IVF Programmes utilize controlled ovarian hyper stimulation which result in more eggs and hence a better chance of pregnancy. Controlled ovarian hyper stimulation is carried out with GnRH agonist or antagonist and gonadotropins (Recombinant or urinary FSH and HMG) injections. Various Protocols are used depending on the age of patient, ovarian reserve and previous IVF cycle.

Controlled ovarian hyper stimulation and monitoring

The duration of treatment varies with the protocol and usually requires around2-4weeks.
GnRH Agonist Injection: GNRHa treatment is given daily to suppress spontaneous ovulation and to ensure that the ovarian follicles grow in synchronous fashion. It usually starts around day 21 of the cycle preceding IVF cycle and continues for about 14 – 20 days. Some patients may need to take this medication for longer periods. Once you start menstruating, blood tests and ultrasound scans will be done to ensure that the optimum response is reached. Once this is achieved, we will proceed to gonadotropin injections.

GnRH Antagonist injection: Unlike the long protocol [GnRH agonist] antagonist shuts down the pituitary immediately. The drug is given daily from sixth or seventh day of gonadotrpin stimulation onward including the day of HCG.

Gonadotropin injections: After achieving down regulation it is advised to continue taking GnRH agonist but to reduce the dose for maintenance and to begin gonadotrophin injections such as FSH or HMG for stimulation, the intial doses of injection is decided to suit each individual. The injections are usually given once a day into muscle /subcutaneous tissue of your thigh,abdomen  or  buttocks for about 10-12 days.

The dose of gonadotrophin is adjusted depending on the response/development of follicle which is evaluated by blood test and ultrasound scans.

The number of follicles is counted and the diameters of the growing follicles are measured. Ultrasound is also used to measure the thickness of the endometrium for the implantation of the embryo. Serial blood sample may be also taken to measure the levels of estrogen. Estrogen production increases as the follicle develops.

When the follicles have reached the desired size, then injection of HCG is given and GnRHagonist / antagonist and gonadotrophin are discontinued. The HCG is required for the final maturation of the eggs before egg collection. The egg collection is scheduled for about 34 -35 hours after the HCG injection.

Sperm Preperation

During the gonadotrophin injection, your husband needs to abstain from sexual intercourse before the egg collection. On the day of the egg collection, your husband needs to produce a fresh masturbated semen sample. The sample is washed in culture medium and prepared in order to separate sperm from seminal plasma.

Egg Collection(OocytePickup)

Vaginal ultrasound guided egg collection is the most common technique. The eggs are collected through a special needle attached to an ultrasound vaginal probe. A mild sedative general anaesthesia will be given to you as the procedure takes around 20-30 minutes. After the egg collection, you will be observed for a few hours before going home. It is important to understand that not all follicles will necessarily contain an egg and that some of the eggs may not be ripe enough for fertilisation.
An overnight fast is required before oocyte pick-up procedures.

Fertilization

The eggs are collected into specially prepared culture medium and examined under microscope and graded for maturity. The eggs are then placed in the incubator at 37 degrees and 5% CO2 for the required period of time (3-8 hrs) before it is mixed with selected sperms. The sperms are added to the collected eggs in a dish to allow fertilisation to occur by natural selection in the laboratory. A check to confirm that fertilisation has occurred is carried out the following day. It takes about 18 hours for the egg to be fertilized and about 12 hours for the fertilized egg to divide into 2 cells, subsequently into four cells and so on. After 48-72 hours from the egg collection, the embryos will usually consist of 4-8 cell each and are ready for replacement in women’s uterus.

EmbryoTransfer

The embryo can be replaced on day two or a day three after egg collection. Embryos are placed into the uterus using a fine catheter. This is usually painless and takes only a few minutes. Usually, three embryos are transferred. A smaller number may be transferred if there are insufficient embryos or the patient is young.

The patient may go home shortly after the embryo transfer. The patient will be given daily medications (progesterone or HCG) to support the lining of the uterus and to enhance the chances of the embryos implantation.

General  advice after Embryo Transfer

There is no restriction on activities. You should take it easy and avoid physical strenuous exercise such as aerobics and horse riding and lifting heavy objects. Eat healthy diet with plenty of fresh fruits and vegetables. Keep yourself well hydrated by drinking plenty of water.

Freezing of Extra Embryos

A proportion of patients may have excess good quality embryos. These may be frozen for future use. Patients do not need to undergo Controlled Ovarian Hyper stimulation and egg collection again for these future thaw cycles.

Pregnancy

The patient would be needed to come to Nirmala fertility within 16 days after the embryo transfer for a pregnancy test. If you are pregnant, subsequent ultrasound scans and blood tests will be arranged to ensure that the pregnancy is proceeding normally.