In Vitro Fertilization
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In vitro fertilization is a series of complex procedures used to improve fertility, prevent genetic disorders, and aid in the conception of a child. During in vitro fertilization, mature eggs are extracted from the ovaries and fertilized in a laboratory. Fertilization takes place in a laboratory dish containing the retrieved eggs and motile sperm. The fertilized eggs develop for three to five days in a controlled environment before being transferred to the woman’s uterus for possible implantation and embryo development. A complete in vitro fertilization cycle takes approximately three weeks. Occasionally, these steps are separated into distinct phases, which can lengthen the process.
In vitro fertilization is the most effective method of assisted reproduction. It is possible to use the couple’s own eggs and sperm for the procedure, or from a known or unknown donor. In certain instances, a gestational carrier — a woman with an embryo implanted in her uterus — may be utilized.
Numerous factors, such as your age and the cause of infertility, influence your chances of having a healthy baby through in vitro fertilization. If more than one embryo is transferred to the uterus, in vitro fertilization can result in multiple pregnancies (multiple pregnancy).
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Our hospital network spans multiple locations across Europe, bringing world-class fertility treatment facilities closer to you with highly trained specialists and state-of-the-art technology. Each clinic is strategically located in major cities, allowing our patients to choose the location that best suits their needs, providing flexibility for consultations, procedures, and follow-up care.
Our medical consultants will advise you on the best choice for your treatment in one of our leading hospitals.
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Conditions that decrease Fertility
IVF may be an option, for instance, if you or your partner have:
- Fallopian tube injury or obstruction. Damaged or blocked fallopian tubes make it difficult for an egg to be fertilized or an embryo to reach the uterus.
- Ovulation disorders. If ovulation is irregular or nonexistent, there are fewer eggs available for fertilization.
- Endometriosis. Endometriosis occurs when tissue resembling the uterine lining grows outside of the uterus, frequently affecting the ovaries, uterus, and fallopian tubes.
- Uterine fibroids. Uterine fibroids are benign tumors that can prevent the fertilized egg from implanting. They are prevalent in women aged 30 to 40.
- Tubal sterilization or removal in the past. Tubal ligation is a form of sterilization in which the fallopian tubes are permanently severed or blocked to prevent pregnancy. In vitro fertilization may be a viable alternative to tubal ligation reversal surgery if you wish to conceive after tubal ligation.
- Reduced production or function of sperm. Sperm can have difficulty fertilizing an egg if their concentration is below average, they have poor mobility, or they have an abnormal size or shape.
- A genetic disorder. If you or your partner are at risk of passing on a genetic disorder to your child, a preimplantation genetic testing may be necessary. After the eggs have been harvested and fertilized, they are screened for possible genetic defects, although not all defects can be detected. Embryos that are free of identified defects can be transferred to the uterus.
- Preserving fertility despite cancer or other health conditions. In vitro fertilization for fertility preservation may be an option if you’re about to undergo cancer treatment that could impair your fertility, such as radiation therapy or chemotherapy. Eggs can be extracted from a woman’s ovaries and frozen to be fertilized in the future.
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IVF Specialist Consultation €200 - €500
45-60 minute video consultation with a world renowned gynecologist from our leading hospitals in Europe. A consultation with a gynecologist is mandatory to correctly plan further treatments.
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In Vitro Fertilization (Package) €5.000 - €10.000
Includes oocyte retrieval, sperm preparation, trophectoderm cell sampling of day 5-6 cytoblast and embryo transfer / embryo freezing for preimplantation genetic testing. Costs of the package vary between our locations.
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Preimplantation Genetic Testing (PGT) €2.000 - €4.000
Screening embryos for genetic abnormalities before transfer.
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IVF Egg Donation Service €5.000 - €10.000
Using eggs from a donor.
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IVF Sperm Donation Service €500 - €1.000
Using sperm from a donor.
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Surrogacy €50.000 - €100.000
An arrangement where another woman carries and delivers a child for intended parents. The procedure is only available at selected clinics outside Europe, due to legal regulations.
In vitro fertilization requires a number of procedures, including ovarian stimulation, egg and sperm collection, fertilization, and transfer of the embryos. A single in vitro fertilization cycle can last between two and three weeks. Multiple cycles may be required to get pregnant.
Preparation for IVF
Ovulation Induction
Egg Retrieval
Sperm Retrieval
Egg Fertilization
Embryo Transfer
Preparation for IVF
Each couple will be required to undergo a number of tests before beginning a cycle of IVF that will use their own eggs and sperm:
- Evaluation of ovarian reserve. During the first few days of your menstrual cycle, your doctor may measure the levels of the follicle-stimulating hormone, estradiol (estrogen), and anti-mullerian hormone in your blood in order to determine the quantity and quality of your eggs. In conjunction with an ultrasound of your ovaries, test results can aid in predicting how your ovaries will react to medication.
- Sperm examination. Shortly before the start of an in vitro fertilization treatment cycle, your doctor will conduct a semen analysis.
- Screening for infectious diseases. Each of you will be tested for infectious diseases, including HIV.
- Embryo transfer procedure simulation. Your doctor may perform a sham embryo transfer to determine the depth of your uterine cavity and which technique will most likely to result be successful in the embryo transfer.
- Exam of the uterus. Before you undergo in vitro fertilization, your doctor will examine the uterine lining.
- Sonohysterography, in which fluid is injected through the cervix into the uterus, and an ultrasound may be used to generate images of the uterine cavity. Or, a hysteroscopy may be performed, in which a thin, flexible, lighted telescope (hysteroscope) is inserted through your vagina and cervix into your uterus for the same purpose.
Ovulation Induction
In the beginning of an in vitro fertilization cycle, synthetic hormones are administered to stimulate the ovaries to produce multiple eggs, compared to the normal monthly production of a single egg. There is a need for multiple eggs because some eggs will not be fertilized or will not develop normally after fertilization.
Various types of medications are used during the in vitro fertilization, including:
- Medications that stimulate ovarian function. You may receive an injectable medication containing follicle-stimulating hormone, luteinizing hormone, or a combination of both to stimulate your ovaries. These medications stimulate the simultaneous development of multiple eggs.
- Medications that promote the maturation of oocytes. After eight to fourteen days, when the follicles are mature enough for egg retrieval, you will be given human chorionic gonadotropin or other medications to help the eggs mature.
- Medications that prevent premature ovulation. These medications stop the body from releasing prematurely the developing eggs.
- Medications that prepare the uterine lining. On the day of egg retrieval or at the time of embryo transfer, your doctor may advise you to begin taking progesterone supplements to make your uterine lining more receptive to implantation.
Your doctor will determine with you which medications to take and when to take them.
Typically, one to two weeks of ovarian stimulation are required before eggs are ready to be retrieved. To determine when the eggs are ready to be retrieved, you may have:
- Vaginal ultrasound, a diagnostic imaging exam of your ovaries to monitor the development of follicles — ovarian sacs where eggs matur.
- To measure your response to ovarian stimulation medications, blood tests are performed. As follicles develop, estrogen levels typically rise, while progesterone levels remain low until after ovulation.
Occasionally, in vitro fertilization cycles must be canceled prior to egg retrieval for one of the following reasons:
- Insufficient number of follicles forming
- Premature ovulation
- Development of too many follicles, that increase the risk of ovarian hyperstimulation syndrome
- Other medical conditions
If your in vitro fertilization cycle is canceled, your physician may recommend modifying your medications or their dosages in order to promote a better response in future cycles. Or, you may might require an egg donor is necessary.
Egg Retrieval
Transvaginal ultrasound aspiration is the most common method of egg retrieval and can be performed in a clinic or doctor’s office 34 to 36 hours after the final injection and before ovulation.
A vaginal ultrasound probe is inserted to identify follicles. The eggs are then extracted by inserting a thin needle attached to a suction device through the vagina and into the follicles using an ultrasound guide. Several eggs can be removed in approximately 20 minutes. If your ovaries are inaccessible via transvaginal ultrasound, the needle may be guided using abdominal ultrasound.
During egg retrieval, sedation and pain medication will be administered. Nevertheless, you may experience cramping and fullness or pressure following egg retrieval.
A nutritive liquid is then used to incubate mature eggs. Healthy and mature eggs will be combined with sperm in an attempt to create embryos. However, not all eggs can be fertilized successfully.
Sperm Retrieval
If using your partner’s sperm, you must provide a sperm sample the morning of egg retrieval at your doctor’s office or clinic.
Typically, a sample of sperm is obtained through masturbation. Testicular aspiration, which involves the use of a needle or surgical procedure to extract sperm directly from the testicle, is sometimes required. Sperm from a donor can also be used.
In the laboratory, sperm are separated from the semen fluid.
Egg Fertilization
Two common methods of in vitro fertilization are available:
- Conventional insemination, during which sperm and eggs are combined and incubated overnight.
- Intracytoplasmic sperm injection, that involves the direct injection of a single healthy sperm into each mature egg. This technique is frequently used when there is a problem with the quantity or quality of the sperm, or if previous in vitro fertilization cycles have been unsuccessful.
In some cases, your doctor may recommend additional procedures before embryo transfer:
- Incubation support. Five to six days after fertilization, an embryo is released from its surrounding membrane (zona pellucida), permitting it to implant into the uterine lining. If you are an older woman or have had multiple failed IVF attempts, your doctor may recommend assisted release, a technique in which a hole is made in the zona pellucida just before embryo transfer to aid in embryo implantation and release. Because the process can harden the zona pellucida, assisted release is also useful for previously frozen eggs or embryos.
- Genetic screening prior to pregnancy. Embryos are allowed to develop in the incubator until a small sample can be extracted and tested for specific genetic diseases or the correct number of chromosomes, usually after five to six days of development. This way your uterus can receive only embryos that do not contain affected genes or chromosomes. Preimplantation genetic testing can reduce the likelihood that a parent will transmit a genetic disorder to their child, but it cannot eliminate the risk entirely and is a well-established alternative to prenatal diagnosis and offers the benefit of avoiding invasive prenatal diagnosis and therapeutic abortion. It is recommend for older female patients and to those with recurrent in vitro fertilization failure or repeated miscarriages (not due to egg transfer) becuase they have an increased risk of having embryos with chromosomal abnormalities.
Embryo Transfer
Embryo transfer is typically performed in a doctor’s office or clinic two to five days after the egg retrieval. The doctor will insert a catheter, a long, thin, flexible tube, into the vagina, through the cervix, and into the uterus. Attached to the end of the catheter is a syringe containing one or more embryos suspended in a small quantity of fluid. The doctor inserts the embryo or embryos into your uterus using the syringe. You may be administered a mild sedative. Generally, the procedure is painless, but you may experience mild cramping. Six to ten days after egg retrieval, an embryo will implant in the lining of your uterus if the procedure is successful .
Typically, the number of embryos transferred is based on the recipient’s age and the number of eggs retrieved. Since the rate of implantation is lower in older women, typically more embryos are transferred, with the exception of women who use donor eggs or embryos that have been genetically tested.
In some nations, the number of transferable embryos is limited by law. Most doctors adhere to specific guidelines to prevent multiple pregnancies, which lead to multiple births of three or more babies due to the higher risk of complications like premature birth, preeclampsia and fetal growth restriction. Ensure that you and your physician are in agreement regarding the number of embryos to be transferred prior to the transfer procedure.
Eggs and embryos that are in excess can be frozen and stored for several years. This allows to reduce the cost and invasiveness of future in vitro fertilization cycles or create a reserve for women who have to undergo chemotherapy or radiotherapy or who risk becoming infertile due to premature ovarian exhaustion or due to other unforeseen medical reasons that prevent the continuation of the treatment (e.g. haemoperitoneum or ovarian hyperstimulation syndrome). The frozen eggs or embryos can also be donated to another couple or a research facility.
Other Procedures
There are other procedures related to aspects of reproduction, either by assisting with fertility issues, influencing the sex of the child, or marking the natural end of pregnancy with the birth of a child. Testicular retrieval of sperm involves extracting sperm from the testicles to aid assisted reproductive techniques for couples facing fertility issues.
Testicular sperm retrieval
Child Sex Selection
Childbirth
Testicular sperm retrieval
In recent years, attention has shifted massively to the possibility of solving serious forms of male infertility. Azoospermia, a pathology characterized by the complete absence of spermatozoa in the ejaculate, is present in 10% of infertile subjects who carry out an analysis of the seminal fluid.
Azoospermia is usually divided, based on the nature of the alteration, into the following types:
- Non-obstructive (or secretory) azoospermia characterized by the complete absence of sperm, usually caused by primary pituitary or testicular insufficiency. We speak of non-obstructive azoospermia (or primary testicular insufficiency) when three fundamental diagnostic criteria are met: azoospermia, testicular atrophy and elevated FSH levels. In these forms the spermatozoa are also absent at the level of the epididymis and only scattered foci of spermatogenesis can be found at the testicular level.
- Obstructive azoospermia is evidenced by the absence of seminal cells in the ejaculate, normal testicular trophism and FSH within normal limits. Spermatogenesis is regular and patients show normal virilization with physiological testosterone levels. The main congenital form of obstructive azoospermia is bilateral absence of the vas deferens.
Following the collection of sperm, from the epididymis or testis, the subsequent fertilization is performed by intracytoplasmic sperm injection. The absence of sperm in semen does not necessarily mean that they are not produced since they can be identified in other locations – testicle or epididymis – and even if in small numbers they can be taken using different techniques. Some of them allow sperm to be recovered from the epididymis or from from the testicles.
Child Sex Selection
IVF sex selection is a process in which embryos are selected based on their sex chromosomes during an IVF cycle in order to produce a male or female baby based on the parents’ wishes.
Clinics typically offer sex selection only for medical reasons related to x-chromosome disorder, such as when couples are aware they are carriers of genetic conditions associated with biological sex.Disorders linked to the X-chromosome are predominantly observed in males.
Pre-implantation genetic diagnosis is the primary method used for selecting the gender of an embryo. During an IVF cycle, numerous embryos will be created, and the highest-quality embryo will be chosen for implantation into the woman’s uterus. Pre-implantation genetic diagnosis is performed prior to implantation to detect genetic defects, but the same procedure can also determine the gender of the embryos.
Outside of medical applications, sex selection can be contentious. Different clinics will therefore have their own policies regarding the implementation of sex selection techniques. For instance, some clinics may only offer it for medical reasons, while others may offer sex selection techniques if a patient requires IVF for a fertility-related medical condition.
Childbirth
After a successful in vitro fertilization treatment, our consultants offer you the opportunity to meet with specialized doctors and discuss your needs when the moment of childbirth arrives: pregnancy scans, postpartum physiotherapy and rehabilitation, among other services.
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