In-Vitro Fertilization (IVF) is a technique in which the egg fertilization takes place outside the woman’s body in the laboratory. Embryos are created there and then placed in the woman’s uterus after a few days. These embryos then implant and grow in the uterus and result in a pregnancy.
In the conventional IVF procedure, the eggs collected from the woman and the sperms from the man are put together in a petri dish and are left to be fertilized by themselves. In this, many eggs may not get fertilized by the sperm, especially if the egg or sperm count is low.
In ICSI (Intra Cytoplasmic Sperm Injection) procedure, each mature egg retrieved is injected with a single sperm. In this way, each egg gets the chance to be fertilized.
These processes involve several steps which need to be coordinated and monitored.
Couples who are not able to conceive after 12 months of unprotected intercourse have infertility and may need IVF. It depends on the cause and duration of infertility. Some examples are:
The success in IVF depends on many factors including the age of the woman at the time of egg collection, cause for infertility, ovarian function, number of embryos transferred, need of donor eggs, etc. In general, the success rate is around 50-70 % per embryo transfer attempt.
1. Before starting treatment
All necessary tests and ultrasound scans are done to make sure that you are ready for treatment and decide the protocol and dosage of drugs to be used for that purpose. All aspects of your personalized treatment are explained to you.
Screening tests of the couple include Hemogram and Blood Group, Blood sugar, Urea, SGPT, Creatinine, TSH, Viral markers, Urine tests. Explaining the procedure and signing the informed consent forms. Counsellors are available at all steps in case you have any worries.
2. Start of the treatment
Treatment starts on the 2nd or 3rd day of the menstrual cycle. We recommend that you come to the clinic between 9am to 1 pm. After performing the baseline ultrasound examination and reviewing all test reports, ovarian stimulation starts.
3. Ultrasound Examination
A vaginal ultrasound examination is done after 5 days of ovarian stimulation to measure the response of your ovaries with regard to the number and size of follicles. The drug dosage may have to be altered depending on your response. The next ultrasound examination is carried out 3-4 days later to again check the progress. You will need around 2-3 visits
for ultrasonography during your stimulation. Your husband will have to give one semen sample for freezing (as a backup) anytime during these visits.
4. Trigger Injection
This injection is given to trigger the final maturation of eggs when they are ready for collection. Egg collection (Ovum Pick-up) is planned approximately 35-36 hours after this trigger injection. On the day trigger is planned, the time for injection ( generally in the the night ) together with details for your hospital admission for egg collection will be informed to you.
5. Ovum Pick-Up
This procedure is carried out with transvaginal sonography under general anesthesia. This procedure takes about 15-20 minutes and you will be able to go home about 3-4 hours after the procedure. It is common to have some vaginal bleeding and pain, but this usually settles in a day or two.
6. Semen collection
A fresh semen sample is collected on the day of egg collection. This is best produced by masturbation and there are collection rooms for this purpose. It is difficult for some men to produce a semen sample on request. Therefore one sample is frozen earlier which can be used if a fresh one is not available and this does not lower your chance of pregnancy. Unless advised otherwise, it is better not to ejaculate for 2-3 days before egg collection. If you require a testicular biopsy (PESA / TESA), it is also done on the day of your wife’s Ovum Pick-Up.
7. After egg collection
Following egg collection, the mature eggs will be fertilized by standard IVF or by ICSI. ( ICSI is a process in which the embryologist collects a single sperm using a highly specialized microscope and micromanipulator and specially developed fine glass needles and injects it directly into the centre of an egg. This is repeated for each mature egg and is used for its fertilization.) The embryologist examines the eggs for fertilization and growth over the next few days and will be informed about the number of embryos formed.
8. Embryo Transfer (ET)
ET is performed generally 5 days ( Blastocyst stage ) or sometimes 3 days after egg collection. We usually transfer one or two embryos. You will be able to see your embryos before transfer. It is a simple procedure needing no medication and is carried out under ultrasound guidance. Embryo transfer is done through the cervix into the uterus using a very fine plastic tube and takes only a few minutes. There is no need for rest afterwards and you can go home or straight to work after the procedure and resume all normal activities. However, heavy work like lifting weights, strenuous activities, etc. should be avoided. Our counsellor will help you in making all this as stress free as possible.
9. Luteal support
You will be asked to take some tablets and / or insert some vaginal capsules ( rarely Injections ) to support this phase after embryo transfer.
10. Pregnancy Test
A blood test is carried out 14 days after embryo transfer. If your test is positive, we will arrange an ultrasound examination 7-10 days later. If negative, further treatment will depend on whether you have surplus frozen embryos stored or not.
11. Embryo freezing
If there are more good quality embryos, it is advisable to freeze them for later transfer. This will be discussed with you before ET, a separate consent form must be signed for embryo freezing.
Elective 'All Freeze'
Sometimes, it is not advisable to carry out an embryo transfer in the same cycle as it may not be safe for you due to high number of eggs or there are reduced chances of pregnancy due to abnormal hormonal levels etc. In such cases, we will freeze and preserve all embryos after discussing with you. These will be transferred in a subsequent cycle. This procedure is very simple as it does not involve any injections or anesthesia.
( Summary of IVF-ICSI treatment procedure:
1st Visit : Usually on Day 2. Consists of basic workup and start of ovarian stimulation.
2nd Visit : Usually on Day 7. Consists of USG monitoring of ovarian follicles and addition of ‘antagonist’ injection.
3rd Visit : Usually on Day 9 or 10. Consists of USG monitoring of ovarian follicles and giving the ‘trigger’ injection.
4th Visit : Usually on Day 11 or 12. Consists of OPU procedure, sperm collection and the process of ICSI and fertilization.
5th Visit : Usually after 3 or 5 Days of OPU. Consists of the embryo transfer procedure.
A pregnancy test is done after 14 days to check for pregnancy.)