In-Vitro Fertilization (IVF)

In-vitro fertilization (IVF) is a fertility treatment in which eggs and sperm are joined together outside the body, in a laboratory, to create an embryo (a fertilized egg) that is then placed into the uterus (womb). The phrase 'in vitro' is Latin for 'in glass', which is why the procedure is sometimes called 'test-tube baby' treatment.

During IVF, the ovaries (the organs that produce eggs) are stimulated with hormones so they release more than one egg at a time. Those eggs are collected and fertilized in the laboratory. If fertilization is successful, one or more embryos are transferred into the uterus a few days later, where they may implant in the uterine lining and grow into a pregnancy. Embryos that are not transferred can usually be frozen for future use.

IVF is recommended when a couple or individual has not been able to conceive naturally, or when other, simpler fertility treatments have not worked. A fertility specialist will assess the full medical picture before recommending IVF.

• Blocked or damaged fallopian tubes (the tubes that carry eggs from the ovaries to the uterus)
• Severe male-factor infertility, such as a very low sperm count or poor sperm movement
• Endometriosis (a condition where tissue similar to the uterine lining grows outside the uterus), affecting fertility
• Ovulation disorders, such as polycystic ovary syndrome (PCOS), when other treatments have not helped
• Unexplained infertility that has not responded to other treatments
• Premature ovarian insufficiency (when the ovaries stop working normally before the age of 40)
• Genetic conditions — IVF can be combined with preimplantation genetic testing (PGT) to screen embryos before transfer
• Same-sex couples or single individuals using donor eggs, donor sperm, or a surrogate (gestational carrier)

IVF may not be suitable in certain situations, and a doctor will discuss these carefully with the patient.

• Significant uterine abnormalities (such as large fibroids or a severely malformed uterus) that have not been treated
• Serious medical conditions that make pregnancy unsafe for the patient
• Very poor ovarian reserve (very few eggs remaining) combined with refusal of donor eggs — success may be very limited
• Active infections that need to be treated first

IVF is a well-established procedure, but it does carry recognised risks that patients should understand before starting.

• Ovarian hyperstimulation syndrome (OHSS) — the ovaries overreact to the hormone injections, causing bloating, abdominal pain, and in severe cases, fluid build-up in the abdomen or chest; severe OHSS is uncommon but requires medical attention
• Multiple pregnancy — if more than one embryo implants, the risk of twins or triplets increases, which carries higher risks for both the mother and the babies
• Miscarriage (pregnancy loss) — the risk is similar to natural conception but may be slightly higher in older patients
• Ectopic pregnancy (a pregnancy that implants outside the uterus, usually in the fallopian tube), which requires urgent treatment
• Egg retrieval complications — minor bleeding, infection, or, rarely, injury to nearby organs during the egg collection procedure
• Emotional and psychological stress — repeated cycles and uncertainty can be emotionally demanding
• Birth defects — current evidence suggests the risk is slightly higher compared with natural conception, though the absolute difference is small
• Premature birth or low birth weight, particularly with multiple pregnancies

Preparing for IVF usually begins several weeks before the actual egg retrieval. The clinic will give a personalised schedule, but the following steps are common to most IVF programs.

Before the cycle starts, patients and their partners are typically asked to: stop smoking, limit or avoid alcohol, maintain a healthy weight if possible, pause or adjust certain medications that could interfere with hormones or the procedure (the doctor will advise which ones), and take folic acid (a B-vitamin supplement). The egg retrieval itself requires fasting — usually no food or drink for several hours beforehand — because mild sedation or anaesthesia is used.

Standard tests and assessments done before IVF usually include:

• Ovarian reserve testing — blood tests measuring hormones such as AMH (anti-Müllerian hormone) and an ultrasound scan (USG) to count the follicles (small fluid-filled sacs in the ovaries that each contain an egg)
• Semen analysis — a laboratory examination of the partner's sperm count, shape, and movement
• Uterine cavity assessment — a hysteroscopy (a thin camera passed through the cervix into the uterus) or a special type of ultrasound to check the inside of the uterus
• Infectious disease screening — blood tests for both partners covering HIV, hepatitis B, hepatitis C, and other infections
• General health blood tests and, if needed, a gynaecological examination

The IVF cycle itself follows these main steps, though the exact order and details may vary between clinics:

• 1. Ovarian stimulation — daily hormone injections are self-administered at home for roughly one to two weeks to encourage the ovaries to produce multiple eggs.
• 2. Monitoring — the patient attends the clinic several times for blood tests and ultrasound scans to track how the follicles are growing and to adjust the medication if needed.
• 3. Trigger injection — when the follicles reach the right size, a final hormone injection (called a 'trigger shot') is given to mature the eggs. Egg retrieval is timed precisely after this.
• 4. Egg retrieval (oocyte pick-up) — under sedation or light anaesthesia, a thin needle guided by ultrasound is passed through the vaginal wall to collect the fluid and eggs from each follicle. This usually takes 20–30 minutes.
• 5. Sperm collection — the partner provides a sperm sample on the same day, or previously frozen donor sperm is prepared in the laboratory.
• 6. Fertilization — eggs and sperm are combined in the laboratory, either by placing them together (conventional IVF) or by injecting a single sperm directly into each egg (ICSI — intracytoplasmic sperm injection). The clinic monitors the fertilized eggs as they develop into embryos over the next few days.
• 7. Embryo transfer — one or more embryos are placed into the uterus through a thin, flexible tube (catheter) passed through the cervix. This step usually does not require anaesthesia and feels similar to a cervical smear test.
• 8. Luteal phase support — the patient takes hormone medications (usually progesterone) after the transfer to support the uterine lining and give the embryo the best chance of implanting.
• 9. Pregnancy test — a blood test is done about 10–14 days after the embryo transfer to check whether the procedure has resulted in a pregnancy.

After egg retrieval, patients are observed in a recovery area for a short time until the effects of sedation have worn off. After embryo transfer, no hospital stay is usually needed, and most patients return home the same day. However, the weeks following the transfer require careful attention to give the embryo the best chance of implanting.

• Rest after egg retrieval is advised for the remainder of that day; most patients can return to light daily activities the next day, but the doctor will confirm this
• After embryo transfer, most clinics advise avoiding strenuous exercise, heavy lifting, and sexual intercourse for a period of time — the team will give specific guidance
• Hormone support medications (such as progesterone, given as vaginal pessaries, injections, or tablets) are continued as prescribed until the pregnancy test and, if the result is positive, often for several more weeks
• Avoid hot baths, saunas, and prolonged heat exposure during the luteal phase (the time between embryo transfer and the pregnancy test)
• Continue to avoid smoking and alcohol throughout the process
• Attend all follow-up blood tests and ultrasound scans scheduled by the clinic
• If pregnancy is confirmed, early pregnancy monitoring — usually with serial blood tests and an early ultrasound scan at around six to seven weeks — will be arranged to check for a heartbeat and rule out ectopic pregnancy
• Emotional support is an important part of aftercare; many clinics offer counselling, and the wait for the pregnancy test can be stressful — reaching out to a counsellor or support group is encouraged
• If the cycle does not result in pregnancy, the fertility team will review what happened, discuss frozen embryo transfer if embryos were stored, and consider whether adjustments are needed for a future cycle