinician and the patients discuss when the embryo transfer should be performed. The most common practice is to perform embryos on day 3 or on day 5 of development. On day 3 we choose the embryos that have a good cell number and our preference goes to those that have a symmetry on their divisions. On day 5 we transfer embryos that have many good cells in both outer and inner part of the blastocyst and we like to give a priority to those that have a more expanded cavity. Both approaches are correct, there is no right or wrong in these situations. There is a trend towards Blastocyst transfer, it has become the holy grail of embryology, but still not all cases are the same. The decision that we are going take will be the result of the interaction between the lab, the clinician and the patients.
Although unlikely to happen, the past few years we’ve seen many scientific groups reporting that they achieved viable pregnancies after transferring embryos which became blastocysts after 7 days of culture (day 7). It has been shown that 5% of human embryos could become blastocyst on day 7 and that we shouldn’t discard them on day 6.
Why would a round of IVF not work?
The outcome of IVF may depend on variety of factors. These may be related to age as well as physical characteristics of the couple. A detailed and thorough investigation before starting IVF will help avoid obstacles during your treatment. Cases associated with embryological development, uterine function, hormonal and metabolic problems are only some of the factors that may affect the final outcome.
Who is IVF NOT for?
The decision for IVF should be made after appropriate medical evaluation. Some couples will not require IVF to start their family. In certain cases, simple adjustments may change their prognosis. Your doctor’s advice will depend on the problem you are experiencing. Some problems can be treated surgically while others may require a pharmaceutical approach.
Michalis Kyriakidis, MD, MSc Gynecologist in Assisted Reproduction, Head Doctor of International Dpt, Embryolab Fertility Clinic
Achilleas Papatheodorou PhD, MMedSc.
Sr Clinical Embryologist, ESHRE certified,
Lab Director, Embryolab Fertility Clinic
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