IVF Explained: How In Vitro Fertilization Helps Couples Conceive

The Zona Pellucida is the envelope that protects the embryo. As the embryo grows, the Zona Pellucida becomes more and more thin so the embryo can “hatch out of it” and implant. Sometimes, the Zona Pellucida is very thick and does not allow the embryo to get out of it. In this case, it is recommended to perform a Laser-assisted Zona Pellucida Hatching, that renders the zona thinner before transferring the embryo. However, it is not recommended to use this technique on all embryos, especially the ones that are presenting a thin zona because internal cells of the embryo can be damaged by the laser shots. We at Azoury IVF clinic, perform assisted Hatching when it is necessary in a routine way, without asking the patient and without charging extra money for it.

The IVF success rate depends on the age of the woman and the cause of infertility. The success rate reaches 70% for every embryo transfer attempt in women younger than 35 years. In vitro fertilization leads to a live-birth in 90% of cases if the couple does not give up.

Embryo implantation is a very complex process involving many factors related to the embryo itself, to the uterus and to the uterine conditions. In contrast to what patients think, embryo glue is not really a GLUE, it is a substance that is added to the transfer media that is suggested to protect the embryo during the transfer process and to increase its chances of implantation. The efficiency of this substance is still debated and it does not guarantee implantation.

All recent studies show that a woman can get back to her normal life directly after transfer. She can climb stairs, kneel to catch things from the floor, drive for a long distance, take a shower, sleep in any position, catch a flight…

The goal of this step is to have a high number of eggs (more eggs = more embryos = more chances of having a baby). Each cycle, a woman generally ovulates only one egg. This egg can be of good or bad quality; it can get fertilized by the sperm or not; the embryo obtained can undergo normal early development or not; it can implant or not. Hence, when we undergo a burdensome IVF cycle, we stimulate the ovaries using hormonal injections in order to obtain the biggest number of eggs possible and have better chances in obtaining a good embryo that will lead to a pregnancy.

Definitely not! And this is a general misconception! Each day a different group of follicles starts growing in a woman’s ovaries. The recruitment of these follicles and their first phase of growth are independent from hormones. When these follicles reach a certain size, their growth becomes dependent on hormones. The biggest and strongest of these follicles starts “taking all the hormones” produced by the woman’s body and continues to grow alone while the other follicles do not have “enough hormones” and die. The injection of hormones used during ovarian stimulation saves these follicles from dying but does not lead to recruiting more oocytes from the ovaries.

Using ultrasound, the doctor can see the follicles and follow up on their growth. The follicles are not the eggs, they are the “bags” that contain the eggs and help them become competent. It is impossible to see the eggs by ultrasound. Some follicles are empty and that’s why there is very often a difference between the number of follicles seen by ultrasound and the number of oocytes retrieved during oocyte pick-up for IVF.

Thousands of clinical trials have been trying to answer this question. It is admitted that hormones that are injected during ovarian stimulation are not toxic and are unlikely to cause cancer. On the other hand it is strongly believed that hormones promote cancer in people that are suffering from it without knowing.

This is the question that no IVF specialist can answer. If we knew the cause that will lead to failure, we would have solved it before transferring the embryos. We can only make assumptions about the causes. Embryo implantation in the uterus is a very complex process and multiple factors are involved. We can monitor and control all the factors we know about, like endometrial thickness, the timing of transfer and the absence of uterine problems. Other factors like immunity are known to play a role but cannot be controlled. The majority of factors remain unknown. Whether we like it or not, we always do our best but the final outcome is in God’s hands.

IVF is a multiple step procedure. The first step, ovarian stimulation, consists in daily hormonal injections for a period that varies between 8 and 12 days. Of course injections are burdensome, but some people require taking injections daily all their life so few days of injections are not a huge deal. The second step is oocyte pick up. It is performed under sedation and it is a painless procedure. The pain after the procedure is similar to regular period pain. The last step is embryo transfer, that takes less than a minute and that does not require any sedation as it is similar to any gynecological check up.

The urine pregnancy test cannot detect pregnancy very early. The pregnancy hormone, bhcg, appears in the blood before it appears in the urine. Blood test needs at least 12 days post-transfer to detect pregnancy. So there is no point in doing a home pregnancy test before that.

Spermatogenesis requires approximately 73 days. So, the sperm that starts being produced today in the testes will be ejaculated in 73 days. So, any treatment for male fertility should be taken for at least 3 months. And any treatment or environmental factor that affects male fertility, like exposure of the testes to high temperature or exposure to toxic chemicals or hormones or even treatments, should be stopped for 3 months in order for fertility to be restored.

The first step of IVF, ovarian stimulation, requires generally between 8 to 12 days, egg pick up and fertilization using ICSI, one day. Embryos will be cultured between 3 to 5 days in the lab and then transferred. So, in general, the process requires 20 days starting day 2 of the period. It will require around 15 additional days if freeze all strategy is indicated. Freeze all strategy is when no fresh embryos are transferred. They are all frozen and transfer occurs in a subsequent cycle.

It is very rare that a couple donates his embryos. So Donated embryos are obtained from the eggs of a consenting egg donor that are fertilized with the sperm of a consenting sperm donor.

It is true that during embryo transfer after IVF, the embryos are placed inside the uterus. However, they do not implant right away and they might move to the fallopian tube and implant in it leading to an extra-uterine pregnancy.

When a woman suffers from severe ovarian failure and her AMH level is very low, lower than 0.1, the only solution possible is IVF with egg donor. Vitamins, DHEA, stem cells and PRP were all proposed to be solutions in the past but none of them has proven to be efficient. In case the woman suffering from ovarian failure is very young we can attempt to do oocyte banking and IVF before resorting to egg donation. In case the ovarian failure is a result of advanced maternal age, egg donation is the most efficient and quickest solution possible.

No one really knows whether the embryo stays in the body or is expulsed after IVF failure. The size of the embryo is in micrometers and not even millimeters it cannot be seen without a microscope so we cannot see it if it is expulsed out of the uterus. However, it is sure that if it does not implant, it will not be receiving any nutriments from the maternal blood so it will degenerate and will die.

Seeing blood or any type of discharge after embryo transfer during an IVF process does not mean that the attempt has failed. A woman can be pregnant and still see blood spotting or brown and black discharge.

Abstinence from any ejaculation is required for 3 days before undergoing semen analysis. If the abstinence is longer, sperm cells will accumulate in the epididymis, concentration will be higher but motility and quality will be reduced. While if the abstinence is lower, concentration will appear reduced but quality and motility will appear good. During the IVF process, very few sperm cells are required, so the less the abstinence the better to have the most fresh sperm cells with the best quality. Same applies when we want to do a sperm DNA fragmentation test. The less the abstinence the better.

The uterus in the body is positioned perpendicular to the cervix and vagina. So, it is horizontal when the woman is in a standing position. It can be retroverted or anteverted but in both cases it is normal and it has no effect at all on the chances of pregnancy.

Most Sunnis agree that egg donation is not permissible, while the majority of Shiite authorities consider it permissible.