IVF Path
Step 1: Stimulation by hormonal therapy with monitoring at IVF Lebanon
In order to induce the production of mature follicles in the ovary, different drugs and hormonal medication should be administered for a certain period of time; the drugs may vary regarding to the stimulation protocol for each woman, those drugs tell the ovaries to produce several eggs. Treatment protocols may vary also, according to whether an intra-uterine-insemination (IUI) or an in vitro Fertilization (IVF) is scheduled. Most commonly the hormonal therapy during ovarian stimulation consists of hormones that occur naturally in the human body (gonadotropins). These hormones are mostly administered by intramuscular or subcutaneous injection. Egg development is monitored using ultrasound to examine the ovaries, and blood test samples are taken to check hormone levels.
Treatment protocols may vary also, according to whether an intra-uterine-insemination (IUI) or an in vitro Fertilization (IVF) is scheduled.
Most commonly the hormonal therapy during ovarian stimulation consists of hormones that occur naturally in the human body (gonadotropins). These hormones are mostly administered by intramuscular or subcutaneous injection.
Egg development is monitored using ultrasound to examine the ovaries, and blood test samples are taken to check hormone levels.
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Step 2: Egg retrieval
Oocyte or egg retrieval is a procedure that marks the beginning of the second phase of an IVF cycle. It occurs when ovarian stimulation is successfully completed.
A minor procedure in IVF Lebanon center, called follicular aspiration, is done to remove the eggs from the ovaries using a hollow needle and ultrasound images as a guide through the vagina (pelvic cavity) and into the ovary and sacs (follicles) containing the eggs. The needle is connected to a suction device, which pulls the eggs and fluid out of each follicle, one at a time.
Egg retrieval is a relatively easy procedure that takes about 10 to 20 minutes, based on the number of follicles present at the ovaries. The whole process is performed under mild sedation and local anesthesia with a recovery period of approximately an hour. The fluid containing the oocyte is aspirated into multiple tubes which are then passed to the embryologists, who empties the fluid into a Petri dish and looks for the egg, under the microscope. When the oocyte is located is removed from the mixture of follicular fluid and blood and is placed into a culture medium of specific chemical composition and proper temperature.
Women programmed for this procedure shouldn’t eat or drink anything from the previous night.
Some women may experience cramping on the day of retrieval, which usually subsides the following day; however, a feeling of fullness or pressure may continue for several weeks following the procedure.
Step 3: Sperm collection
On the day of egg collection, the husband gives a sperm sample. The semen specimen should be obtained following a 3-4 day abstinence from sexual activity and masturbation is the preferred method of collection.
The semen sample can be frozen a sample several days before the day of oocyte retrieval (fresh samples are always preferred).
After collection the semen sample is delivered to the lab where it is properly prepared for IVF. The purpose of the preparation is to isolate the motile spermatozoa from other elements of the semen and activate them in order to be capable to fertilize the mature oocytes.
Step 4: Insemination and fertilization
Several hours after egg retrieval and semen preparation, a process called insemination, will be achieved. This process consists in the mixing of the sperm and egg. The sperm and eggs are placed in incubators located in the laboratory. The sperm usually enters (fertilizes) an egg a few hours after insemination.
If the chance of fertilization is low, the laboratory staff may directly inject the sperm into the egg. This is called intra-cytoplasmic sperm injection (ICSI). Once this occurs, the fertilized eggs are considered embryos. When the fertilized egg divides, it becomes an embryo. IVF Lebanon Laboratory staff will regularly check the embryo to make sure it is growing properly. Within about 2 to 5 days, a normal embryo has several cells that are actively dividing.
Step 5: Embryo transfer
The embryos are usually transferred into the woman’s uterus the third or fifth’s day following egg retrieval. At this stage, the fertilized egg has developed into a two-to-four cell embryo or blastocyst. The whole procedure is very easy and usually takes just few minutes followed by an additional 30 minute rest period. Sedation is not required, apart from exceptional cases; however patients must have a mildly full bladder so the doctor can visualize the uterine cavity using an abdominal ultrasound.
The transfer process involves a speculum which is inserted into the vagina to expose the cervix. The doctor will clean the area with a non-toxic solution. IVF Lebanon embryologists load the selected embryos into a specially designed catheter in a small amount of culture medium. A predetermined number of embryos are suspended in fluid and gently placed through a catheter into the womb. This process is often guided by ultrasound. Once complete, the embryologist examines the catheter to confirm that all embryos were deposited to the uterus. If not, the procedure is repeated.
More than one embryo may be placed into the womb at the same time, which can lead to twins, triplets, or more. The exact number of embryos transferred is a complex issue that depends on many factors, especially the woman’s age. Unused embryos may be frozen and implanted at a later date.
The procedure is usually painless, but some women experience mild cramping.
These steps are followed by rest and watching for early pregnancy symptoms.
A blood test will be used, twelve to fourteen day after the embryo transfer, to determine if successful implantation and pregnancy have occurred.
If embryo implantation has occurred, beta-HCG hormone will be detectable in the woman’s blood at that time. This hormone is what we look for with a pregnancy test.
It is not recommended to take a urine pregnancy test after IVF treatment. The reason is that there are a lot of false negative results.
What are the risks associated with in vitro fertilization?
As with most medical procedures, there are some potential risks. The risks of in vitro fertilization depend upon each specific step of the procedure. Ovary stimulation carries the risk of hyper stimulation, where the ovaries become swollen and painful. This condition, ‘Ovarian Hyper stimulation Syndrome’, is usually rare, mild, and involves the following potential side effects: nausea, vomiting, lack of appetite, or a feeling of being bloated. More severe symptoms which occur in 1% of cases include the following:
| Severe abdominal pain | Severe nausea or vomiting | Decreased urinary frequency |
| Dark-colored urine | Shortness of breath | Around 4 kg weight gain within three to five days. |