Pregnancy may not occur for many reasons. In such cases, assisted reproductive technologies (ART), particularly in vitro fertilization (IVF), can help. This is a method in which eggs and sperm are combined outside the woman’s body—in a laboratory. The resulting embryos are then transferred into the uterus, where one or more may implant and develop into a pregnancy.

It is important to understand that IVF does not eliminate the causes of infertility, but helps to overcome them. The method allows doctors to achieve what the body cannot, regardless of the specific diagnosis.

When is IVF used?
Initially, IVF was used for tubal factor infertility—blocked or absent fallopian tubes. Today, it is used for various forms of infertility:

• Endometriosis
• Male factor (low sperm count or quality)
• Unexplained infertility
• Age-related infertility

Main Stages of the IVF Program:
1. Ovarian stimulation – maturation of multiple eggs in one cycle
2. Egg retrieval – collecting the eggs
3. In vitro fertilization – “in a test tube”
4. Embryo culture – 2 to 6 days in the lab
5. Embryo transfer to the uterus

Stage 1: Ovarian Stimulation
In a natural cycle, only one egg matures. During IVF, the ovaries are stimulated to produce 10–20 eggs, since not all will fertilize or develop into viable embryos. The more mature eggs, the higher the chance of successful fertilization and pregnancy.

Hormonal medications used include:

• FSH (Gonal-F)
• hMG (Menopur)
• hCG (Ovitrelle, Pregnyl)
• Clomiphene citrate (Clostilbegyt)
• GnRH agonists and antagonists (Cetrotide, Diphereline, etc.)

Personalized Approach
At VitroMed Clinic, drugs and dosages are selected individually, based on age, diagnosis, and past stimulation responses. Follicle growth is monitored via ultrasound and, if needed, estradiol blood tests.

Stage 2: Egg Retrieval
Egg retrieval is performed transvaginally under ultrasound guidance, usually with short-term anesthesia. A special needle aspirates the follicular fluid containing eggs. The procedure lasts about 30 minutes, after which the patient rests for 2–3 hours.

Stage 3: In Vitro Fertilization
The retrieved eggs are placed in a nutrient medium and incubator. On the same day, the partner’s sperm is prepared. If collection is difficult, sperm can be frozen in advance.
Two fertilization methods are used:

• Conventional IVF – eggs are combined with sperm in a dish
• ICSI – a single sperm is injected directly into an egg (used in severe male infertility)

Stage 4: Embryo Culture
18–20 hours after fertilization, the embryologist checks for two pronuclei—evidence of successful fertilization. Development is monitored daily. By day 3, the embryo should have 6–10 cells; by day 5, it should reach the blastocyst stage. Transfer may occur from day 2 to day 6 after retrieval.

Stage 5: Embryo Transfer
This is a painless procedure done with a thin catheter under ultrasound guidance. Typically, 1–2 high-quality embryos are transferred to minimize the risk of multiple pregnancy. Remaining embryos can be frozen.

After the Transfer
A blood test for hCG (pregnancy hormone) is done 10–14 days later. Until then, avoid:

• Overheating (hot baths, saunas)
• Intense physical activity
• Sexual intercourse

The patient may follow a normal lifestyle—complete bed rest is not required.

Possible Challenges

• Poor ovarian response: more common in women over 35 or with low ovarian reserve
• Ovarian hyperstimulation syndrome (OHSS): common in PCOS patients. The cycle may be delayed or embryos frozen.
• Failed fertilization: may occur even with normal eggs and sperm, for unknown reasons

Conclusion
IVF is an effective technology offering hope to couples with various forms of infertility. Modern protocols and personalized care increase the chances of success, even in complex cases. It is important to understand that the first attempt may not work—and that’s not the end, but part of the journey.