In vitro stands for any biological procedures performed outside the organism it would normally occur in.
In vitro, is the Latin phrase for in glass. This relates to early research of tissue cultivation outside the living organism from which they came and were carried out in glass containers like petri dishes, beakers and test tubes.
In vitro fertilization is usually executed within shallow dishes called Petri dishes, different from tube-shaped containers of glass or plastic resin from which “test-tube babies” came from.
In vitro fertilization (IVF) is used to overcome female infertility due to problems in the fallopian tube. It can also aid in male infertility, when there is a defect in sperm quality. For a successful IVF, it commonly requires a healthy ova (egg cell), sperm that can fertilize, and a uterus that can maintain pregnancy. This gives chance for a woman, who had gone through menopause, to conceive.
Given our advancement in reproductive technology, IVF success rates considerably improved compared to a few years ago. There was a time implanting multiple embryos, in hopes one embryo will stick and complete pregnancy states, led to risk of multiple births and health defects. At present, doctors can by far identify the fittest embryo for a single implant.
According to statistics, the worldwide quoted success rate of a conventional IVF cycle is approximately 40%.
Just like a woman’s monthly cycle, no two women will have exact IVF protocols. What is given here is timeline and information of a typical IVF cycle, which can vary to some degree. The cycle will roughly take 8 – 10 weeks from beginning to end.
The IVF cycle begins with the woman taking birth control bills for 14 – 21 days. It seems counterproductive but this is necessary to get some precise hormone control in the cycle before the actual IVF cycle. Some women might not be given birth control pills. Intake will highly depend on the doctor’s recommendation.
Next step will be taking Lupron / Antagon / Cetroride for 12 – 15 days at the start of the recommended IVF cycle. These medications work by shutting down or controlling ovaries to prevent premature ovulation. Follicles, when stimulated will ripen.
The start of many ultrasounds will begin here, to check ovary size and search for any ovarian cysts. Ultrasound may also be used to measure uterus lining.
During this phase, the doctor will keep an eye on growth and development of follicles the ovaries are producing. This is important to aid the doctor to make a decision whether medications need to be increased or otherwise in dosage. This may take about 7 – 12 days.
The trigger injection is a crucial point. The injection brings on the egg’s maturation. It loosens the egg’s attachment from the follicle wall and allows suitable instance of egg retrieval. If the doctor sees eggs not maturing properly or he feels too many follicles maturing, IVF cancellation may happen.
Egg retrieval usually takes 34 – 37 hours after the trigger shot. Once the woman is relaxed and comfortable (possibly with sedative or anesthesia) a trans-vaginal ultrasound will be used to guide a needle to the ovaries and remove fluid and egg from the follicle. Fluid and eggs are passed to the embryology lab and placed in plastic culture dishes and kept within IVF incubators under controlled environmental conditions.
One or more of the eggs will be placed back in the uterus (embryo transfer), after eggs and sperms were watched and cultured in the IVF lab for 3 – 5 days. By day 5, embryos are now called Blastocysts (a structure formed in the early development of vertebrates).
Progesterone supplements typically begin on the day of the day of egg retrieval and before embryo transfer. This will help compensate for medications used to control hormones heavily during the IVF cycle. Progesterone is necessary to support a pregnancy. This supplement can be administered via injection, pills, vaginal gels or suppositories, depending on what the doctor prescribed. Progesterone supplements intake will last at least 2 weeks.
Between 9 – 14 days after the transfer, the clinic will call for a blood pregnancy test. Home urine pregnancy tests are not advised as they may pick up remnants of the trigger shot and give fake positive results.
If results are positive, the doctor will continue administering progesterone supplements and closely monitor the patient with additional blood work and ultrasound.
If results are negative, the doctor will stop progesterone intake so period can arrive.