IVF procedure

The In vitro fertilization – IVF process is performed in several steps, such as:

A single cycle of the IVF procedure may take nearly two weeks. And, you may, sometime, require more than just a single cycle.

Ovulation induction

In case you decide to utilize your own  eggs in the IVF procedure, the treatment will start with giving you artificial hormones for stimulating your ovaries.  This is a necessary step for producing several eggs, instead of just a single egg that usually develops in every menstrual cycle.

Multiple eggs are required as some of the eggs may not fertilize or develop usually after the fertilization. You may also need many different medicines, like:

For stimulating your ovaries, you may be given injectable medicine(s) having:

These medicines help in stimulating several eggs for developing at a time.

  • Oocyte maturing medicines

As the follicles get ready for retrieving the eggs, usually after about 8 to 14 days, you are given Gonadotropins or Human Chorionic Gonadotropin (hCG) and/or other medicines for maturing the eggs.

  • Medicines for preventing premature ovulation

These medicines help in preventing the body from expelling the developing eggs prematurely.

  • Medications for preparing the uterine lining

On the egg retrieval day or at the embryo transfer time, your doctor may advise to start taking progesterone hormonal supplements for making the uterine lining thicker and friendlier for the embryo implantation.

Your doctor may like working with you to ascertain which medicines to take and when to take them. In general, you require ovarian stimulation for about 1 to 2 weeks before the eggs get ready for collection. For ascertaining when the eggs get ready for collection, your doctor may often perform:

  • Vaginal ultrasound – It is an imaging examination of the ovaries for monitoring the follicle growth (The follicles are filled ovarian sacs filled with fluid wherein your eggs attain maturity.)
  • Blood Tests – The blood tests are performed for measuring your body’s response to the ovarian stimulation medicines – the estrogen levels usually increase as the follicles develop and the progesterone levels reach the low levels until the ovulation takes place.

At times, the IVF cycles are required to be cancelled before the egg retrieval for one of the following reasons:

  • The number is developing follicles is found to be inadequate
  • Premature ovulation
  • The number of developing follicles is much higher and you run a risk developing hyperstimulation syndrome
  • Other medical grounds

In case your cycle is cancelled, your doctor may advise you to change medicines or their doses for promoting a better response during your future IVF cycles. Alternatively, you may be recommended to go in for an egg donor.

Sperm retrieval

In case you want to use your spouse’s sperm, he is advised to provide the sample of his ejaculated semen at the Clinic through a hurried copulation or masturbation on the morning when your eggs are likely to be retrieved.

Sometimes, other procedures like, testicular aspiration, are needed to be performed. In such procedures, the sperm are directly extracted from the testicles, instead of ejaculated semen, with the help of a needle or a surgical method. At times, donor sperm are also used. Sperm are then separated from the seminal fluid in the laboratory.

Egg retrieval

Egg retrieval may be performed at the Clinic nearly 34 – 36 hrs. after the last injection and prior to your ovulation. During the egg retrieval process, you may be given pain and sedation medicines. Trans-vaginal ultrasound aspiration is considered the standard egg retrieval process.

An ultrasound transducer is placed into your vagina for identifying the follicles. Afterwards, a slender needle is introduced into the ultrasound guide to pass through your vagina and guided into the follicles for retrieving the eggs. In case your ovaries are inaccessible through the trans-vaginal ultrasound, laparoscopy or the abdominal surgery is performed for retrieving the eggs.

In the laparoscopy procedure, a small incision is done just near your navel area. Through this incision a slender screening device, called a laparoscope, is introduced for guiding the needle. Since the needle is attached to a suction device, the eggs are easily collected from the follicles.

The entire process of retrieving multiple eggs takes about 20 minutes. After the egg retrieval process, you might experience a feeling of fullness and pressure, besides cramping in your abdomen. The mature eggs are kept in a nutritive liquid, called culture medium, for incubation.

The eggs that are looking healthy and mature are mixed with sperm cells in an attempt of creating embryos. Nonetheless, not all the eggs get effectively fertilized.

Fertilization

Fertilization may be tried by two usual methods:

  • Insemination

During the process of insemination, mature eggs and healthy sperm are fused for overnight incubation.

  • Intracytoplasmic sperm injection (ICSI)

In the ICSI procedure, just a single strong sperm is injected into every mature egg directly. ICSI is generally used when the quality of sperm is not so good or their numbers are less. Or, in case the fertilization efforts during earlier IVF cycles have not been successful. In some circumstances, your doctor may advise you to go in for other procedures before performing embryo transfer, such as:

  • Assisted hatching

Nearly 5 to 6 days after the fertilization takes place, an embryo hatches from the surrounding membrane, called zona pellucid, permitting it to embed into the uterine lining.

In case you happen to be an elderly woman or have had several unsuccessful IVF trials, your doctor might suggest you go in for assisted embryo hatching. It is a procedure wherein a hole is prepared in the zona pellucida just prior to the transfer for facilitating the embryo hatching and its implantation.

  • Pre-implantation genetic testing

Embryos are placed in the incubator to allow their development up to a point when a small sample can possibly be taken for examining any genetic diseases or the right number of chromosomes.

This stage comes generally comes after 5-6 days of development. Embryos that do not hold affected chromosomes or genes can be moved to your uterus. With pre-implantation genetic examination, the likelihood of passing on the parental genetic problems to their offspring can be considerably reduced.

This does not mean that the risks of passing on parental genetic problems in the offspring get completely eliminated.  Prenatal examination is still recommended.

Embryo transfer

Embryo transfer is generally performed at the Clinic, after two-to-six days of the egg retrieval. You may be given a mild tranquilizer.  The embryo transfer process is generally painless, although you may experience a gentle cramping.

The doctor will introduce a long, slender and supple tube, called a catheter, into your vagina, through the cervix of your uterus. A syringe having one or more embryos, suspended in a small quantity of fluid, is attached at the end of the outer catheter. Using the injectable syringe, the doctor places the embryo(s) into your womb.

In case the embryo transfer is successful, the injected embryo(s) may get implanted in the uterine lining about 6 to 10 days after the eggs retrieval.

After the procedure

Subsequent to the embryo transfer procedure, you are usually allowed to take up the general routine activities, though your ovaries may get enlarged. You are advised to avoid dynamic activities that may cause discomfort.

Distinctive side effects may include:

  • Because of the swabbing of your cervix before performing the embryo transfer, you may pass a small quantity of clear or bloodstained fluid after the embryo transfer.
  • Your breasts may become tender because of high levels of estrogen levels
  • You may also experience mild bloating and cramping in the abdomen
  • Constipation

If you happen to develop pain, severe or moderate, after the embryo transfer, you are advised to contact your doctor to seek his or her advice.

The doctor may examine you for evaluating your complications, like severity of the ovarian hyper-stimulation syndrome, Chlamydia or Gonorrhea infections and ovarian torsion (twisting of the ovaries).

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