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In-Vitro Fertilization Process

In-Vitro Fertilization (IVF) is also known as ‘test-tube-baby’, as the fertilization takes place outside the body (inside a test tube).


The indications of In Vitro Fertilization (IVF) Process include:

  1. Tubal factors (tubal blockage or dysfunction)

  2. Endometriosis

  3. Male factors infertility

  4. Immunological infertility (antisperm antibodies)

  5. Repeated unsuccessful IUI

  6. Unexplained infertility

  7. Sperm/ egg/ embryo donation

  8. Surrogacy


The female partner undergoes controlled ovarian hyperstimulation (COH), either with long protocol, short protocol or antagonist protocol, depending on her condition. At Metro IVF, an hCG injection is given to mature the eggs when the leading follicles have reached 18mm. 34 hours later, oocyte pick up (OPU) will be done.


OPU is the process of aspirating the eggs through the vagina. This is performed under sedation or general anesthesia. At Metro IVF, before OPU, the female partner should comply with the instructions as follow:

  1. Nil by mouth (strictly no food and drink) from midnight before OPU

  2. Do not put on contact lenses, make-up, perfume, and nail polish on the day of OPU

  3. Leave valuable things at home

  4. Arrange somebody to take you home after the OPU because you cannot drive within 24 hours after the procedure


During OPU, follicular fluid is aspirated and collected into a test tube using a suction pump with controlled negative pressure. The fluid collected will then be passed to the embryologist in the IVF laboratory which is adjacent to the operation theater. The OPU will take 15 minutes to one hour to complete, depending on the number of follicles to be aspirated. The embryologist will examine the fluid under a stereomicroscope and look for the eggs. The eggs collected will be cultured in culture media and kept in a CO2 incubator, where the temperature and CO2 are maintained at 37ºC and 5% respectively, for two to four hours so that most of the eggs will reach final maturation (complete Meiosis I).


On the same day, the male partner has to produce his semen by masturbation similar to that in semen analysis. He is advised to comply with the instructions listed below:

  1. 3 to 5 days of abstinence prior to semen collection

  2. Inform the nurse if he was sick or on any medication for the past 2 months

  3. Collection by masturbation is preferred

  4. Wash hands with soap and clean with water before semen collection

  5. Do not use lubricant, soap, or perfume during semen collection

  6. Avoid spillage when semen is collected


After the semen is produced, the laboratory technician or embryologist will process the semen to concentrate live and motile sperm. The sperm will be kept for intracytoplasmic sperm injection (ICSI) later.

Intracytoplasmic Sperm Injection

ICSI is a newly developed technique that has greatly improved the management of male infertility due to severe oligozoospermia (low sperm count) and asthenozoospermia (low motility). This technique can treat those men who produce extremely poor-quality sperm. In ICSI, we need a few sperm and one sperm is injected directly into one egg using a fine injection pipette.

A fertilized egg, the zygote, is determined by the formation of two pronuclei and two polar bodies 18 hours after insemination. The first cell division can be observed 26 hours post insemination (see video). At this time, the zygote develops into a two-cell embryo.

The embryo will then divide into four cells 48 hours after insemination and then 8 cells at 72 hours. The eight-cell embryo is now ready to be transferred back to the uterus. Normally a maximum of three embryos will be transferred back. The excess good-quality embryos that are not transferred may be kept for freezing.

Embryo transfer (ET) requires no sedation or anesthesia and it is similar to that of IUI. However, ET requires ultrasound guidance. A speculum is inserted into the vagina to hold it open.

Ultrasound guidance enables the doctor to visualize the insertion of an ET catheter into the uterus so that can ensure that the embryos will be placed near the fundus and minimize the trauma to the endometrium. The whole procedure just takes 5 minutes to complete (see video).

  1. After ET, the female partner will require some luteal support such as vaginal pessary or injection. She has to take extra care such as:

  2. Rest more and avoid excessive physical activities. Bed rest is not necessary.

  3. Remember to take progesterone medication daily

  4. Drink plenty of water

  5. Do not take any medication without doctor's consultation

  6. Avoid sexual intercourse for at least three months

A urine or serum pregnancy test will be done two weeks after the procedure to confirm pregnancy.

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