“For the past years, IVF technologies have significantly evolved, success rates have improved greatly and more and more couples every year turn to IVF to help them conceive.
Taking in consideration constant development of the industry, it may often be overwhelming for couples to keep up with the latest information and fully grasp all available opportunities. However, knowledge feeds confidence. The more you understand your every next step the more secure you feel about your choice.
We are here to support you during your whole IVF journey, to provide you with all information you need and help you learn all about IVF process and what to expect from it”
Dr. Valeria Magomedova 
Chairman of the Board of Latvian Human Reproduction Society
Medical director and fertility treatment specialist at Your Doctors clinic
In vitro fertilization or IVF – is a process of egg fertilisation by sperm outside of woman’s body.
IVF consists of following steps:
However, there are many steps before actual IVF procedure takes place.
This guide is designed to describe these steps in detail, as well as tell you what is expected from you at each step.
Once the reasons for infertility have been identified, your fertility specialist will come up your treatment options. Many couples are surprised to learn that IVF procedure may not be the only treatment option for them. Sometimes doctors turn to IVF procedure only after other treatment methods haven’t proved to be successful.
IVF procedure may help to conceive a baby if:
- woman has problems with ovulation or quality of oocytes, blocked fallopian tubes, endometriosis
- man has problems with sperm quantity or motility
- in case of unexplained infertility
Hint: Unexplained infertility is recognised in those cases, when after all examinations, the cause of infertility has not been found. Around 10% of all infertile couples are affected by unexplained infertility.
1. Ovarian stimulation
In a normal ovulation cycle, one egg matures each month inside one of the woman’s ovaries. The purpose of ovarian stimulation is to get many eggs to increase your chances for successful result. In order to achieve that you would need to inject medications every day for about 11-14 days.
2. Follicular growth monitoring
During ovarian stimulation you would need to come to the clinic 3-5 times for ultrasound to monitor follicular growth. These ultrasounds are already included in the price of the procedure and you don’t have to pay for them separately. Depending on the results of these ultrasounds doctor may extend or shorten the time of your stimulation.
Glossary: Follicle is a – fluid-filled ”sacs” where the egg matures.
3. Trigger shot
When your doctor confirms that follicles have developed to the right amount and size, stimulation is complete. Date and time for ovarian puncture is set and trigger shot is scheduled accordingly. This last injection triggers eggs maturation and 36 hours after the injection eggs have to be retrieved. It is very important to do the trigger shot at the exact scheduled time, as the date and time of the ovarian puncture will depend on it. It is not possible to change the date or time of the ovarian puncture once trigger shot is done.
4. The day of the procedure
On the day of IVF/ICSI procedure both you and your partner have to come to the clinic. Your partner will have to deposit a sample of sperm for IVF procedure and you will have to undergo ovarian puncture for egg retrieval. If your partner cannot be at the clinic on the day of the procedure, it is possible to freeze his sperm before that and use thawed material.
5. Egg retrieval – ovarian puncture
During ovarian puncture eggs are retrieved. To avoid any kind of discomfort procedure is carried out with use of general anaesthesia. Ovarian puncture is done vaginally (it can be compared with gynaecological ultrasound), retrieving eggs with the help of an aspiration needle. This procedure is minimally invasive and most women need only a few hours to recover. If you do not experience any discomfort, you can return to your normal lifestyle the next day (unless told otherwise by your doctor).
Glossary: Eggs = oocytes.
6. Fertilisation
Once eggs are retrieved, they are merged with your partner’s (or donor’s) sperm. Sometimes sperm needs additional help in fertilization. In these cases embryologist turns to ICSI procedure. It is an assisted reproductive technology that involves direct injection of a sperm into an egg.
Fact: Did you know that, according to statistics, the percentage of successful egg fertilization is higher after ICSI than after just IVF? Nowadays, fertility specialists around the world recommend ICSI procedure for better results to all patients regardless of sperm quality.
The next day embryologist checks if fertilisation was successful and informs the couple about it.
Fact: Not always number of retrieved eggs is equal the number of successfully fertilized eggs. It depends on the quality of eggs and sperm.
7. Embryo development
Those eggs that have successfully fertilised are called embryos. They are cultivated in the incubator until 3rd or 5th day of development. Embryos development is monitored (on the 1st, 2nd, 3rd and 5th days) and marked in a special protocol. After every check-up embryologist informs a couple.
8. Embryo selection
On the day of embryo transfer embryologist selects the best 1 or 2 embryos for the procedure. Remaining embryos, if there are some, are frozen and may be used for future IVF cycles.
9. Embryo transfer
Depending on your age and clinical situation doctor will recommend 1 or 2 embryos for embryo transfer. Embryo transfer is performed by transferring embryos in woman’s uterus using special catheter. This is a short procedure carried out without anaesthesia with no recovery needed. You can return to work on the same day, however some restrictions will apply. You would need to take medications strictly according to the treatment protocol prepared by your fertility specialist. Doctor and medical staff will provide you with all essential information about what to do and most importantly what not to do after embryo transfer.
Successful implantation
If procedure is successful, embryo attaches to the uterine wall, continues to develop and becomes a baby.
10. Pregnancy test
14 days after embryo transfer you have to take blood test for pregnancy – HCG. If test result shows HCG amount higher than 1 it means than implantation was successful and pregnancy has occurred. It is not recommended to take urine pregnancy tests as they are less accurate and may show false results.
Positive result
In case of a positive result you would need to come for the US examination two weeks after pregnancy test. During this examination doctor will be able to confirm the intrauterine pregnancy. After two more weeks, doctor will be able to confirm heartbeat during US examination.
Glossary: Intrauterine pregnancy = pregnancy that is developing inside the uterus (where it should be).
Negative result
Unfortunately, IVF does not give you 100% guarantee for success. Sometimes it takes several trials to achieve a positive result. There are many reasons for that and after a few failed IVF attempts doctors suggest to do embryos genetic testing. In case if pregnancy test is negative you and your fertility doctor can start preparation for next cycle or FET and write a new protocol as soon as menstruation begins.
11. Prenatal or pregnancy care
A pregnant woman can get prenatal or pregnancy care starting from 8th pregnancy week. It lasts up until a baby is born and 6 more weeks after delivery. You can get pregnancy care at our clinic (with your IVF doctor) or in your home country.
In some cases, use of donor material is the only chance for many loving couples to become happy parents of a long-awaited child. IVF cycles with donor material are becoming more common and help thousands of couples to fulfill their dream.
Egg donation
For women, who:
- had several unsuccessful previous IVF/ICSI procedures
- have premature ovarian failure (POF)
- have a high risk of transmitting an inherited genetic disease to the child
- have ovarian exhaustion after chemotherapy or radiation therapy
- have poor quality own eggs
it is recommended to consider egg donation programs.
The first step of egg donation program is to select a suitable egg donor. Our clinic’s specialist will help you to choose a donor based on your criteria.
Egg donation in Latvia is completely anonymous. Your choice of a donor will have to be based on overall data, such as eye colour, hair colour, weight, height, body type, blood type, Rh factor, education and hobbies.
Your and donor’s cycles will have to be coordinated. You will get a protocol from your doctor to prepare for embryo transfer and the donor will be prepared for egg retrieval. You have to follow this protocol strictly or the procedure will be impossible to perform. On the day of ovarian puncture, donor eggs will be fertilized with your partner’s (or donor’s) sperm. Embryo transfer will usually take place on the 3rd or 5th day of embryo development (that is 4 or 6 days after egg retrieval accordingly). You may also choose to freeze all embryos and prepare for Frozen Embryo Transfer instead.
Sperm donation
For men, who:
- have azoospermia
- have ejaculation disorder
- have a high risk of transmitting an inherited genetic disease to the child
it is recommended to consider sperm donation program.
A woman will be prepared for egg retrieval just as she would be in IVF cycle with partner’s sperm. Our clinic’s specialist will help you to choose a donor based on your criteria. All sperm donors in our clinic are from CRYOS International – the largest sperm bank in the world. You can either choose from the donors we already have or order the material suitable for you directly from CRYOS and they will ship it to us.
Sperm donation in Latvia is completely anonymous.
Your choice of a donor will have to be based on overall data, such as eye colour, hair colour, weight, height, body type, blood type and Rh factor.
This treatment method can be also used by a single healthy woman in reproductive age.
Embryo donation
Embryo donation program is recommended in cases, when both partners have indications for using donor material.
One or two thawed donor embryos are transferred to the woman’s uterus within this program. In this case both gametes are from anonymous donors. Woman is prepared for Frozen Embryo Transfer with donor embryos according to the protocol prepared by fertility specialist.
Usually this preparation will only include tablets to take.
Frozen Embryo Transfer or FET
In case the IVF/ICSI procedure results in more embryos than can be transferred during one embryo transfer, then remaining embryos are frozen. Frozen embryos can be used for a Frozen Embryo Transfer to plan a second baby, or in case of an unsuccessful result of the previous attempt. In this case there is no need to undergo the whole procedure again (including ovarian stimulation). Your fertility specialist will prepare a FET protocol for you to get prepared for the procedure (usually includes medication, but no injections), then on the scheduled day of Frozen Embryo Transfer one or two of your frozen embryos will be thawed and placed into your uterus.
Sometimes when during ovarian stimulation OHSS is anticipated all embryos are frozen for FET and no “fresh” embryo transfer is carried out to let the woman’s body to recover from stress.
PICSI
is sperm selection method that ensures that only the best available sperm is used for fertilisation. This method is used when partner’s sperm has low fertilization potential.
Assisted hatching
is a procedure right before the embryo transfer where an opening is done in the “shell” of an embryo using a laser. Often after embryo thawing “shell” of an embryo is too thick for it to easily get out of it by itself. In this case assisted hatching is recommended to increase the chance of successful implantation.
Freezing
If IVF procedure results in more quality embryos than is necessary for transferring into the uterus, the rest of the embryos can be frozen and stored for an unlimited period of time. The chance of embryo survival after thawing is more than 95% using vitrification method. As a result, embryos that survive freezing/thawing process are exactly the same as non-frozen/thawed embryos and are able implant successfully and ensure a development of a healthy baby. Frozen embryos can be used after unsuccessful IVF procedure or after childbirth if a couple wants another baby.
Eggs and sperm can also be frozen for future use. Frozen material can be stored for an unlimited period of time that does not affect its quality.
PGD/PGS
Preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS) is testing for genetic abnormalities in an embryo before transferring it to the uterus. Testing is carried out at an early stage of embryo development, this is why this procedure is only available within IVF or ICSI programs. The main advantage of the PGD and the PGS is the ability to detect genetically defective embryos before pregnancy.
IUI
Intrauterine insemination is infertility treatment method where a sperm sample is passed into the uterus using special catheter. Only specially prepared high quality sperm is passed into the cervix. IUI may be done with partner’s or donor’s sperm. This method does not require an anaesthesia and resembles the natural fertilisation.
Embryo Glue
is a special medium which helps an embryo to attach to the uterine wall, potentially increasing a chance for positive result and is used during an embryo transfer.
According to ESHRE (European Society of Human Reproduction and Embryology) statistics the average success rate of the IVF procedure is around 35%.
Be sure to discuss with your doctor your individual chances before starting the procedure. Even though fertility specialist cannot give you a 100% guarantee for a successful outcome, doctor can still give you the approximate success rate based on the overall statistics and the experience in treating similar cases.
On average, one IVF/ICSI cycle with a woman’s eggs and a partner’s sperm costs around 3 600 – 5000 EUR with medications for ovarian stimulation. This amount may be lower or higher and depends on the amount of medications you will need for ovarian stimulation and whether you need any extra procedures.
To find out the exact amount, you have to come to fertility specialist’s appointment where doctor will develop a treatment plan including an ovarian stimulation protocol that is suitable for you.
You can calculate all costs with the administrator after the visit based on this individual treatment plan.
Sometimes stimulation is prolonged or higher doses of medication are needed during ovarian stimulation. It is not possible to foresee these extra costs in advance, so you have to keep that in mind.
To learn more about IVF costs, click here.
Advantages:
- Successful experience. First successful IVF procedure was carried out in 1977 and technology is getting more advanced every year since. It has been in use long enough to make extensive research on children who were conceived using this method. No medical problems that would be connected with this conception method have been discovered so far.
- No connection to cancer. Medical research has shown that there is no connection between medications for ovarian stimulation and cancer. In addition, the latest research, which was presented in the 2018 EIM (European IVF Monitoring) meeting, shows that children who were conceived using the IVF method are affected by cancer as often as children who were conceived naturally.
- Advanced methods. IVF technologies are constantly being improved. For example, the development of embryo freezing technology has led to an increase in the survival rate of embryos after thawing, which had a significant impact on success rates.
Disadvantages:
- Expensive and time consuming. In vitro fertilization requires expensive laboratory procedures and medications. Repeated doctor’s office visits during ovarian stimulation for US examinations require a lot of time and commitment.
- Multiple pregnancy. Since more than one embryo can be transferred to the uterine cavity during embryo transfer, the chance of multiple pregnancy is about 20%. Multiple pregnancy is often associated with risk for both mom and baby. It is important to discuss with your doctor how many embryos it is best to transfer in your case.
- Ovarian Hyperstimulation Syndrome (OHSS). OHSS can occur as a result of ovarian stimulation when woman’s ovaries react too well to stimulation medications and produce a lot of eggs. About 10-20% of women get Ovarian Hyperstimulation Syndrome, but it usually passes moderately. Your Doctors clinic has developed a special technology to reduce the effects of ovarian hyperstimulation.