In Vitro Fertilisation (IVF)

During in vitro fertilization (IVF), one or more egg cells are brought together with sperm outside the body and following successful fertilisation and embryonal development the embryos are then transferred into the uterine cavity.

Various combinations of medications can be used in this process; they are known as protocols:

  • Conventional IVF
  • Mini-IVF™ or Soft IVF
  • During a natural cycle (NC-IVF)
  • Donor IVF

Which of these techniques is applied depends on various factors.

Procedure

1. Hormonal Stimulation

During conventional in vitro fertilisation, optimal hormonal conditions are created by administering medication-based treatment in advance with a relatively high number of egg cells being released. FSH or mixed FSH/LH injections are injected daily under the skin. Additional medications are necessary to avoid premature ovulation.
When a sufficient number of follicles have developed, the “trigger injection” is administered to complete the egg maturation process and to detach the egg cells from the follicular wall.

2. Egg Cell Collection

Approx. 36 hours after the trigger injection, a procedure called a follicular puncture is carried out under ultrasound guidance, and usually a short-term general anaesthetic is given. If only between 1 and 3 follicles are presented, the collection can take place without anaesthesia.
A puncture needle is used to collect fluid from the follicles with the samples, which is then sent to the laboratory. The egg cells are removed from the liquid at the egg cell laboratory.

3. Addition of Sperm via IVF or ICSI

Depending on the quality of the sperm, either IVF or ICSI is now carried out: For IVF, between 50,000 and 100,000 sperm are applied to each egg cell using a pipette. For ICSI, one sperm cell is injected directing into each egg cell. If there is no sperm in the ejaculate, then this can be collected using testicular sperm extraction (TESE).
The petri dishes with the cells are then placed in an incubator overnight.

4. Fertilisation Assessment

Bild zur Befruchtskontrolle

After 19-21 hours, the egg cells are assessed to determine how many have progressed to what is known as the pronuclear stage. It must then be decided which and how many egg cells will be allowed to develop further.

5. Embryo Culture

Depending on the age of the women, other diagnoses, and the number and course of previous cycles of treatment, a decision is made in the laboratory of how many egg cells should continue to be cultivated. This enables the embryos with the best implantation potential to be chosen and transferred a few days later. At this stage, other fertilised egg cells can be frozen for later treatment cycles.
The culture process usually lasts 2 to 3, or 4 to 5 days. A transfer on day 5 is known as a blastocyst transfer.

6. Embryo Transfer

Embryo transfer is carried out 2 to 5 days after the addition of sperm. Using ultrasound guidance, a catheter is inserted, and the embryos carefully placed into the uterine cavity. The process is usually pain-free. The administration of progesterone over the subsequent 14 days ensures optimal mucous membrane conditions for the implantation of the embryo.
Agitation and physical activity should be avoided in the phase following the transfer, e.g., intensive exercise and excessive increases in temperature. Otherwise, there are no special instructions. Sex can have a positive effect.
14 to 15 days after fertilization, a blood or urine pregnancy test will confirm if the treatment was successful or not.