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An IVF procedure

The process of IVF, commonly known as test-tube fertilization, involves removing the eggs from the woman's ovaries so that the sperm can fertilize them outside the body in a laboratory setting. The sperm can be either the man's own or donated. When the fertilized eggs, called embryos, divide after a few days, the embryo that seems to have the best quality and the greatest likelihood of pregnancy is selected and transferred into the uterus. Similar to what happens naturally after fertilization, the embryo implants into the uterine lining and continues to develop. Surplus embryos of high quality can be frozen for future use.

This is how an IVF treatment works.

Step 1: Workup
A fertility workup is required to identify the reason for your infertility before you can start IVF treatment. You are welcome to come to us for treatment, whether you had the workup with us or at another clinic. Because it is crucial that we have access to all of the results, we ask that you provide copies of your medical records. You will meet a doctor at your initial visit who will thoroughly review your medical history and make a treatment plan. After the planning, you will meet a nurse or midwife who will show you how the various medicines work.

Step 2: Hormone stimulation
During an IVF treatment, the woman is stimulated with hormone injections (follicle stimulating hormone, or FSH), which cause several eggs to mature at the same time. The woman’s own hormone production must be suppressed by another hormone to avoid too early ovulation.
There are two different types of stimulation protocols, a long and a short. During the long stimulation, a nasal spray with dampening hormones is taken for a couple of weeks before the FSH injections start. This is called the Agonist Protocol. The short variant of stimulation consists of the FSH injections and then additional hormone injections (suppressing) for about 5 days, which is called the Antagonist Protocol.
The methods can be considered equivalent in most cases, but sometimes there may be reasons to choose one over the other. Your responsible doctor determines which treatment method is best for you. 

Step 3: Egg retrieval

The hormone stimulation lasts for about 10–14 days, and during that time the activity in the ovaries is monitored with ultrasound scans and occasionally also with blood tests. When the eggs are mature, they are sucked out of the follicles using a thin needle that is inserted transvaginally and guided by ultrasound.

Pain relief is given during the procedure. The follicular fluid is handled by the embryologists in the lab, who use a microscope to look for the eggs.

The procedure takes about 15 minutes, and when finished, you can enjoy coffee in your patient room. You can leave the clinic after about an hour. Of course, your partner is welcome to attend the egg retrieval.

On the morning of the egg retrieval, the man provides a sperm sample, from which the best sperm are collected through so-called “gradient centrifugation.” If the IVF treatment is performed with donated sperm, these are thawed and prepared for fertilization on the same day as the egg retrieval.

Step 4: Fertilization
Eggs and sperm are placed together in a bowl of nutrient solution in a warming cabinet overnight, and the sperm swim to the eggs to fertilize them. In some cases, when the sperm cannot fertilize the egg on its own, a sperm is injected directly into each egg by microinjection (intracytoplasmatic sperm injection, or ICSI). Typically, 50-70% of the eggs are fertilized; this percentage varies depending on the maturity and quality of the eggs as well as the sperm.
The following day, the eggs are checked to see which have been fertilized; these then have two nucleus precursors, one from the sperm and one from the egg. Later that day, they fuse to form a single nucleus, and the fertilized egg can begin to divide. The first day, it divides into two cells, the second into four, and so on, becoming an embryo.
Here you can see our film about embryo development.

Step 5: Embryo transfer

On the second day after egg retrieval, when the embryo consists of 4-6 cells, the embryos are assessed, and the best embryo is selected for transfer. If there are many fertilized eggs, it may be beneficial to culture embryos until day 5 for transfer, when they have developed into blastocysts. Through blastocyst culture, the embryologists get more information about the quality of the embryo and can select the one that is judged to have the best chance of developing into a pregnancy. The reason why embryos are not always cultured for 5 days is that the uterus is the absolute best environment. There is always a trade-off between being able to select the embryo with the highest quality and providing the best growth environment.

The transfer is done with a thin catheter that is inserted into the uterus via the cervical canal. The procedure is like a regular gynecological examination; it takes about 5–10 minutes and is not painful.

If there are numerous high-quality embryos on the day of the transfer, surplus embryos can be frozen and used for a possible transfer in the future. Only in exceptional cases do we put in two embryos to avoid a twin pregnancy. To support the uterine lining’s ability to receive the embryo, the hormone progesterone is given for about three weeks in the form of vaginal tablets or gel.

Step 6: The wait
You can live as usual in the weeks following the return. If the pregnancy test, which is taken about 3 weeks after egg transfer, shows a positive result, an ultrasound examination is done about 5 weeks after the embryo transfer to see that it develops properly in the uterus.
If the pregnancy test is negative, a return visit to the doctor is scheduled to discuss how to proceed. It is usually difficult to determine why there was no pregnancy. The chances are assessed individually after each attempt, and in some cases minor adjustments are made, for example, to the hormone doses. Within the span of three treatments, roughly 70% of treated couples or women give birth to a child. The chance of becoming pregnant is the same throughout each cycle of treatment.

Things to consider during treatment
You can live as usual after the embryo transfer. Some women choose to take it easy, but there is no evidence that exertion or heavy lifting reduces the chance of getting pregnant. No sick leave is needed afterwards. You are welcome to exercise if you wish, but we usually advise against extreme physical exertion, e.g., long-distance running.
Tobacco, alcohol, and other drugs should, of course, be completely avoided after the embryo transfer. Drugs that are unsafe to use during pregnancy must also be avoided.

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