The IVF procedure
 Stimulation of egg growth
Spontaneously, a cycling woman will ovulate only one egg each month. To increase the chance of obtaining pregnancy, an effort is made to recruit as many eggs as possible. This goal is achieved by fertility drugs (e.g. Pergonal(R), Puregon (R), Humegon(R), Metrodin(R), Gonal-F(R), Decapeptyl (R) etc). The growth and development of the eggs is closely monitored by repeated ultrasound studies and blood tests for hormone levels (estradiol and progesterone). Based on the information obtained from these tests, the optimal timing for ovulation is determined. Ovulation itself is triggered by an injection (usually Chorigon(R) or Pregnyl(R)), after which the egg retrieval is scheduled.
Egg retrieval Egg retrieval is scheduled some 32-36 hrs. after the ovulation induction. The procedure itself is performed at the hospital by a Transvaginal route. A needle, guided by ultrasound imaging, is inserted through the vaginal wall into the ovaries, where the follicles containing the eggs are punctured and aspirated. The released eggs are transferred to the lab where their developmental stage is assessed. General anesthesia is usually used for this simple procedure. The procedure takes about 10-15 minutes, and the patient can return home a few hours after it.
Sperm preparation
Sperm is obtained by masturbation. It then undergoes a series of lab procedures to prepare it for interaction with the egg.
Fertilisation
Eggs are kept in dishes to which sperm is added at the proper concentration. The dishes are kept in an incubator where the environment (temperature, humidity, gas composition) is carefully monitored. In given time intervals the eggs are assessed for fertilisation, and subsequent divisions. The fertilised egg divides into two daughter cells, which continue to divide rapidly as shown in the following photographs. This assessment is based on morphology. Hence the detailed chromosomal composition of the embryos cannot be addressed without further tests.   
Embryo transfer
Embryos that have satisfactorily divided are transferred to the uterus 2-3 days after fertilisation. This simple and painless procedure does not require sedation or anesthesia. The embryos are laden on a small plastic catheter, which is gently introduced through the cervix into the uterus. Once in the uterine cavity, the embryos are gently released and the catheter is withdrawn. The patient can return home after several hours of rest.
Follow-up
Generally, we recommend that following embryo transfer the patient should refrain from physical exertion, however, complete bed rest does not seem to be contributory. Just take it easy and hope for good news. Given the nature of cycle stimulation, we prescribe medications to support the young embryos hormonally. The presence of pregnancy is established by using a sensitive test for human chorionic gonadotropin (hCG), which is the hormone secreted by the placenta. If pregnancy is established, monitoring is continued, until ultrasound imaging allows a direct visualisation of the developing fetus.
  
Advanced Artificial Reproductive Technology
Recent years have witnessed a rapid advancement in the treatment of the "male factor", that is, those couples where the husband cannot produce good quality sperm in the required concentration. Novel techniques have been developed with which a single sperm is injected into the egg. This procedure, referred to as ICSI (Intra Cytoplasmic Sperm Injection) can accomplish fertilisation with only minimal number of viable sperm. However, ICSI is a novel procedure, and its impact on embryo and fetal development is not fully elucidated yet. | 
