The In Vitro Fertilisation (IVF) Process

Days, Steps and Procedures in the IVF Process

When In Vitro Fertilisation (IVF) is defined as “eggs are extracted, fertilized in a laboratory and returned to the uterus” it sounds quite simple.

A more detailed description begins to reveal some of the complexity of this process. During IVF treatment, eggs are surgically removed from the female partner’s ovary. In a glass dish (“in vitro”), outside the body, it is mixed with sperm. The eggs are examined 18 hours later, to see if they have been fertilized. The following day they divide into cells and these fertilized eggs, called embryos, are then placed in the women’s uterus three to five days after the removal.

It is only, however, a full overview of the steps and procedures involved in a typical 28-day IVF plan at Cape Fertility as detailed below that provides a realistic picture of the IVF process.

Day 1

The first day of your period is Day 1 of your cycle and the 28-day IVF cycle.

Day 2-3

Treatment is usually started with medications within the first two to three days of your period.

Fertility Medications

On day 2 or 3 of your cycle, you will start taking fertility medications to stimulate egg growth. These medications may include tablets or fertility injections containing FSH (Follicle Stimulating Hormone). The most commonly used medication is Gonal-F and can easily be injected by patients.

Serious side effects of the medication are rare, but the most common is enlarged ovaries. Fortunately, with modern medicine, this can be avoided in most cases.

You will also take medication such as Cetrotide to suppress normal pituitary function and prevent ovulation prior to the time of the egg collection. Possible side effects of fertility drugs are headaches, nausea, painful breasts, mood swings, bloated feeling and increased vaginal discharge. Most women have no or minimal side effects.

Day 8

Monitoring of your IVF treatment cycle through blood tests and ultrasound scans usually starts on Day 8 of the cycle.

On Day 8 you will have the first scan with your fertility specialist. Using an ultrasound scan, your specialist will be able to see the follicles containing eggs.

Day 10

On Day 10 you will have a second scan to closely monitor the development of the follicles and any reaction to the medication.

Day 12

On Day 12 you will have a third scan. If the eggs are ready for collection, you will have a trigger injection in the evening. The eggs are triggered 36 hours prior to the egg collection by using an injection called HCG (Human Chorionic Gonadotrophin) such as Ovitrelle.

Day 14

Day 14 is an important milestone, as the eggs are retrieved.

Egg Collection

The egg collection procedure is performed under sedation in our custom-designed procedure room. An anaesthetist will make sure that you will not feel anything during the procedure, but you will need to stay at the Cape Fertility for approximately 2 hours.

A transvaginal ultrasound is performed, and the eggs are extracted with a fine needle attached to the ultrasound. In our laboratory, right next to our procedure room, the follicular fluid is examined under a microscope to check how many eggs were collected.

Progesterone hormone is given after the egg collection to prepare the lining of the uterus (womb) for embryo transfer. This may be given as a vaginal gel (eg Crinone), pills inserted vaginally (eg Uterogestan), vaginal pessaries (eg Cylogest), an injection (eg Gestone) or oral tablets (eg Duphaston).

A fresh sperm sample is also collected on the same day as the egg collection, and the eggs are fertilized in the laboratory after collection.

Day 14 – 17 or 19

For the next three to five days, the fertilized eggs – called embryos – are nurtured under controlled conditions in the laboratory.

Thanks to new techniques of embryo culture, embryos can now be grown in the laboratory longer until they reach the blastocyst stage (on day 5 in the lab). This means that embryos that fail to grow can be detected and better quality embryos can be chosen for transfer into the uterus.

Better quality embryos also mean that fewer embryos – usually one or two – can be transferred with excellent success rates, while the chance of a multiple pregnancy or twins is reduced. If there are more than two quality embryos, the others are frozen (cryopreserved) and stored in liquid nitrogen to be used in future treatment cycles.

You can read more about the process and procedures that take place in our lab in our article: In Vitro Fertilisation (IVF) – What is the Process in the Lab?…

Day 17 or Day 19

Day 17 or Day 19 is a special occasion – the day the fertilised eggs (embryos) are transferred into the uterine cavity!

Embryo Transfer

Embryo transfer is a painless procedure performed in our special procedure room. A speculum inserted into the vagina allows the specialist to visualize the cervix and a thin plastic tube is used to transfer the embryos directly into the uterine cavity. To ensure the embryos are transferred into the correct place, an ultrasound scan is performed.

After the embryo transfer, the progesterone medication, as well as folic acid vitamin tablets should be continued. In addition, the doctor may sometimes recommend baby aspirin or heparin injections.

Day 28:

In a final step on the journey, a pregnancy test can be done around Day 28.

Pregnancy Test

A blood test to check for pregnancy will be performed 14 days after the egg collection.

Support every step of the way

The process of having IVF treatment is quite a journey, but when you have your IVF treatment at Cape Fertility, you will enjoy truly individualised and personalised care.

At Cape Fertility, we value each individual patient. We use patient-friendly protocols and provide you with a customised cycle sheet, describing exactly what happens on each day, and when and how each step must be completed – from what medications should be taken and when monitoring needs to be done.

This will be prepared and carefully monitored by a team of fertility experts. You will work closely with your highly qualified and well-experienced reproductive specialist. You will also enjoy the support of your own IVF co-ordinator, with a 4-year University Degree as Bachelor of Nursing (or equivalent) and many years of experience in fertility and IVF treatment.

Your IVF co-ordinator will guide you through every one of the various steps of the IVF process, plan your treatment dates and monitoring, show you exactly how the medications should be taken and answer the practical questions you may have while offering advice and support. You can meet our team of IVF co-ordinators at capefertility.co.za/ivf-co-ordinators.

All the procedures in the IVF process are done at our purpose-built premises in Claremont, in the beautiful City of Cape Town. Adjacent to our Main Reception and Staff Offices, we have an IVF Procedure Room, a modern, sophisticated Laboratory and an Embryo Transfer room. These facilities, along with our experienced team, ensure all the latest Assisted Conception Techniques, including IVF, are used with great success at Cape Fertility.

Your first step is simply to contact us by clicking here…

At Cape Fertility, we value each individual patient and we look forward to providing you with our signature individualised and personalised care.