If we cannot conceive naturally, it’s good to know which options we have in the world of artificial reproduction treatments (ART).
When we are confronted with the fact that we are not able to have a child in the natural way, we are directed to a fertility center. At the clinic it’s easy to get overwhelmed with all the new information we have to take in. As beginners, we didn’t even know which are the ways to consider or what are the differences between the different forms of fertility treatments. The most commonly known fertility treatment is IVF, but it’s not the only one. But which are real options for us, and which direction should we take?
"We also have to talk about the classic in vivo fertilization. Simply put, have sex because anything can happen at any time."
The first two are relatively simple solutions to treat infertility, such as Planned Intercourse and Artificial Insemination.
The simplest fertility treatment is called Planned (or Timed) Intercourse. In this procedure a mild ovarian stimulation can be involved, promoting the growth of 2-3 follicles ideally. If the follicular growth is optimal (the doc checks it though ultrasound), ovulation can happen naturally or can be provoked by a trigger injection. By the end of the process the doctor will determine the days when it is most recommended to be together (have sex). This is a relatively natural fertility solution with some extra help. I think it’s an option for couples with good test results.
The second option is Artificial Insemination. The treatment starts with hormonal ovarian stimulation, and followed by a trigger injection. Even the most fertile days are determined by the doctor. However, the fertilization doesn’t take place by natural intercourse. By the end of the stimulation phase the male partner is asked for sperm collection. Sperms that have been washed and concentrated are placed directly in the woman’s uterus, cervix or fallopian tubes around the time the ovaries release one or more eggs to be fertilized. Insemination is usually recommended when everything is fine with the sperm and the woman’s fallopian tubes (or at least one of them) are permeable. The procedure is completely painless, it’s less expensive compared to IVF, but the success rate is lower: only 15-20%.
The next option is IVF (In Vitro Fertilization), which I think is the most known fertility treatment type. The main difference compared to the previous treatments is that the fertilization happens outside the body – ‘in vitro’ means ‘in a test tube’. The procedure is longer, more expensive, more complicated and involves a higher hormonal load than insemination.
What are the main stages you are going to undergo during an IVF treatment?
- Ovarian Stimulation. The goal of ovarian stimulation is to achieve multifollicular development by administering daily hormone injections, hoping more follicles, more eggs will be available for fertilization. There are several different medication protocols in use to achieve this. In the case of short protocol, the stimulation starts on Day 2 or 3 of the menstrual cycle, and takes about 7-11 days. The long protocol can take up to 4 weeks. It starts on Day 20 of the menstrual cycle with a 10-day long medication which helps to shut down the ovaries first. In step two the same ovarian stimulation starts as in the short protocol.
- Trigger Injection. If the follicles are sufficiently mature, the Trigger helps the growth and maturing of eggs.
- Egg retrieval, and Sperm Collection. 36 hours after the Trigger Injection the Egg Retrieval is going to take place. Using ultrasound, the fluid containing the eggs is collected from the follicles through the vagina with a needle. At the same time sperm is collected from the male partner.
- Fertilization. After collection, the eggs and sperm are cleaned in the embryologist’s laboratory, then a group of sperm is put together with the eggs to be fertilized. Practically the same thing happens in the incubator as in nature. There is no special intervention, they just organize a date between the eggs and sperm.
- Embryo development. The fertilized eggs spend 3-5 days in a special incubator at the embryology lab. The embryo divides and multiplies its cells. The embryologist selects the most viable embryo(s) for transfer by the end of the process.
- Embryo transfer. 3-5 days after fertilization, the most viable embryos are transferred back to the uterus with a simple, quick and painless procedure.
- 2-week-wait. The time period from embryo transfer to pregnancy test. If all goes well, implantation takes place during this time, and the embryo attaches to the uterus lining and continues its development there.
It’s also good to know about ICSI (Intracytoplasmic Sperm Injection), as a special type of IVF treatment. It is practically one of the methods used in egg fertilization. It is usually recommended when sperm quality is not the best, or only a few eggs are available for fertilization. During ICSI procedure the embryologist selects the most beautiful and healthiest sperm and injects it directly into the egg. This can increase the chances of successful fertilization.
We also have to talk about the classic in vivo fertilization. Simply put, have sex because anything can happen at any time. We can meet a million wonderful stories; I also have several close friends who once had a baby arriving magically. Yet they had a paper about that impossibility. Never give up!
