In Vitro Fertilization (IVF / ICSI)
In vitro fertilization (IVF) is one of the most effective assisted reproduction treatments for couples who face difficulties conceiving.
This method has been used for decades and has helped millions of couples worldwide have a child.
Today, with modern IVF and ICSI techniques, treatment is tailored to the needs of each couple, significantly increasing the chances of achieving pregnancy.
What is in vitro fertilization (IVF)?
In vitro fertilization (IVF) is an assisted reproduction method in which eggs are collected from a woman’s ovaries and fertilized in the laboratory with sperm. After fertilization, the embryos are cultured for a few days and then one or more are transferred to the uterus, with the goal of implantation and pregnancy.
Depending on the characteristics of each case, fertilization may be carried out either with the conventional IVF method or with intracytoplasmic sperm injection (ICSI), in which a single sperm is injected directly into the egg.
The choice of the most appropriate technique is made after evaluating the couple’s history, the woman’s age, and the results of the necessary tests. The aim is always to select the treatment that offers the best chances of success with the safest and most personalized approach.
What is the ICSI method?
The ICSI method (Intracytoplasmic Sperm Injection) is a specialized in vitro fertilization technique in which a single sperm is injected directly into the egg with the help of a microscope and specialized micromanipulation in the embryology laboratory.
This technique is mainly used in cases of male infertility, when there is a low sperm count, reduced motility, or problems with sperm morphology. With ICSI, the chances of fertilizing the egg are increased, even when the sperm presents significant difficulties.
ICSI vs IVF
Unlike conventional in vitro fertilization (IVF), in which eggs and sperm are placed together in a special culture medium so that fertilization occurs naturally, in the ICSI method the embryologist selects a single sperm and injects it directly into the egg.
The choice between IVF and ICSI is made by the physician and the embryology team after assessing sperm characteristics, the couple’s history, and the results of previous IVF attempts. The goal is to select the method that offers the best chances of fertilization and the development of healthy embryos.
How is in vitro fertilization (IVF) performed? – The step-by-step process
In vitro fertilization is a process carried out in consecutive stages. Each stage of treatment is designed individually, depending on the woman’s age, medical history, and the causes of infertility. Although each treatment may vary slightly, the basic IVF process includes the following stages.
Ovarian stimulation
The first stage of IVF is medication-based ovarian stimulation, with the aim of producing more eggs in a single cycle. The woman receives hormonal treatment for approximately 8–12 days, while regular ultrasound and hormonal monitoring are performed during this period to track follicular development.
When the follicles reach the appropriate size, a special injection is given to trigger the final maturation of the eggs before egg retrieval.
Egg retrieval
Egg retrieval is the process of collecting eggs from the ovaries. It is usually performed 34–36 hours after the trigger injection for final maturation.
The procedure is performed under light anesthesia and usually lasts about 10–20 minutes. With ultrasound guidance, the doctor collects the eggs from the follicles using a thin catheter. The eggs are then immediately transferred to the embryology laboratory.
How many eggs are needed for IVF?
There is no ideal number of eggs that guarantees success. In general, the more eggs collected, the greater the chance of obtaining high-quality embryos.
In practice, collecting 8 to 15 eggs is considered satisfactory for one IVF cycle, although in many cases success is achieved with fewer.
The number of eggs depends on ovarian reserve, age, and the woman’s response to ovarian stimulation medication.
Fertilization (IVF or ICSI)
In the laboratory, the eggs are fertilized with sperm. Depending on sperm characteristics and the couple’s history, the following may be used:
- the conventional IVF method, in which eggs and sperm are placed together in a special culture medium, or
- the ICSI method, in which a single sperm is injected directly into the egg.
After fertilization, the fertilized eggs begin to develop into embryos.
Embryo culture
The embryos are cultured in the laboratory for several days, usually from 3 to 5 days. During this period, embryologists monitor their development and assess their quality.
The selection of embryos to be transferred to the uterus is based on embryo quality and stage of development.
Embryo transfer
Embryo transfer is the final stage of in vitro fertilization. One or more embryos are placed inside the uterus with the help of a thin catheter.
The procedure is simple but extremely important for the success of the treatment. It does not require anesthesia and usually lasts only a few minutes. After embryo transfer, the woman can usually return to her daily activities shortly afterward. A pregnancy test is typically performed about 10–14 days later.
IVF success rates
IVF success rates vary from case to case and are influenced by several factors.
Proper fertility assessment and a personalized treatment approach contribute to better IVF planning and help optimize the chances of success.
Factors affecting success
Woman’s age
A woman’s age is a key factor in the success of IVF. Over time, the number and quality of eggs decline, which affects the chances of fertilization and the development of healthy embryos. For this reason, timely fertility assessment helps with proper treatment planning.
Egg and sperm quality
The quality of eggs and sperm significantly affects fertilization and embryo development. In cases of male infertility, the ICSI method may be used, in which a single sperm is injected directly into the egg.
Endometrial health
For pregnancy to occur, the embryo must implant successfully in the endometrium, which is the inner lining of the uterus. Proper preparation and good endometrial quality are important factors for successful implantation.
Embryo quality
Embryo quality significantly affects the chances of implantation and the progression of a pregnancy. Embryos are assessed in the embryology laboratory, where their development is monitored before embryo transfer.
At our clinic, before the start of any IVF cycle, special emphasis is placed on identifying and addressing the causes of infertility.
For example, if chronic endometritis or increased sperm DNA fragmentation is present, these factors are addressed first before treatment begins. This approach often leads to natural conception even before IVF treatment starts.
Symptoms after embryo transfer
After embryo transfer, many women wonder whether there are symptoms that may indicate that IVF was successful. In practice, symptoms can vary significantly from one woman to another and are not a reliable indication of pregnancy.
In the days following embryo transfer, mild symptoms may appear, which are often related either to embryo implantation or to the hormonal treatment used during therapy.
Common symptoms before the beta hCG blood test may include:
- mild pain or a feeling of heaviness in the lower abdomen
- mild bloating
- breast tenderness
- fatigue
- light vaginal bleeding (spotting)
Pregnancy is confirmed only through a blood test measuring beta human chorionic gonadotropin (β-hCG), which is usually performed 10–14 days after embryo transfer.
Possible side effects of IVF
In vitro fertilization is generally considered a safe assisted reproduction treatment; however, like any medical procedure, it may be accompanied by certain side effects. Most are mild and temporary and are mainly related to the medication used for ovarian stimulation.
During treatment, some women may experience symptoms such as:
- bloating or a feeling of heaviness in the abdomen
- mild abdominal pain
- breast tenderness
- fatigue
- mood changes
These symptoms usually subside after the treatment cycle is completed.
In rarer cases, ovarian hyperstimulation syndrome (OHSS) may occur, a condition in which the ovaries respond excessively to the medication. Most cases are mild, and careful monitoring during treatment helps with early prevention and management.
IVF after 40 or at an older age
A woman’s age is one of the most important factors affecting fertility and IVF success rates. After the age of 40, the chance of natural conception gradually decreases, mainly due to the decline in the number and quality of eggs.
Nevertheless, IVF can be an effective option for many women at this age, especially when there is proper fertility assessment and personalized treatment planning. Evaluation of ovarian reserve, hormonal testing, and ultrasound examination help the physician determine the most appropriate approach for each case.
In some cases, additional assisted reproduction techniques or different treatment strategies may be needed to increase the chances of success.
At more advanced ages, such as after 45, achieving pregnancy with one’s own eggs is usually extremely difficult. In these cases, other options may be considered, such as IVF with egg donation, always in accordance with the applicable medical and legal framework.
Frequently asked questions (FAQ)
An IVF cycle usually lasts about 4 weeks. The actual treatment—that is, ovarian stimulation, egg retrieval, fertilization in the laboratory, and embryo transfer—is completed in 2 to 3 weeks. The remaining time αφορά the waiting period for the result, with the pregnancy test performed 10–14 days after embryo transfer. The process usually starts at the beginning of the menstrual period.
Egg retrieval is usually performed under light anesthesia so that the procedure is painless. It lasts about 10–20 minutes, and most women can return home the same day.
Pregnancy is confirmed with a blood test measuring beta human chorionic gonadotropin (β-hCG). The test is usually performed 10 to 14 days after embryo transfer.
The cost of IVF may vary depending on the clinic, the treatment protocol, and any additional techniques that may be needed. For this reason, cost estimation is usually made after medical evaluation and treatment planning.
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