IVF Procedures

There are several surgical and non-surgical procedures involved in IVF. Again, not everyone does all of them. You only do the procedures that are relevant to your particular medical situation. I'll just mention those that I've been through because that's all I know, but there are probably additional procedures that aren't listed here.

Hysterosalpingography (HSG): This uses ultrasound and x-ray together to examine the uterus and fallopian tubes. It is used to diagnose/rule out certain problems like blocked tubes, tumors, polyps, etc. and was also used for a practice run for our upcoming transfer. This is done while the patient is awake, with no pain meds. They inject dye into the uterus, then x-ray to see what the dye does. It shows if there is a tube blockage, and if there isn't, the dye just leaks into your abdomen and is absorbed by your body. Probably considered non-surgical. Uncomfortable but not too painful.

Here's an example of the HSG procedure (Image from reproductive.org)

Hysteroscopy: This one really sucks. A hysteroscopy can be done for many reasons related or not related to fertility. For fertility treatment, they use a camera to look for and/or take out any polyps, tumors, fibroids, scar tissue, etc. in the uterus, then they scrape down the uterus (basically a d/c) to allow fresh lining to grow. They put you under for this procedure, and it requires some physical recovery. This procedure is done when you're first starting the fertility cycle.

Example of hysteroscopy showing uterine polyps (Image from dallasivf.com)

Egg Retrieval: This is another procedure where they have you under anesthesia. For a Fresh IVF cycle, you are growing as many follicles as possible, which are monitored for size via ultrasound every few days. Once you have several follicles that are large enough, they trigger ovulation with a shot, then they perform an egg retrieval where they take each egg + fluid within follicles out individually by needle. This procedure hurts. Bad. If you'll be doing this some time in your life, just know that it won't be fun, but you can totally get through it. I wish someone had told me it would hurt, so I could prepare myself. It's more the pain in the several days after the procedure as your ovaries swell from trauma. But then they heal and you feel like a regular human again. :)

This is an ultrasound of one ovary with many growing follicles ready for retrieval. (Image from advancedfertility.com)

GCSF Wash: Very simple, uncomfortable but not painful. You go into the doctor, they inject into the uterus a saline solution with hormones to grow the uterine lining. You remain lying down for ~10 minutes afterward. Then go home and go about your day while leaking fluid for several hours. :)

IVIL: This is a non-surgical procedure, called intravenous intralipids (or IV lipids). It's not part of every IVF plan, but I've done it for most of mine. IV Lipids are a treatment for things other than fertility as well, but its basically egg white and other lipids (fats) in the form of a milky IV liquid that is supposed to help with overall nutrition, possible immune factor of infertility, and help to reduce risk of miscarriage. I guess it's a bit of a hot topic as to whether or not it significantly changes your chances, but I don't really care at this point. Bring it on. You go into the doctor's office and they give you this IV once before your embryo transfer and then again after a positive pregnancy test.

Embryo Transfer: This is the coolest part in my opinion. Also very uncomfortable. You go in with a full bladder, husband is allowed to be present. You are awake and under no pain meds because it shouldn't be too painful. They show you (through microscope) your little embryo(s) in their petri dish and you watch as they suck them up into a pipette, bring them to you, ultrasound guided inject them into the uterus (not into the lining, just into uterus). Then you go home and have to chill on the couch for 72 hours, trying not to think/worry about what is/isn't happening. Even with the most sophisticated IVF cycle, implantation is always something you just hope for. There is no way to manually implant an embryo. So at this point you continue with all your medications and hope for the best!

Embryo ready for transfer

This is a hatching embryo (yes, human embryos do hatch from a shell)

IUI: This is a different type of fertility cycle, as mentioned before. But for this actual procedure, ovulation is triggered with a shot, then they bring you back into the office within a specific amount of time (determined by your doctor). The man has to provide sperm that same day, which they then wash/clean (not sure how you wash something microscopic) and count. The actual IUI procedure is brief, the doctor injects the sperm into your uterus at a calculated position. You remain lying down for ~10 minutes, then go home and don't do anything strenuous for a few days. Uncomfortable (as always) but not too painful.

(All images that aren't my own were used from public websites geared toward education on each of these procedures individually).