For many couples, in vitro fertilisation (IVF) offers the best chance of achieving a pregnancy. IVF treatment may be recommended in a range of conditions affecting fertility, including sperm abnormalities, endometriosis, tubal damage, unsuccessful ovulation induction and unexplained infertility.
The IVF process
During the IVF process, the sperm fertilises the eggs in the laboratory (rather than in the woman’s fallopian tube). This involves placing the egg from the woman together with many thousands of sperm (typically 100,000). If the sperm profile is poor, the process of fertilisation is carried out by intracytoplasmic sperm injection (ICSI), where a single sperm is injected into each egg. Fertilisation then takes place over a number of hours in a culture dish, maintained under ideal conditions in the laboratory.
The fertilised embryos grow in the laboratory over two to five days, before being transferred into the woman’s uterus in a simple procedure called embryo transfer. This involves passing a very fine tube containing the embryo(s) through the cervix and into the uterine cavity. Usually one embryo at a time is transferred, with additional embryos stored by freezing for use in subsequent treatments.
The IVF process step by step
The active phase of an IVF treatment takes place in the first two weeks of a cycle, and involves a number of steps. Here we explain what happens in a typical IVF cycle:
Step 1: Fertility Specialist Appointment
At your consultation with your Fertility Specialist, your medical history will be reviewed, any initial tests ordered, and initial advice provided. Based on the results of the initial tests, a treatment plan will be recommended. Should your doctor recommend IVF, your doctor will explain the IVF process. The following points outlined in this IVF process step by step diagram will help you understand the IVF process timeline. This diagram relates to a typical IVF treatment cycle, known as the down regulation IVF treatment cycle, one of the most common treatment protocols for patients commencing IVF treatment.
For patients accessing genetic testing or PGD treatment cycles, review the PGD process here
Step 2: New Patient Appointments
As a new patient, you can visit the Patient Liaison Administration team in person, or alternatively your Patient Liaison Administrator will contact you to arrange your new patient appointments. In accordance with the new ART Act 2008 effective from 1st January 2010, all patients undergoing ART treatment in Victoria are required to undertake a Criminal (Police) Record and Child Protection Order check, prior to commencing treatment. The Patient Liaison Administrator will talk to you about the checks at this time and assist in the process. It is advisable to review the ART Act 2008 information on this website for all the necessary details on how to go about organising your checks. It is essential that you provide your police checks to Melbourne IVF prior to attending your counselling appointment.
These appointments can be organised over the phone or face to face, and include a:
- Counselling appointment
- New patient appointment with a nurse; and a
- Patient Liaison Administration appointment
Step 3: Mandatory counselling session
Attend a mandatory counselling session with both partners, to assist in considering any issues that may arise throughout upcoming treatment and to sign mandatory consent forms. The counsellor will explain the supportive counselling available to you during your treatment, as well as help you prepare psychologically and emotionally for treatment.
Step 4: New patient information session with a nurse
Attend a new patient information session with a nurse who will explain the IVF treatment process with you, including any specific treatment ordered for you by your fertility specialist as part of your IVF treatment. They will teach you how to administer the injections and medications, and discuss the IVF process timeline with you.
Step 5: Patient Liaison Administrator appointment
Attend an appointment with a Patient Liaison Administrator to explain the IVF costs structure associated with your IVF treatment and answer any questions that may arise.
Step 6: Preparing for treatment
Once you have made the decision to proceed with IVF treatment, it is really important that you call the Patient Liaison Administration team on the first day of your period, to organise payment, so you are ready to begin treatment without delay. The Patient Liaison Administrator will organise for you to speak with a member of your nursing team, who will co-ordinate your treatment.
Step 7: Treatment Begins
To commence your IVF treatment, call the nurses to advise of day 1 of your period. The nurses will provide information on beginning the oral contraceptive pill (OCP) on day 5 of your period. The nurses will then coordinate the dates of the remainder of your IVF treatment plan.
Step 8: Down regulation medication begins
Down regulation medication is used to suppress your own natural hormones (referred to as down regulation) so that we can control the IVF cycle. When the Follicle Stimulating Hormone is introduced and the eggs start to grow it will stop them from being released naturally. This medication is continued until the trigger injection two days prior to egg collection.
Step 9: Hormone Stimulation
Once we have confirmed ‘down regulation’ of your own hormones through a blood test, the 'stimulation phase' of IVF treatment can begin.
The FSH injection is a synthetic hormone that is self administered, which stimulates development of ovarian follicles (think of a small sac that holds the eggs). The nurses will have shown you how to administer these.
Naturally there will be a number of follicles that are receptive to grow every month but only one reaches maturity. By administering a higher dose of FSH than is naturally produced each month, we are able to recruit some of those follicles that wouldn't normally grow to maturity.
Step 10: Treatment Monitoring
Throughout your IVF treatment we monitor how you are responding to medication with blood tests and ultrasound scans, to measure the endometrial thickness, size and number of follicles on both ovaries. Based on this information your fertility specialist will determine when you are ready for egg collection.
Step 11: Trigger Injection
Once you have the optimum number and size of developed follicles you are ready for the trigger injection. The role of the trigger injection is to trigger the final maturation of the eggs ready for your egg collection. The nurses advise you two days before your egg collection of the exact time that you are required to administer the trigger injection. This is usually 37 hours before egg collection.
Step 12: Egg collection-day surgery
The egg collection procedure - in other words the IVF egg retrieval process - is undertaken in a day surgery unit under an anaesthetic and the procedure takes around 30 minutes. You will be at the hospital for around 4 hours and will need someone to drive or escort you home afterwards (don’t plan to work that day). The procedure is performed using an ultrasound guided probe. Attached to the ultrasound probe is a needle guide through which the fine needle passes through the vaginal wall into the ovary and draws the fluid (and egg) from the ovary. The tube containing the follicular fluid is then immediately passed to the Melbourne IVF laboratory and checked to ascertain whether it contains an egg.
On the morning of your egg collection your partner will need to provide a fresh semen (sperm) sample (unless using frozen sperm) so we can inseminate your eggs after collection.
Step 13: Fertilisation
Following egg collection, if you are having IVF treatment the egg and sperm will be placed in a dish allowing fertilisation to occur.
If you are having ICSI treatment, an embryologist will insert one single sperm directly into the egg, allowing fertilisation to occur.
Step 14: Embryo Development
The day after egg collection a representative from the embryology laboratory will contact you to let you know the time for embryo transfer the following day.
The embryos will grow under the care of the embryologists for normally two days. Any extra suitable embryos will be frozen for future use.
Step 15: Embryo Transfer
The embryos are returned to the woman’s uterus in a procedure called an Embryo Transfer, a simple procedure similar to a pap smear, performed by a Fertility Specialist.
No anaesthetic is usually required for the procedure, which involves a speculum being inserted into the vagina, and a narrow (2-3mm diameter) soft tube called a catheter, gently passed through the opening of the cervix.
Step 16: Embryo Freezing
Any additional embryos that are not transferred during an IVF treatment cycle, and are suitable for freezing, can be frozen for future use.
Melbourne IVF normally grows embryos in the laboratory for 2 days after egg collection, and because of this most women (almost 60%) will also have embryos frozen. In women <36 years of age, three quarters will have embryos frozen. Using methodology developed at Melbourne IVF, 95% of embryos will be suitable for transfer once thawed. An alternative method of growing embryos for 5 days (known as blastocyst) to suit the needs of some patients.
For more on IVF success rates and IVF statistics click here.
Step 17: Pregnancy blood test
A pregnancy blood test will be organised for two weeks (14 days) following embryo transfer.
A blood test is the only reliable pregnancy test, as urinary pregnancy test kits can provide a false reading due to the hormone medication used in IVF treatment.
Should the pregnancy test be positive, the nurses will organise an appointment with your Fertility Specialist for an ultrasound scan normally at around 6 weeks.
Once a positive pregnancy test is confirmed, you should be reassured that your pregnancy is medically no different to a naturally conceived pregnancy.
IVF treatment with minimal disruption
At Melbourne IVF, your fertility specialist does all he or she can to give you the best chance of a successful pregnancy while minimising the disruption to your everyday life. Careful research and practice have demonstrated that minimal monitoring is a safe, patient-friendly and highly effective approach to IVF treatment.
Information about IVF treatment medication and procedures
Medications and treatment procedures of IVF treatment, and their treatment cycle protocols will be prescribed by your fertility specialist. For existing Melbourne IVF patients, a step-by-step guide to the different cycles, including Antagonist, Down Regulation and Flare treatment cycles, can be found in the fertility forum section of the website.