The phases of the IVF cycle

The IVF procedure can be carried out both through ovarian stimulation and naturally, when spontaneously collecting the matured ovule.


IVF cycle with ovarian stimulation


I.Ovarian stimulation

The purpose of ovarian stimulation is to launch the formation and growth of several ovules. The process of ovarian stimulation is carried out through specific medication therapy. The medication to be infused is administered daily. The effect is monitored through ultrasound examinations and hormonal analyses. To evaluate the process, the doctors asses the number and the size of ovarian follicles, as well as the appearance of the uterine mucus (endometer).


II.Collecting the oocytes and the sperm

The oocytes are collected through vaginal ovarian punction with local or general anesthesia, which is guided through ultrasound. The sperm, collected on the same day, is prepared in order to remove the fluid and the unwanted cells and to choosethe best spermatozoids. In the event of surgical extraction of the sperm, the collecting is carried out under anesthesia by the urologist.


Conduct rules for female patients before the puncture and aspiration

We recommend  the female patients to avoid sexual contact during 2-3 days before planning the puncture for aspiration of the oocytes.

The evening before the punction, it is forbidden to consume food products, alcohol and to smoke. Moreover, in the morning of the procedure, chewing gum is highly contraindicated.

Please, come to the appointment with your partner. The anesthetist will provide several instructions before the puncture and aspiration, while sperm samples will be collected from your partner through masturbation in a sterile recipient.


After the aspiration of the oocytes, the patient will remain in the ward for 2-4 hours longer and will be able to go home as soon as she feels well enough. The result of the procedure, the rate of the oocytes fecundation respectively, will be communicated by phone the next day by either the doctor or the secretary. The embryo transfer will be carried out in two days from the aspiration.


III. Fertilization and cultivation in the laboratory

The ovules and the prepared sperm are put into contact and incubate for a couple of hours. In certain situations the spermatozoid needs to be infused directly in the ovule, with the aid of microhandling equipment. This technique is called introcitoplasmatic spermatozoid injection (ICSI). If the fertilization has taken place, the laboratory cultivation lasts 2-5 more days. Some embryos evolve normally, while others get defragmentated or interrupt the evolution, as a consequence of natural selection. This happens too in the event of spontaneous pregnancies. The embryos standing the greatest chances to get implanted are selected in order to be inserted into the uterus. The natural selection process continues in the uterus. Only one aut of 5 apparently normal embryos will determine the conception. The extended cultivation of embryos for more than 72 hours allows for the efficient selection of healthy embryos.  On average, 30-40% of the embryos get in the stage of blastocyst stage (normal stage of implantation), but there is the risk of having no balstocyst for the transfer into the uterus.


IV.The embryotransfer

With the aid of a catheter inserted into the cervix, the embryos are deposited in the uterus. The transfer is painless. A bigger number of transferred embryos increases the success chances but also the risk of a multiple pregnancy (twins, triplets, etc). Usually a number of two embryos are transferred into the uterus, while the additional embryos can be cryopreserved or donated. The transfer of cryopreserved embryos does no longer require all the previous stages. After the insertion of the embryos, the patient will remain in repose for two hours. Consuming of liquids is contraindicated in order to prevent the increase of the pressure on the urinary bladder. After two hours, the patient can check out and will remain in repose the following days. After this period, she can begin her normal activties again. She will have to avoid sexual contact for a period of two weeks.


V.The treatment of hormonal support

For 10-14 days, meaning in the frametime between the embryotransfer and the pregnancy test, it will be necessary to perform the administration of the medication for hormonal support (vaginal suppositories with progesterone: Utrogestan, Gestone). If no pregnancy is confirmed, you have to wait until the next menstrual cycle in order to start a new treatment. When treatments are numerous, the chances of success are lower, as they can undeline cases of infertility hard to solve.


Natural IVF cycle

IVF can be performed even without the ovarian stimulation, by only collecting the spontaneous mature ovary. However, some medication for preventing the spontaneous ovulation is administered and the cycle is monitored through ultrasound investigations and hormone testing.  In the absence of the possibility to choose the best embryo or to transfer two embryos, the chances of success are much lower. In many cases, the cycle is annulled, since no embryo is obtained. The IVF during the natural cycle is indicated for women with no contraindications or those who don’t respond to stimulation medication.