In-vitro-Fertilisation IVF - Kinderwunschpraxis Tübingen

IVF is the abbreviation for „In Vitro Fertilisation“ and means „fertilisation outside the body“. This therapy is performed, for example, in women with tubal occlusion, but also in couples where all other therapeutic methods have already been exhausted. In order for IVF to be successful, sperm production with sufficient concentration and motility is required, as well as a healthy uterus and at least one functioning ovary in the woman. Before commencing therapy an application needs to be submitted to your health insurance concerning the costs. The application form is available in our clinic once the costs and the insurance situation have been explained to you during consultation.

Stimulation
Ovum Retrieval
IVF-Laboratory
Embryo transfer
Pregnancy test

1. Stimulation

First, the ovaries must be stimulated so that more eggs mature than in the natural menstrual cycle. The stimulation takes place around the 2nd day of the cycle, with hormones (FSH or HMG), which are usually injected by the women themselves under the skin with a thin needle. In order to monitor the response of the ovaries to the medication, the first ultrasound check is performed on day 8 of the cycle. This can be done at our practice or at your gynecologist’s office, who will then send us the results. The size of the follicles determines the next steps, in terms of further dosage of medication and the next ultrasound check. Hormone stimulation is continued until the eggs are mature with a follicle size of around 20mm, which is usually after 10-12 days. At this point, ovulation is induced with an evening injection of the hormone HCG. 36 hours later the egg collection (follicle puncture) and sperm delivery take place in our practice, before ovulation actually occurs.

2. Follicle Punction (Egg collection)

Follicle puncture is performed with ultrasound-guidance through the vagina. For this purpose, a thin hollow needle is attached to the ultrasound probe, which is inserted into the vagina. The needle is used to pierce through the vaginal membrane into the follicles located directly behind it, and to aspirate all the follicular fluid. The procedure is performed on an empty stomach under sedation and lasts 10-15 minutes. Afterwards, the patient rests in our recovery room and may drink and eat. Pain medication is available, although it is rarely required. The sperm delivery is done in parallel with the follicular puncture and couples can go home together afterwards, but the woman may not drive herself due to the anaesthesia.

3. IVF Lab

During the egg collection, the aspirated follicular fluid is immediately transferred to the laboratory. The eggs in the fluid are retrieved, counted and stored in an incubator. The partner’s sperm are prepared and combined with the eggs in a nutrient rich solution in the early afternoon. Then – without further manipulation – fertilisation takes place. The next morning, a microscope is used to check how many of the eggs are fertilised. This can be recognised by the presence of two nuclei (pronucleus stage), which will fuse later as the cell becomes an embryo. Around 50-70% fertilisation rate can be expected from IVF. You will be informed about the fertilisation result by our laboratory staff immediately by phone, and the date for embryo transfer will be set. The fertilised eggs continue tob e cultured in the incubator until transfer. If there is a surplus of fertilised eggs,

these can be frozen (cryopreservation) in the pronuclei stage after consultation with you. Cell division begins during the course of the first day and the embryos are cultured in the lab until day 5. They are observed daily, which allows for good differentiation and selection of an embryo with optimal developmental potential. There is also the option to culture embryos in the Embryoscope, which is an incubator with cameras built in. This way, the embryos can be observed around the clock without disturbing them or exposing them to light and temperature changes.

4. Embryo transfer

During embryo transfer, an embryo is inserted into the uterine cavity with a soft plastic tube using ultrasound guidance. We recommend the transfer of a single good embryo. Up to 5 surplus day 5 embryos can be frozen (cryopreserved), if they have a good quality. The statistical probability of pregnancy is between 30-40%, however this pregnancy rate does decrease after the age of 40. When transferring two embryos, a high-risk twin pregnancy develops in 20% of pregnant women.

5. Pregnancy test

In the two weeks following embryo transfer, until the pregnancy test, the embryo should develop further and settle in the uterine lining. Restrictions in lifestyle such as stopping exercise/sports or being written off sick from work, are not necessary during this time. However, many women find these last 12-14 days particularly stressful, as „nothing more happens“. The pregnancy test is performed 12-14 days after the embryo transfer (depending on which day the embryo was transferred) with a blood test at your gynecologist or our practice. Even if bleeding has already started, a pregnancy test is necessary, as bleeding is not uncommon in early pregnancy.