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IVF GUIDE:


Every cycle ART multiple steps, and each occurs at a specific time during a four to six –week period. The procedures starts the month preceding the actual IVF CYCLE. The following is provided only as a general guide. Remember that you will be following an individual protocol designed specifically for you. They differ from the protocol recommended to your friends or other women.

Cycle preceding IVF Cycle
Start of oral contraceptives or documentation of ovulation (mid-luteal)
Start of GnRH agonist theraphy.

IVF Cycle

Step-1 – Initiation of Oral Contraceptives

Some patients will receive oral contraceptives in the cycle prior to the ART cycle. This ensures that GnRH analog theraphy work proper time if you have irregular cycles. There is also evidence that oral contraceptive can help prevent ovarian cysts, which may develop during GnRH analog therapy. You will usually begin a pack of oral contraceptives when your nurse instructs you take Alternatively, we may prescribe progesterone for patients who ovulate irregularly or not at all.

Step 2-GnRh Agonist Administration

You will usually begin treatment with a GnRH aginst on the sixteenth day of oral contraceptive pills or the sixth day of progesterone, although this may vary. You do not need a pregnancy test before you start the GnRH agonist.

We will instruct you to reduce the dosage of GnRH analog by one-half on the day you begin ovarian stimulation. You will use the analog until the day of hCG (human chorionic gonadotropin) administration.

Step 3-Baseline Pelvic Ultrasound

Around the time of your expected period, we will perform an ultrasound scan to examine the ovaries, to make sure, they are properly suppressed.

Step 4- Ovarian stimulation

In general, we start ovarian stimulation after menstrual bleeding begins if the baseline ultrasound shows no significant cysts.

There are several medications to stimulate follicle(egg) development. Some subcutaneously (just under the skin using a smaller needle.)

Step 5 - Monitoring of Follicle Development

We monitor follicle development with a combination of vaginal ultrasound and hormone measurements (blood tests). We must do these tests frequently during the ART cycle to ensure that you take the proper dosage of medication. We usually see patients two to three days for an ultrasound and anestradiol level. This allows us to adjust the dose of medication in an effort to improve the development. When the largest follicle reaches 16-18 mm, we usually schedule daily visits for ultrasound exams and serum tests. The amount of medication we prescribe each afternoon depends upon the results of the blood tests and ultrasound.

Step 6 – Final Oocyte Maturation and hCG Administration

Human chorionic gonadotropin (hCG) is a hormonal drug that stimulates the final maturatiom of the oocutes. Determining the time for hCG administration is critical. If it is administered too late follicles may be postmature(atretic) and will not fertilize. Optimal oocyte maturity occurs when we administer the hcg when more than four follicles measure at last 18-20 mm and serum estradiol is greater than 2,000 pg/ml. The drug is given as single intramuscular or subcutaneous injection. The time of the injection is based on the time at which we schedule the egg collection.

Step 7 – Transvaginal Oocyte Retrieval

Oocyte retrieval is performed about hours 34-36 hours after hCG has been administered. An anesthesiologist usually administers intravenous medications (sedatives and pain relievers) in order to minimize the discomfort that may occur during the procedure from these medications are much less common than with general anesthesia. Most patients sleep through the procedure and breath without assistance. A team member will discuss anesthetic options with you prior to your retrieval.

Once you are comfortable and relaxed, your physician will place the ultrasound transducer into the vagina. A guide attached to the transducer leads the needle through the wall of the vagina and into each follicle in the ovaries. Your physician will collect the oocyte and follicular fluid into a test tube for transport to the Embryology lab. The laboratory staff will examine the oocytes microscopically.

After the retrieval, you will be taken to a recovery room where you will be observed for 1-2 hours. When you are fully awake, your vital signs are stable, and you have urinated, you will be released to go home. You may have vaginal spotting and lower abdominal discomfort for several days following this procedure. Generally, patients feel completely well within 1-2 days. You should notify your physician immediately if you develop severe pain, heavy bleeding, or fever after these. One week or so after the retrieval, you watch for signs of ovarian hyperstimulation, i.e. shortness of breath, increased abdominal distention, weight decreased urine output etc.

The number of oocytes retrieved is related to the number of ovaries present, their accessibility, and the number of follicle formed in response to stimulation. Ultrasound provides only an approximation of the number of oocytes that one can expect to recover on average, 8-15 oocytes are retrieved per patient.

Step 8 – insemination of Oocytes

The Embryology laboratory staff examines the fluid aspirated from follicles for the presence of oocytes. It is important to determine the maturity of the oocytes in order to time the insemination properly. The oocyte can only be fertilized for a short interval of about 12-24 hours. If the oocyte is either immature or postmature (too old), it may not be capable of fertilization and normal development.

Semen is usually collected by masturbation the morning of the retrieval. The staff will instruct you regarding time of collection and transportaion to the office.

The laboratory staff prepares the semen speciment for insemination using techniques designed to separate the sperm from the material present in the ejaculate. As a result of this process, we select the most active sperm to inseminate the oocyte. We add about 10,000 sperm in a culture dish with each oocyte. The dish is placed into an incubator which maintains a specific temperature level of humidity, and concentration of carbondioxide. After 12-20 hours, the laboratory staff may detect evidence of fertilization with the microscope. Normally, approximately 70% of oocytes fertilize.

Step 9 – Embryo transfer

The embryo transfer procedure is usually performed three to five days after the oocyte retrieval. This procedure is nearly identical to uterine measurement or an intrauterine insemination. Your physician will pass the same type of catheter gently through the cerwix and the uterus and deposit the embryos into the uterine cavity along with an extremely small amount of fluid. You will require no anesthesia for the embryo transfer. You will be discharged after resting for two hours.

Several studies have indicated that maximal IVF-ET pregnancy rates occur in most cases with the transfer of two to five embryos depends on your age.

Step 10 – Progesterone Supplements

You will administer progesterone daily beginning on the day after oocyte retrieval. Supplemental progesterone helps prepare the uterine lining for implantation.

This daily medication will continue until your pregnancy test. If the test is positive, you may be advised to continue to take for several more weeks.

Step 11- Hormonal Studies and Pregnancy Test

We will usually perform a serum pregnancy test and a progesterone determination 9-12 days after the embryo transfer. If the test is negative, we will instruct you to stop the progesterone.

Step 12 – Early Pregnancy follow up

We will follow your early pregnancy for approximately three. This close scrutiny is necessary to try to identify miscarriage ectopic pregnancies and to counsel you regarding the status and treatment of multiple gestations.

Step 13 - Post IVF Counsultaion

If you are unsuccessful and do not achieve an ongoing pregnancy with your in vitro fertilization cycle, you should a consultation with your physician to review the cycle and discuss future treatment options.

 


 
   
 
 
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female infertility
Infertility in kerala
Improve fertility
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ICI in kerala
ICSI videos
IVF and ICSI
Infertility and ICSI
IVF Guide
About Surrogacy
Terms and Condition
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Donor Egg Cost
Donor Sperm Procedure
Laparoscopy Procedure
What is embryo?
Low Sperm count