In Vitro Fertilization - I.V.F - Steps of In Vitro Fertilization - Egg Retrieval - Embryo transfer. To learn More visit www.layyous.com

2. A British Woman Delivered First Baby By IVF - Louisa Brown

3. What do we mean by In Vitro Fertilization?
Retrieval Of
Eggs From
Ovaries
Addition Of
Sperm In Lab
Dish To Make
Fertilization
After
Formation Of
Embryo In Lab
Special Media
Transformation
To Mother
Uterus

4. Idiopathic Causes
• Mainly after 2 years
of unprotected
intercourse with no
obvious cause of
infertility
Female Causes
• 1- Problems Of
fallopian tubes
obstruction, or
salpingectomy due
to ectopic
pregnancy, or
hydrosalpinx.
• Endometriosis.
• Ovulation
problems.
• Antibodies that
affects both eggs
and sperms.
Male Causes
• Defects in sperm
quantity and/or
quality
• In-ability of the
sperm to penetrate
the cervical mucus
• No sperms seen in
the semen fluid.
Genetic Diagnosis
• Pre implantation
genetic diagnosis to
rule out genetic
disorders

6. First step: Evaluation

7.  Producing many good follicles to be Fertilized.
 Short or Long protocols: Is done by daily
injections of gonadotropins.
 Regular monitoring by ultrasound scan is done.
 Following the follicular development and adjust
the dose of the injections accordingly,
 After reaching certain size, the final
maturation of those follicles is done by giving
HCG.

8.  Egg retrieval is done 34 to 37 hours post HCG injection.
 This procedure is considered as minor surgery.
 It is done under general anesthesia, using ultrasound guide.
 It takes 15 to 20 minutes. Not more than two hours are
required for the patient to recover.
 Then, the patient can leave the hospital. A needle is used to
aspirate all the follicles.
 The fluid is passed over to the embryologist, who identifies and
separates the eggs.

9.  The eggs are prepared and stripped from the surrounding cells.
 At the same time, sperm preparation is done using a special
media.
 We need from 10,000-100,000 motile sperm to be put beside
each egg in a special dish, this is called traditional I.V.F.
 It is different from intra-cytoplasmic sperm injection (ICSI, in
which we need only one sperm to be injected in the cytoplasm of
the egg)
 Which is indicated in cases where sperm is present in the testes
but the semen fluid does not contain sperm.

11. After 16 to 18 hours after the eggs, called zygotes, are fertilized,
They are cultured in special incubators to support division and
development.
In this step, if the couple has a history of certain genetic disease
and the gene that is causing that problem is identified, we may do
pre-implantation genetic diagnosis.
Grading of the embryos is done using specific criteria.

12.  The Embryos are transferred into the uterus after 2 to 5 days from the
date of pick up.
 Depending on the quality and quantity of the embryos.
 Using a special embryo transfer catheter.
 The patient is given drugs to help support the implantation procedure.
 There is no need for a lengthy hospital stay after the embryo transfer
procedure (usually one hour is sufficient).
 Residents of other countries can travel the next day if they wish.

13. Ovulation induction: Embryo
transfer
• Ovarian hyperstimulation
syndrome
• Lower abdominal pain.
• Nausea and vomiting.
• Oliguria.
• Shortness of birth.
• Accumulation of fluid in the
abdominal cavity.
Egg Retrieval
• Anesthesia complication.
• Lower abdominal pain.
• Mild vaginal Spotting as a
result of the needle used for
the pick up.
• Intra-abdominal bleeding.
• Genital tract infection.
• Intestinal injury or bladder
injury in rare cases
IVF Procedure
• In Case of Success:
• There is risk of multiple
pregnancies and its
complications.
• Risk of miscarriage.
• Ectopic pregnancy.
• In case of failure:
• There is risk of developing
depression for both members
of the couple. Do not forget
the financial burden.
Side Effects Of IVF

14. Two weeks post embryo transfer,
if the blood tests give positive
result. We can see the pregnancy
sac one week after the blood test.

15. Women's age
• Less than 35 years old (41-
43%). In our center, 65-70%.
• Between 35-37 years old
(33-35%). In our center, 50-
55%.
• Between 38-40 years old
(23-27%). In our center, 30-
35%.
• After 41 years old (13-18%).
In our center, 20-22%.
Other Statistics
• Repetition of four trials:
success rate (70-80%).
• Repetition of after three
trials: success rate (60-65%).
• If four embryos are
transferred the percentage
of success becomes 40%.
• If three embryo transfer the
percentage 35%.
• If two embryo transfer the
percentage 25%.
• One embryo carry 17%
success rate.
Other Factors
• increasing the number of
embryos transferred, the
success rate increases
• risk of multiple pregnancies
increases and miscarriage
increases
• Quality of the eggs and
sperm.
• Number and quality of
embryos

16. Other factors that play a role in the success of I.V.F:
Is there a genetic abnormality which will decrease the rate of implantation?
Is the endometrial lining of the uterus of good quality, or not?
What happens if ovulation occurs before the eggs are retrieved?
In this case we have two choices:
1 - Cancel the cycle and start again the following month.
2 - Do intrauterine insemination, if possible.
We must mention that 10 days post embryo transfer, you can do your
normal daily activity. You can travel and have intercourse 2 weeks later.

17.  Regular cycle or not.
 Semen fluid analysis
 Sometimes AMH.
 Smoking.
 BMI (body mass index) and percent of fat in the body
 Health of the tubes.

18.  Assisted Hatching.
 Intracytoplasmic morphologically selected
sperm Injection – IMSI
 Men And Women Guide to Preparing for IVF
 Treating Failed In Vitro Fertilization