In Vitro Fertilisation (IVF)

One of the oldest and still widely used extracorporeal methods of infertility treatment is standard in vitro fertilisation (IVF).

Several million children conceived by IVF are born every year all around the world.

The world's first "test-tube" baby was born in 1978. Louise Brown was born in the United Kingdom thanks to the medical team headed by Dr. Robert Edwards and Dr. Patrick Steptoe. The first IVF baby in then Czechoslovakia was born only 4 years later.

IVF is suitable especially in cases when a sufficient number of eggs is retrieved, when the spermiogram parameters are satisfactory and when the woman is young enough and is undergoing her first or second fertilisation attempt, because the percentage rate of fertilised eggs is slightly lower compared to intracytoplasmic sperm injection. In a certain number of cases, however, there is a risk of complete fertilisation failure.

Therefore, standard IVF is not recommended in the event of previous unsuccessful fertilisation attempts, a small number of retrieved eggs (less than 5), decreasing spermiogram parameters, immune-related infertility, and if the woman is older than 35 years or is suffering from endometriosis.

Standard IVF takes place in the following steps:

1. The first step is the hormonal stimulation of the ovaries. The hormones are administered by a subcutaneous injection and the growth of a sufficient number of follicles with eggs in the ovaries is monitored by ultrasound examinations.
2. Once the eggs mature, they are retrieved. The retrieval is an outpatient and minimally invasive procedure. It is performed under short-term anaesthesia and takes from 10 to 20 minutes. The surgeon uses a needle guided by a transvaginal ultrasound probe to pierce the vaginal wall and to reach the ovaries. Through the needle, the surgeon then aspirates the follicular fluid containing the eggs into tubes and sends the tubes to the embryological laboratory. The embryologist immediately identifies the eggs, places them into a culture plate with a nutrient solution, and into an incubator. Within 2 or 3 hours after the procedure, the female client may leave the IVF centre in the company of another person and may consult a physician over the phone if she experiences any problems.
3. On the day of the egg retrieval, the male client collects and delivers a semen sample after abstaining from sexual intercourse for 3 to 5 days. Abstinence is recommended to ensure the maximum possible quality of the semen (i.e. sufficient sperm number and good motility). In the laboratory, the semen sample is prepared for subsequent egg fertilisation – usually by density gradient centrifugation, washing, and active migration. While the sperms are being prepared for fertilisation, a process known as capacitation is induced when the sperm membrane is activated, the motility of the sperms concurrently increases along with their ability to bind to the zona pellucida, allowing them to penetrate through the coat layers, and to fertilise the egg. The laboratory process substitutes the natural process taking place during normal conception when the sperms pass through the cervix, the uterus and the fallopian tubes on their way to the egg.
4. The retrieved eggs and the prepared sperms are placed together in a cultivation incubator. Fertilisation takes place spontaneously as the sperm penetrates the egg.
5. After 16 to 20 hours of the co-incubation of the sperms and the eggs, the embryologist checks the fertilisation rate, i.e. how may eggs have been fertilised. A vast majority (more than 95%) of the fertilised eggs develops into the cleavage stage.
6. The embryos are then cultivated for another 3 to 6 days in the laboratory. During this time, their development is examined and recorded on a daily basis.
7. The final step is the embryo transfer when one or two embryos are introduced into the uterine cavity. It is a painless procedure. The transfer set (a thin concave catheter) containing the cultivation solution with the embryo(s) is inserted into the uterine cavity through the vagina and the cervix. A minimum amount of the cultivation solution is then applied directly in the uterus under ultrasound guidance.