| In Vitro Fertilization (IVF) |
| In Vitro Fertilization means fertilization out side the body. In this the sperm and eggs are put together in disposable sterile 4 well plastic dishes. |
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| Oocyte |
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The egg. |
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| Follicle |
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Follicle is the fluid filled swelling in the ovary which contains the egg. The egg itself is too small to be seen and measured using ultrasound. We expect a follicle to grow by about 2 mm in size each day until it ovulates releasing an egg at about 20-22 mm size. |
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| Ovarian stimulation |
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The hormone treatment which is given to develop several follicles in the ovaries instead of the usual single follicle produced in a natural cycle. |
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| Insemination |
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The adding of sperm to achieve fertilization. |
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| Fertilization |
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The process in which a sperm enters an egg and triggers further development. We say fertilization has occured when we see two nuclei inside the egg cell under the microscope - the nucleus from the sperm and the nucleus from the egg. |
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| Polyspermia |
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Sometimes, more than one sperm enters an egg so that there is an abnormal number of a chromosome. Such an abnormal embryo is not transferred. |
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| Embryo |
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"Embryo' Comes from the Greek word meaning "to swell and grow". When we use the word we mean a fertilized egg which has divided at least once to reach the two cell stage & beyond. |
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| Embryo Transfer (ET) |
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The transfer of the embryos from the 4 well dish to the woman's uterus. |
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| Embryos Cryopreservation |
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The freezing of embryos for storage (at-196oc) until they can be thawed and transferred to the uterus in later cycles. |
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| Biochemical Pregnancy |
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Early embryo development begins but does not become established, so that pregnancy tests are positive at first but later become negative. This is not a miscarriage and is usually followed by fairly normal period. |
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| Blighted Ovum |
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This is a common form of miscarriage. Ultrasound shows that there is a pregnancy sac and placenta growing without a fetus. Usually curetting is a option for clearing the product of conception. |
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| Ectopic Pregnancy |
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A pregnancy growing outside the uterus, mostly in the fallopian tube. It cannot continue grow and must be removed immediately for the woman's safety. |
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IVF-STEP BY STEP
This is a rough guideline for the IVF/ICSI treatment cycle. The actual treatment in a couple may vary depending on the woman's age, indication, response to treatment etc, this will be finalized at the time of your consultation. This includes the following. |
- Fresh IVF/ICSI Cycle
- Frozen Embryo Transfer Cycle
- Donor Recipient Cycle
- Embryo/Egg Donation Cycle
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| I. FRESH IVF/ICSI CYCLE: |
Before Starting
When you are ready to start treatment you should see a doctor at VHFRC confirm that all tests have been done and to have any special aspect of your own treatment or recent changes explained and discussed. Screening tests will be checked and sometimes repeated. These are: |
Wife
- Complete Hemogram, Blood Sugar, Urea, SGPT
- Hepatitis B [HBsAg]
- HIV
- Other Blood test as per your profile.
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Husband
- Sperm test within 6 months
- Hepatitis B [HBsAg]
- HIV
- Other Blood test as per your profile
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| A semen sample is generally collected and stored (cryopreserved). This can be used at the time of the procedure if the sample on that day is not good or if the husband is not present or is unable to give a fresh sample. The wife is generally put on a low dose of oral contraceptive pills from the 3rd/4th/5th day of the period. This helps in programming the treatment cycle and avoids unnecessary delays. The wife is also given iron and vitamin tablets and the husband is given a course of antibiotics. |
| Counseling
Couples with infertility problems does face many frustrations and disappointments so they are under stress. IVF itself can be physically and emotionally taxing and the uncertainty while waiting for result can be very stressful. We acknowledge this and believe in making your experience with us as stress free as possible. Our counselor/ consultant will be ready to help you at any stage of treatment. Consent forms must be signed before starting treatment. Group/ single couple counseling can be planned, depending upon the need of the patient. |
Ovarian Stimulation:
Drugs are used to stimulate the ovaries to produce several eggs instead of the usual one to increase the chances of pregnancy. Many variations are used and yours may be different from others. Our doctor will advise you regarding your own drugs and its dosage.
In general there are 3 types of protocols, (Long, short and antagonist) and 2 types of drugs (recombinant and urinary) The cost of the treatment and to some extent the success rate depends on the drugs used. The doctor will discuss this with you before selecting and prescribing the stimulation protocol for you. |
A:- LONG PROTOCOL:
Women receiving the Long Protocol start injections on the 21st day of the previous cycle (i.e. when about 4-5 oral pills are left.) She is asked to come to VHFRC on the 2nd or 3rd day of her next period for starting the actual stimulation, Sonography and sometimes a blood test is done and then the actual stimulation is started. |
B:-SHORT/ANTAGONIST PROTOCOL:
For women on the short or antagonist protocol, all the injections are started on the second day of period.
Drug treatment starts from the 2nd day of the cycle and lasts for about 9-12 days till the eggs become mature as determined by ultrasound examination and if necessary, a blood test. To minimize disruption, many women prefer their husbands/another relative/family doctor to give their injections at home or even do it themselves. We can teach you or your husband to do this. However, if your prefer, VHFRC nurses can see patients and give injections daily. It is common to have some discomfort and mild side effect while taking the drugs. The main serious side effect is over response, (Hyper stimulation) which is severe in about 1 in 100 stimulated cycles. |
Ultrasound Examination:
A vaginal ultrasound examination is done after 4 days of drugs to measure the response of your ovaries. This shows the number and size of the follicles growing in the ovaries. This is a guide to how many eggs to expect and when they will be mature. This is used to decide whether your drug dosage needs any alternation and to plan the day of egg collection. Generally about 3 scans will be carried out during the stimulation protocol. The husband is not needed during these monitoring visits.
Sometimes if the response is very poor and only one or two eggs seem likely, the chances of pregnancy may be low and we may suggest canceling the cycle. |
HCG injection:
hCG injection is given to trigger the final maturing of the eggs ready for collection. Eggs collection is planned 34-36 hours after hCG injection. The day of egg collection will usually be decided when you have the scan and will depend on the size and number of follicle.
On the day hCG is planned, the time for injection that night together with details for your hospital admission for the egg collection will be informed to you by your doctor. The embryologist will inform you about the time for sperm collection by your husband. |
Egg Collection:
You will be asked to get admitted early in the morning on the day of egg collection. You should not eat or drink from midnight the night before the procedure.
The eggs are collected through the vagina under ultrasound control, using a fine needle, which is passed through the vagina into the ovary. Fluid from the follicles is sucked through the needle into a test tube and is passed immediately to the laboratory next door where the scientist checks for eggs under the microscope. The eggs are than placed in culture fluid in special dishes in the incubator at baby temperature. The procedure is performed under general anesthesia, but can be carried out under sedation if you prefer. The procedure taken about 15-30 minutes. You will be able to go home about 2-3 hours after the procedure and arrangement will be made for your ET time two or three days later. It is common to have some vaginal bleeding after egg collection from where the needle passes through the vaginal wall. This usually settles in one to two days and does not affect your chances of pregnancy. Some discomfort from the swelling of the ovaries is common and any painkiller can be safely used. Although this is a very minor surgery, it is not without risk. |
Sperm Collection
A fresh sperm sample is collected on the days of egg collection. This can be done just before or just after egg collection.
The sperm sample is best produced by masturbation and there is a room for this purpose. Lubricants should NOT be used as they can effect fertilization. It is difficult for sometimes for some man to produce a sperm sample on request. If you are worried about this aspect please discuss it with your doctor before starting treatment, so that arrangement can be made to freeze semen, which can be used if necessary. if you live close to hospital, it may be possible for you to produced the sperm sample at home. Sexual activity may be continue during the treatment cycle, it is better not to ejaculate for two days before the egg collection. However, more then 4 or 5 days with out ejaculation may reduce sperm Quality. |
| after egg collection
The egg will be fertilized either by standard IVF or by ICSI. On the next day, the embryologist examines the eggs for fertilization but in about 15% of cycle no eggs is fertilized, If this happens, it will be cleared to you and cycle will be cancelled. |
Embryo Transfer (ET)
ET is done two or three days after egg collection. It is simple procedure needing no medication. The women's legs are rested in stirrups and the embryo is passed through the cervix into the uterus through a very fine plastic tube.
There is no need to rest afterwards; you may go straight to home or back to work and resume all normal activity including sexual intercourse, However, heavy work like lifting weights, climbing staircase etc. should be avoided.
If there are more than three good quality embryos, it may be possible to freeze them for later transfer. This will be discussed with you before ET; Separate consent form must be signed for embryo freezing. The wife will be asked to take some injection and/or tablets after embryos transfer to support the luteal phase. |
Pregnancy Test
You will be given a date for a pregnancy about 14 or 15 days after embryo transfer, It is important that you get the test done even if you have a period, as there is a small chance of pregnancy even then.
If it is positive we will arrange an ultrasound examination 7-10 days later. If the test is negative, further treatment will depend on whether you have frozen embryos stored or not. |
INTRACYTOPLASMIC SPERM INJECTION (ICSI) |
What is it?
Micro Manipulator ICSI is a process in which the embryologist collects a single sperm using a highly specialized microscope and specially developed fine glass needles and injects it directly into the center of an egg. This process is repeated for each of the mature eggs that have been collected. |
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Whom is it for?
ICSI is mainly used for couples with extremely poor sperm OR where poor fertilization has been seen in previous IVF cycle OR where is reason to believe that ICSI will be the only way to achieve fertilization. It is also used in patient with azoospermia (no sperm), where sperm are obtained by testicular biopsy epididymal aspiration. |
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What is Assisted Hatching?
Hatching is a natural process before embryo implants, in certain condition if the fertillized ova fails to implant then with the help of LASER, process can be made easy. |
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What is I.M.S.I?
With the very high resolution imaging (7200x) Morphological normal sperms are selected for ICSI procedure. This helps in improving pregnency sucess in I.V.F. Programmes |
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FROZEN EMBRYO TRANSFER CYCLE |
| Treatment protocol for transfer of frozen embryos is very simple. The wife is supported on tablets (Estradiol valerate) from the second day of her periods for proper development of the lining of the uterus. She will have to come for sonography to see the development of the lining of the uterus she will have to come for sonography once or twice to monitor the response. When the lining has developed properly, progesterone tablets are added and embryo transfer is carried out 2 or 3 days later. Husband is not required during the entire treatment cycle, except for depositing semen sample. |
