A Complete IVF Guide: Everything You Need to Know About IVF
1. When To Consult For Infertility?
A woman between the ages of 22 and 29 has a 25% chance of conceiving a child per cycle. At 35, the probability of pregnancy does not exceed 15%, while at 40, this probability drops to 10%.
Practically
It is advisable to consult:
- If you are under 35 years old: after 10-12 months of failed attempts.
- If you are over 35 years old: After 6 months of failed attempts.
2. First Infertility Consultation
During this first infertility consultation, your gynecologist will ask both of you (you and your partner) about the duration of your infertility, your medical and surgical history, and family history. He will also do a pelvic exam. If necessary, he or she will order more exploratory tests that include:
Hormone Evaluation
FSH, LH, OESTRADIOL, antimüllerian hormone (HAM or AMH), TSH, PRL, etc.
This is a blood test that will be performed on day 3-4 of the cycle in the analysis laboratory of the ART center. Its objective is to evaluate the ovarian reserve and eliminate a hormonal cause of ovulatory dysregulation.
Antral Follicular Count (AFC)
This is a pelvic ultrasound that will be done in the clinic on the 3rd or 4th day of the cycle. Its purpose is to evaluate the ovarian reserve by ultrasound.
Practically
Combination of the two tests: The patient goes to the laboratory to take blood samples shortly before the appointment with the AFC doctor.
Hysterosalpingography
This review is not systematic. It is done in a radiology center. Make an appointment with your radiologist on day 5 of your cycle.
The Tests Include
- Spermogram-Spermocytogram
- Migration survival test
- sperm culture
Purpose
Evaluate the quality and quantity of male gametes and ensure the absence of infection. Semen collection is carried out in the ART laboratory.
Practically
Make an appointment at the ART laboratory. Next, the technician will explain the conditions to be respected.
3. Second Infertility Consultation
The purpose of this consultation is to explain your test results, establish the diagnosis, and suggest a course of action.
If the orientation is to enter an ART protocol, the Doctor will explain your chances of success and the assisted reproduction process in a clear and detailed way. You will then discuss your file in a multidisciplinary consultation meeting so that the entire ART team can validate the decision made with you.
More information: In some cases it will be necessary to expand the medical assessment. Therefore, several consultations will be necessary before establishing a therapeutic strategy, if necessary.
4. Multidisciplinary Consultation Meeting
The clinical and biological teams are brought together for the multidisciplinary consultation meeting. Its objective is to study each file in order to validate the type of treatment appropriate for each couple.
Practically
At the end of this meeting, you will receive a letter informing you of the final choice of the type of ART treatment, which has been decided for you. This letter will explain the steps to follow. A help file will be attached to this letter. To prepare your questions, carefully read it.
5. Administrative Opening of The File
Nurse Interview
You must bring the following on the day of the interview:
- Photocopy of identity cards
- Photocopy of the birth certificate.
- In the case of ART treatment with donor sperm: the consent of the couple before a notary or judge is required.
- After the various information and explanations provided, you will have to:
- Verify that you are in agreement with the chosen ART method.
- Give your consent (or refusal) to the freezing of embryos
The nurse will then establish prescriptions for mandatory biotests prior to ART treatment.
In The Laboratory of The ART Center
With the prescriptions provided, the mandatory biological tests will be carried out before treatment:
Then, you will participate in an interview with the biologist whose objective is:
- Describe the method you selected to use and the practical progression of your attempt.
- Answer any questions you may have
Now that your file is complete, you can begin IVF or ICSI treatment.
6. IVF Process
The different stages of IVF procedures-
The in vitro fertilization (IVF) process consists of reproducing in the laboratory what occurs naturally in the fallopian tubes: fertilization and the early stages of embryonic development. It is developed in six phases:
A. Ovarian Stimulation
It consists of injections intended to ensure the growth of more follicles in the ovaries.
During treatment
The Doctor will follow the maturation of the follicles through ultrasound monitoring and biological hormonal monitoring (estradiol and LH).
B. The Onset of Ovulation
During the last stimulation follow-up visit, the doctor will decide the start date of ovulation. The trigger is decided when at least 2-3 follicles of 16-18 mm in diameter are present with an estradiol level corresponding to the number of mature follicles displayed. The onset of ovulation is induced by subcutaneous injection. The oocyte puncture will be scheduled for the morning after the activation injection.
Practically
The injection time is very precise. Example: If you trigger ovulation on a Monday night at 10:00 p.m., the ovum puncture will take place on Wednesday morning around 9:00 a.m.
C. Oocyte Puncture
Oocyte puncture is the medical act that collects the follicular fluid (containing the oocytes) in the ovaries. The sample is taken in the clinic’s operating room 32 to 36 hours after the Ovitrelle injection. The patient will then undergo a brief general anesthesia (10-15 minutes) during which the doctor will puncture the oocyte. The puncture needle will collect follicular fluid through the vaginal wall under ultrasound guidance.
The same morning, the spouse must report to the laboratory for collection at the scheduled time of the appointment. The spouse will be informed of the number of ovules punctured. In the late afternoon, the patient must leave the clinic with a companion.
D. Embryo Transfer
In the first three to six days following fertilization, one or two embryos are transferred. The embryos are gently placed into the uterus using a thin catheter. You can get back to your regular activities after this painless operation.
E. Cryopreservation
Embryos that are not transferred can be cryopreserved. They can be used later during a defrost cycle. Currently available data show that pregnancy rates with cryopreserved embryos are equivalent to a new transfer. The law allows you to store your embryos for 10 years.
In our unit and according to clearly established criteria, we prefer to have a single embryo transfer protocol to maximize your chances of pregnancy and minimize the risk of high-risk multiple pregnancies. We will talk with you about it throughout the process of your care.
F. Pregnancy Test
Fourteen days after the egg is punctured, a blood test confirms the onset of pregnancy (in vitro fertilization pregnancy test).
In the event of a negative test, the continuation of treatment is discussed with you in consultation with your doctor.
In the event of a negative test, the continuation of treatment is discussed with you in consultation with your doctor.
