In vitro fertilization process consists of four steps.
Step one involves encouraging production of multiple eggs from the ovaries, using several different medications.
They include GnRH agonists for pituitary down regulation, and to inhibit premature egg maturation, combined FSH & LH for controlled ovarian stimulation, and hCG trigger for the final maturation of eggs.
Step two involves collection of the eggs from the ovaries, using vaginal ultrasound.
Third step involves mixing of sperms and egg, to facilitate fertilization.
In the 4th and final step, the embryo is placed in the uterus using a small thin catheter.
Many factors may influence a couple’s chance for success.
Including women’s age, underlying cause for infertility, quality of the sperms, and the response of the woman’s ovaries to medication.
In addition, each phase of the in vitro fertilization cycle may or may not be successful.
For example, if the ovaries have a poor response to medications, few or no eggs may develop, resulting in cancellation of the cycle.
There is also a small chance that fertilization may not occur due to defects in sperms or eggs.
Moreover, formed embryos in vitro may be of poor quality, and lack the ability to develop.
Finally, embryo transfer may be technically difficult to perform.
The most common reason for failure in an in vitro fertilization cycle is failure of the embryo to implant within the uterus, typically associated with the quality of the embryo.
For couples with severe male factor infertility, in vitro fertilization with intra cytoplasmic sperm injection, yields very good results.
During this procedure, a single sperm is injected directly into the ovum, facilitating the fertilization.
Finally, there is another method known as assistant hatching technique, which improves the success rates for special populations.
It involves making a hole in the covering around the embryo, known as the zona pellucida.
This technique is offered to older patients who had repeated failure of implantation.

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