In Vitro Fertilization (IVF) Process

The Intended Parent’s Role

In Vitro Fertilization and Uterine Embryo Transfer (IVF/UET) is a widely accepted assisted reproductive treatment for infertile couples worldwide. This technique has been utilized since its inception in the late 70’s. In the United States of America, IVF/UET began in early 1980 and it has been well received within the medical community and with infertile couples. In the mid 1980’s, the dimension of a third party (Surrogate Mother) was added for those couples who could produce embryos through IVF, but the wife could not carry the pregnancy.

The criteria for consideration for IVF/UET is based on the Intended Mother’s reproductive ability, her general health, history of medical problems and her husband’s reproductive abilities, as well. When the Intended Mother is unable to carry the pregnancy, then a Surrogate Mother I selected using the same criteria as described above. She must be free of any health concerns and have an excellent pregnancy history.

As you may anticipate, this procedure is physically and emotionally demanding as well as very expensive. In view of these complexities, here is the general background of the procedures.

The IVF/UET Process

The IVF/UET process is divided into the following 5 steps:

  1. Follicle Development
  2. Oocyte (Egg) Collection
  3. Oocyte Culture and In Vitro Fertilization
  4. Uterine Embryo Transfer to Intended Mother
  5. Luteal Phase Monitoring and Support
Steps 1 through 3 are completed by the Intended Mother or her Egg Donor and the medical laboratory.  They are described below:

Step 1: Follicle Development

IVF can be accomplished by using the Intended Mother’s cycle without the use of fertility drugs; however the disadvantages in terms of the number of eggs retrieved, fertilized, transferred and frozen are great.  Therefore, most commonly, the IVF process includes the use of fertility drugs.  The physician’s office will supply a list of the fertility drugs and the possible side effects at the screening appointment.
There are certain medications that are utilized to induce several follicles to develop.  The monitoring of the follicle development is usually accomplished by:

  • Ultrasound – to actually view the follicle growth
  • Blood and/or Urine Tests – determine level of estrogen, progesterone, LH
  • Treatment cycle data

The ultrasound equipment, like radar, sends out a very high frequency sound wave that reflects off the pelvic structures and return back to the equipment.  These echoes are instantly transformed by a computer and an image is projected.  The video images are visualized in different intensities of grays; outlining the actual female anatomy.

The ultrasound procedure is usually done with the use of a trans-vaginal probe.  The bladder does not need to be full and, in addition, there are several studies that have shown that the ultrasound procedure is not harmful to the egg within the developing follicle or even to an early pregnancy.

Although the ultrasound gives a profile of the follicle development, the blood and/or urine tests assist further in determining the maturing level.  Several office visits are necessary to monitor the progressive follicle growth.  The physician evaluates the data from each visit to determine the appropriate time to administer the medication to trigger the final stages of ovulation.

Step 2: Egg Collection

The egg retrieval is done by a trans-vaginal ultrasound aspiration and is usually performed under mild anesthesia.   This procedure is an ultrasound guided technique whereby a long, thin needle is passed through the vagina into the ovarian follicle and suction is applied to retrieve the egg.

Step 3: Egg Culture and In Vitro Fertilization

Once the eggs are retrieved, they are examined in the laboratory and each one is graded for maturity.  The maturity of an egg determines when the processed sperm will be added to it.  The processed sperm is placed together with each retrieved egg in a separate laboratory dish to allow the fertilization process to occur.  The dishes are placed in an incubator set at the same temperature as the woman’s body.

After a period of time, the eggs are examined under a microscope for the first signs of fertilization.  When the embryos have reached the expected stage of development, any embryos in excess of the number agreed upon for the embryo transfer, are frozen for future use.  The Intended Mother or her Egg Donor will receive written instructions of care and notice of when she may resume her normal activities.  The recovery period is generally very short.

The Surrogate Mother’s role in the IVF/UET begins prior to the embryo transfer.  She takes several medications that prepare the endometrium (uterine lining) to receive the embryos.  The physician will determine when she must begin the daily progesterone injections and she is to continue them until ordered to stop by the physician.

A pregnancy test will be performed two weeks following the embryo transfer.  If a pregnancy occurs, the Surrogate Mother will have several visits to the clinic to monitor the hormone level and the progress of the embryo(s).  This monitoring is done by blood tests and ultrasound.  If pregnancy does not occur, the physician will instruct the Intended Mother when to stop the medications and when to expect her menstrual period.


Steps 4 & 5 (completed by the Surrogate Mother)

The Surrogate Mother is seen several times during the treatment cycle for the purpose of monitoring her endometrium (lining of the uterus). Prior to the embryo transfer, she takes several medications that prepare the endometrium to receive the embryos. The physician will determine when she must begin the daily progesterone injections and she is to continue them until ordered to stop by the physician.

The embryo transfer is performed with the Surrogate Mother in a gynecological position and requires no anesthesia. After the proper cleansing procedures, a tiny plastic catheter is introduced into the uterus through the cervix and the embryos are transferred into the endometrial cavity. The Surrogate Mother is required to stay in this position for a short period of time, and then the nurse will reposition her per the physician’s instructions and monitor her for the required time.

When the Surrogate Mother is released after the embryo transfer, she will be taken to a hotel for complete bedrest; getting up only to use the bathroom. This regiment is continued for 2 more days. After this time, the Surrogate Mother may resume her normal activities with the limitations provided to her by the physician at the time of the embryo transfer. Some of the limitations are:

  • Complete Pelvic Rest
  • No douching or sexual intercourse
  • Showers only – no tub baths
  • No strenuous activities – no exercising, running, heavy lifting including children, groceries, luggage, etc.

A pregnancy test will be performed two weeks following the embryo transfer. If a pregnancy occurs, the Surrogate Mother will have several visits to the clinic to monitor the hormone level and the progress of the embryo(s). This monitoring is done by blood tests and ultrasound. If pregnancy does not occur, the physician will instruct the Surrogate Mother when to stop the medications and when to expect her menstrual period.


Cycle Cancellation

The physician establishes the acceptable level of response to the treatment during the cycle.  If at any point, the Natural Mother’s or the Surrogate Mother’s response to the treatment falls below that established level, the physician will most likely cancel the cycle.


Click here to read more details about the Surrogate Mother’s role in the IVF/UET process.