IVF – in vitro fertilisation.
The Wunschbaby Institut Feichtinger in Vienna is one of the leading institutes for assisted reproduction and in vitro fertilisation (IVF).
What is IVF and how does it work?
With the IVF method, several hundred thousand sperm are added to each egg. The best sperm then finds its own way into the egg.
IVF at a glance
Fertilisation in the laboratory
When is IVF the method of choice?
In cases of blocked fallopian tubes, endometriosis or PMOS (formerly PCO syndrome) – and provided the male partner's semen analysis is normal – conventional IVF is the method of choice in assisted reproduction.
30–40 percent per cycle
The chance of becoming pregnant with the help of IVF treatment is 30–40 percent per cycle – depending on the age of the couple, the hormonal baseline, underlying conditions (diabetes mellitus, high blood pressure, etc.) and lifestyle factors (excess weight, stress, nicotine use, excessive alcohol consumption, etc.).
How IVF works – in seven steps.
IVF treatment usually follows these seven steps.
Hormonal stimulation of the ovaries
With only a few exceptions, IVF (in vitro fertilisation) or ICSI (intracytoplasmic sperm injection) treatment is carried out after hormonal stimulation of the ovaries. The aim of hormone therapy is to allow several follicles to mature simultaneously on both ovaries in order to obtain several eggs capable of fertilisation.
A preparatory phase ("down regulation") tunes the body for the actual stimulation by suppressing the body's own hormone production and release. This can be done via daily injections under the skin (subcutaneous) or by taking certain medications orally – with the advantage that the stimulation phase becomes easier to control externally.
For the subsequent stimulation of the ovaries, FSH (follicle-stimulating hormone) and LH (luteinising hormone) are used in pure form or as a combination preparation. During hormone treatment, a specific amount of these hormones (depending on age, weight, etc.) is injected subcutaneously every day, always at the same time of day. The technique is explained and demonstrated in detail at the start of treatment and can be carried out by the patient herself or by her partner – daily visits to the doctor are not necessary.
Close ultrasound monitoring allows the number of follicles, their growth and the build-up of the uterine lining to be observed precisely. Once the follicles have reached a certain size, ovulation is triggered with the hormone hCG (human chorionic gonadotropin). This makes it possible to determine the optimal time for egg retrieval, shortly before ovulation.
Egg retrieval
36 hours after the "trigger injection", the eggs are retrieved transvaginally (through the vagina) under ultrasound guidance. Using a needle, the follicles are located under ultrasound view, punctured, and the follicular fluid together with the egg it contains is aspirated. The eggs are then isolated from this fluid under the microscope, transferred to a special culture medium and incubated at 37 °C.
Follicle puncture takes 5–15 minutes on average, depending on the number of follicles. To make the procedure easier, our patients receive a combination of sedatives and painkillers. The follicle puncture is performed on an outpatient basis – all that is required is an observation period of 1 to 2 hours in our recovery rooms.
Sperm collection
The sperm sample is collected by masturbation after 2–3 days of abstinence (no ejaculation) on the day of egg retrieval. This is not always easy "on command" or under time pressure and stress – so in exceptional cases the sample can also be brought from home. Please note that the time between collecting the sample and handing it in at the institute must not exceed two hours.
Fertilisation – conventional IVF
The retrieved eggs are fertilised on the same day. After a special preparation technique, the sperm are brought together with the eggs in a small dish – fertilisation takes place the "natural" way.
The next day, it is checked under the microscope how many of the eggs actually show signs of fertilisation (two pronuclei and two polar bodies).
Embryo transfer
2–5 days after fertilisation, 2–3 embryos are placed into the uterus under ultrasound guidance using a thin, flexible plastic tube (catheter).
The day on which the embryo transfer takes place depends on the number of fertilised eggs. If 1–4 eggs have been fertilised, they are usually returned to the uterus 2–3 days after the puncture. During this time, the embryos are observed daily as they develop (cell division) and assessed according to criteria such as cell division rate and regularity of cell division. The embryos of the best quality are selected for transfer.
With five or more embryos, a transfer on day 5 after fertilisation is aimed for – a so-called blastocyst transfer. The blastocyst is the most advanced embryonic stage that can be achieved outside the body. If there are more good-quality embryos than intended for transfer, these can be cryopreserved (frozen in liquid nitrogen).
Placing the embryos takes only a few minutes and is generally painless. Afterwards, we recommend that our patients relax for 20–30 minutes in our recovery rooms.
Assisted Laser Hatching (ALH) – help with "hatching"
The egg or embryo is surrounded by a firm shell, the so-called zona pellucida. When the embryo reaches the blastocyst stage in the course of its development, it must hatch out of this shell in order to implant in the uterus. Sometimes, however, this shell is "hardened" or unusually thick, which makes implantation difficult or even impossible. In these cases, the zona pellucida is scored or thinned using a laser to make it easier – or possible at all – for the growing embryo to "hatch" and thus to implant.
Implantation phase (luteal phase)
Egg retrieval marks the start of the second half of the cycle, the so-called luteal phase. In this phase, the body's own production of the corpus luteum hormone is supported with medication, preparing the uterine lining (endometrium) optimally for the implantation of the embryo. The medications used in the luteal phase can be administered as intramuscular depot injections, subcutaneous injections, tablets or vaginal suppositories.
Two weeks after fertilisation of the eggs, a pregnancy can be detected at the earliest by measuring the pregnancy hormone hCG in blood or urine. If a pregnancy is confirmed, luteal phase support is continued until the 12th week of pregnancy.
Frequently asked questions about IVF.
How does an IVF treatment basically work?
An IVF usually proceeds in seven steps: hormonal stimulation of the ovaries, egg retrieval, sperm collection, fertilisation in the laboratory, embryo transfer, if needed laser-assisted hatching support (assisted hatching), and medicinal support of the implantation phase. You will find the complete procedure described in detail above on this page.
How long does an IVF take – and how often do I have to come to the institute?
An IVF cycle corresponds in its duration roughly to a monthly cycle: around two weeks of stimulation, then the egg retrieval, a few days later the embryo transfer, and then about two weeks of waiting until the pregnancy test. Daily visits to the doctor are not necessary – you or your partner can administer the hormones yourselves. For the ultrasound and hormone checks, you come to us briefly several times.
What are the chances of an IVF – and what role does age play?
The most important influencing factor is the age of the woman: with increasing age, the number and quality of the eggs decline, and with them the prospects per treatment cycle. In addition, the hormonal baseline, underlying conditions such as diabetes mellitus or high blood pressure, and lifestyle factors such as excess weight, stress, nicotine and excessive alcohol consumption play a part. How your personal starting position is to be assessed is something we discuss on the basis of your findings – it can only be answered seriously on an individual basis.
What is the difference between IVF and ICSI?
With IVF, several hundred thousand prepared sperm are added to each egg; the sperm finds its own way into the egg. With ICSI, a single sperm is selected and placed directly into the egg with a fine hollow needle. IVF requires an essentially normal semen analysis – ICSI is the method of choice when semen quality is significantly reduced. All further steps are the same for both methods.
What risks and side effects does an IVF have?
The hormonal stimulation can lead to a feeling of tension in the lower abdomen, mood swings and – in rare cases – overstimulation of the ovaries; that is why we monitor closely by ultrasound and adjust the dosage individually. The egg retrieval is a short outpatient procedure under sedatives and painkillers, in which, as with any procedure, rare complications such as bleeding or infections are possible. If several embryos are transferred, the probability of a multiple pregnancy increases. We inform you about all points in detail before treatment begins.
How many IVF attempts are sensible?
There is no universally valid number. Several cycles are often necessary, and an unsuccessful attempt does not mean the method will not work for you – every cycle gives us additional information about stimulation response, egg quality and embryo development. We use this information to adjust the next cycle. At the same time, we tell you openly if we consider another path more promising.
What does an IVF cost and what does the IVF Fund cover?
In Austria, the IVF Fund can cover part of the costs of an IVF or ICSI treatment if certain medical and personal requirements are met – these include, among other things, the indication and age limits. The Wunschbaby Institut Feichtinger has had a contract with the IVF Fund since the year 2000. Whether a cost contribution is possible in your case and what your own share will be is something we check together with you in advance, and we lay everything out transparently before you decide.
Do I need to take sick leave for an IVF?
Most women continue to work normally during the stimulation phase – the check-up appointments are short. You should take the day of the egg retrieval off, since you will receive sedatives and painkillers and must not drive yourself afterwards; an observation period of one to two hours with us follows. A quieter daily routine is also advisable on the day of the embryo transfer. If it helps you, we will issue a confirmation – just ask us.
„Ich habe nach einem Jahr Klinik gewechselt, nach 3 Fehlversuchen. Bei Doktor Feichtinger hat es direkt beim ersten Mal geklappt. Ich bin sehr zufrieden & habe mich von Anfang an wohl gefühlt. Der Wechsel der Klinik war die beste Entscheidung.“
Experience IVF step by step
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