Various steps of an IVF treatment cycle:- Term IVF stands for Invitro Fertilization which means “fertilization outside the human body”. This term applies to any form of assisted conception where fertilization takes place outside the body.
In this process after the basic investigations we select the stimulation protocol to be used.
We have to follow the natural process of formation of egg in a woman, in which the first 5 days of menstrual cycle is the time of recruitment of the growing follicles in a woman’s ovary which later start growing and reaches size of 18-20mm in 10-14 days. Following this pattern, we start stimulating the ovaries from D2 (using FSH or FSH+LH preparation) with the aim of recruiting more number of eggs for further growth in the cycle. This stimulation continues and patient is examined periodically by TVS, and growth (Size X Number) of growing follicles is monitored. When majority of follicles reach 18-20 mm, a night trigger of HCG 10,000 IV is given and Ovum pickup is performed at 36hrs. after HCG.
Process of Ovum PU :- It is a short procedure (10-15 min) performed under short general anesthesia in which eggs are retrieved through the Vagina guided by Ultrasound. After the procedure patient recovers in the recovery and can go back home or to their restrooms and resume to normal chores/normal diet.
Collection of Sperms :- At the same time the male partner is asked to give semen sample in a special private collection room. You may do this alone or with your wife. [We freeze the sperm sample of all patients before the pick up as a backup because many a times patient fails to give sample on the day of PU]
Fertilization :- Thereafter, the collected semen sample (marked with the name of the patient) is washed in the Andrology Lab and passed on to the Embryology Lab. By now in the Lab the Embryologist would have separated the eggs from the fluid retrieved from the ovaries. Later the Eggs and the Sperms are kept together in one dish filled with nutritive media and kept in an incubator. After 48 hrs. the dishes are checked for any Embryos, and out of them 2-3 Embryos are chosen for transfer. If we have excess Embryos from the process, then they can be frozen with patient’s consent.
Embryo Transfer( ET ) :- It is a gentle procedure where no anesthesia is given and Embryos are transferred under ultrasound guidance. Patient is required to rest for 2 hrs. after ET.
After ET :- Patient is given daily injections of progesterone as well as Oral/Vaginal progesterone Support. Urine Pregnancy Test is performed after 14 days of ET.
Bed Rest( ET ) :- Research has shown that extended bed rest has no benefit. We do not recommend any bed rest and you can have light activity for 3-4 days after the procedure. Following which you can resume your daily chores, as long as they don’t involve heavy weights or strenuous exercise.
For Whom :- For patients with following reasons-
- More than 5 Yrs. Of infertility
- Failed IUI’s
- Blocked Tubes
- PCOD-not conceived after 4-6 cycles of OI+IVI
- Advanced maternal age/ Menopause
- Suboptimal semen parameters.
Success consists of going from failure to failure without loss of enthusiasm.
Failed IVF/ICSI Cycles :- For patients with following reasons-
Like all achievements in life are built on failures, please be prepared to accept that the pregnancy success rate with IVF/ICSI are 40-50% per cycle and net live birth rate is 37% per cycle. This means 63% of treatments would fail. Common Causes of failure are:-
- Suboptimal Sperm Quality
- Suboptimal Eggs Quality
- Thin Lining
- Hormonal imbalance created by the injections given to produce good eggs, which might put the uterus out of phase for receiving Embryos.
Chances of conception are 37% per cycle. This implies that even if all goes well failure might be unexplained and implies the necessity of more cycles.
Measures suggested for failed IVF’s :-
- Repeat cycle with change of dosage or protocol
- Embryo freezing
- Higher dose of injection to get more eggs and Embryos
- Use of Endometrial scratching
- Use of donor eggs
- Use of donor sperm
- Use of donor embryos