The most complete and detailed process of IVF

What is the whole process of IVF? In vitro fertilization requires the whole process of checking ovulation, egg and sperm retrieval, in vitro fertilization, sperm and egg combination transplantation, hormone supplementation and subsequent observation of whether the sperm and egg combination has implanted the embryo. Each step requires strict operation. Once a mistake is made, the entire in vitro fertilization operation will fail. The actual steps of doing IVF are as follows:

1. Zoning planning of super ovulation period

Because the length of the menstrual cycle varies from person to person, and there are also differences in different cycles of the same patient, it is not easy to arrange the time for egg retrieval for IVF. Moreover, there is only one normal uterus in the cycle, and only one test tube embryo can be produced after fertilization. The pregnancy rate of transplanting one test tube embryo is very low. Therefore, it is necessary to adopt zoned superovulation to enhance and improve the ovaries, so as to achieve the goal of not being restricted by the natural cycle, obtaining multiple healthy eggs, providing multiple test tube transplants, and synchronizing the growth of progesterone with the function of the uterine wall as much as possible. The zoned super ovulation period usually involves adding GnRHa first to stimulate the body's FSH and LH to promote ovulation, and then administering HMG or FSH ovulation drugs to stimulate the development of eggs in the ovaries. The dosage of the drugs is adjusted according to the patient's response to the drugs. The number of eggs obtained will vary depending on the patient's age and the dosage of the drugs used.

2. Follicle monitoring

In order to evaluate the effect of uterine and ovarian stimulation and determine the time of egg retrieval for in vitro fertilization, intravaginal B-ultrasound is required to monitor the size of follicles, and blood tests are conducted to check the E2 value (estrogen) and adjust the dosage. When two to three or more eggs are larger than 1.8 cm in diameter, and the number of eggs larger than 1.4 cm is consistent with the E2 value, human chorionic gonadotropin (hCG) can be injected to promote egg perfection. The IVF egg retrieval is done 34-36 hours after the hCG injection.

3. Egg retrieval for IVF

The most common method of egg retrieval for in vitro fertilization is to pass the egg retrieval needle through the vaginal vault and directly into the uterus and ovaries to collect oocytes under local anesthesia and then immediately move the oocytes into a culture dish containing in vitro fertilization cell culture medium under a microscope and place it in an incubator at 37°C for shaping.

4. Sperm collection

The male sperm is retrieved on the same day as the egg retrieval for IVF. Wash your hands before collecting sperm and use masturbation to collect semen at night. The large cup provided has been tested for sterility, so you do not need to touch the rim or inside of the cup when taking samples. The collected sperm is processed by upstream and downstream method or Percoll density gradient centrifugation.

5. In vitro fertilization

4-5 hours after the IVF egg retrieval, the processed sperm and egg cells are placed in the same cell culture dish. After 18 hours of mutual cultivation, the fertilization status can be observed under a microscope. If the quality of sperm is very poor and natural fertilization is not possible, forced fertilization by microinjection must be performed (see intracytoplasmic sperm insemination).

6. Test tube transplantation

The combination of sperm and egg takes 48-72 hours outside the body to develop into an 8-16 cell stage embryo. At this time, the number of test tube embryos to be transplanted is decided based on the patient's age, previous pregnancy and the quality of the test tube embryos. Unnecessary test tube embryos can be refrigerated and stored. IVF generally does not require anesthesia. At present, test tube embryos are mostly transplanted 2-3 days after fertilization. I chose test tube transplantation 3-5 days after fertilization. The later the time of test tube transplantation, the higher the requirements for external body shaping, but the later the transplantation time is more in line with the physiology of pregnancy. At the same time, it can also naturally replace inferior test tube embryos, which can increase the pregnancy rate and reduce the rate of multiple births.

7. Growth hormone supplementation after embryo transfer

At present, we mostly use injection to give corpus luteum copper and progesterone. If pregnancy is confirmed, hCG supplementation will be switched to continue until the 10th week of pregnancy.

14 days after embryo transfer, a urine test or blood test can be performed to confirm whether the pregnancy is confirmed.