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In vitro fertilization is the procedure that takes sperm and eggs to fertilize them in a laboratory and plant the embryo thus created in the ovary. In IVF sperm and eggs may be used both from the partners and from donors.

Assisted reproductive procedures using your own eggs require some hormonal treatment to control your ovulation and avoid unpredictable ovulation. Usually this procedure is done by using on of two similar types of gonadotropins- releasing hormone analogue. We present you two examples of controlled ovulations:

* - GnRH agonist injected or on nasal administration for 10 days to shut down the ovaries. Next, you undergo daily ovary-stimulating hormone injections and close monitoring for 2 weeks before egg retrieval. At home, you or your partner injects you with gonadotropins or follicle-stimulating hormone (FSH) to make your ovaries produce multiple eggs (super ovulation).
* - FSH treatment with injections , then adding GnRH antagonist injection after about 5 days; this stops the production of luteinizing hormone (LH) within an hour or two.

Blood estrogens level is checked after a week, and ultrasound monitoring to see whether the eggs in the follicles are maturing. Dosage changes in the second week based on the results and monitoring continues. If follicles fully develop, you are given a human chorionic gonadotropins (hCG) injection to stimulate the follicles to mature. The mature eggs are collected 34 to 36 hours later by needle aspiration guided by ultrasound.

Collecting the sperm. There are two ways of doing that: through masturbation or through a small incision in the scrotum. The second method is used when there is a problem with the sperm production or when ejaculation is blocked.

The fertilization and the embryo transfer. The sperm and eggs are placed in a dish in a sterile environment with controlled temperature and pressure for 48-120 hours. The fertilized eggs are then selected and the best 2-4 embryos are inserted into the uterus through a catheter (a thin flexible tube). The remaining embryos are cryopreserved for future attempts.

The embryos thus implanted in the uterus may then result in pregnancy and birth of one or more children.

What comes after treatment?

IVF technique can be very demanding for a woman. It requires periodic blood tests, hormones tests, periodic doctor consultations, plus, some of the injections the treatment requires may be quite painful, thus it can trigger emotional issues.

The good side is that this procedure is done on an outpatient basis and need a short recovery time. Yet, depending on the doctor's recommendation, the patient may need on bed rest for a few days or meet some restrains and encounter cramps.

Reasons and results of IVF

This treatment is an option if one of the following is causing infertility:

* - Woman suffers from severe endometriosis
* - Man encounters low sperm count
* - Failure of artificial or intrauterine insemination
* - Unexplained infertility for a long time
* - Blocked or missing fallopian tubes in a woman
* - Unsuccessful tubal ligation reverses surgery

IVF success rate is about 25 percent. It is very closely connected to many factors that caused infertility, prior pregnancies, genetic inheritance and age.

Once the woman ages, so does her supply of eggs and the chances for healthy pregnancy and birth even in case of IVF. So, many women that passed the age of 40 choose donor eggs instead of their own for a higher rate of success.

What are the risks

OHS and multiple pregnancy are the first risks of IVF.

Super ovulation needs close monitoring on the ovaries, blood and hormones level during the IVF procedure because it has a 0.5 ' 2 % rate of developing severe OHS which is rarely life threatening.

Multiple pregnancies represent a risk for both mother and children. 30% of the IVF pregnancies produce twins, 5%produce triplets and 0.6% produce more then 3 children.

Before deciding how many embryos to implant in your uterus, the doctor will advice for the best options pending on all the factors involved. You will most likely have this conversation with your doctor before the treatment begins and again before the implantation. In case if more than 2 embryos will be implanted, you will probably be advised on the multi fetal reduction pregnancy to increase the chances for a healthy pregnancy and healthy child.