When you visit an infertility specialist!
When a couple has decided to go ahead with IVF/ICSI cycle they are advised certain blood tests for both husband and wife.
An ultrasound is done to check the condition of ovaries and uterus to rule out any other problem.
Semen analysis and culture are done. Sometimes sperm function tests are also performed.
If the wife has not undergone hysteroscopy then it is done before starting the cycle.
Any abnormality found in the tests or any medical condition must be treated before IVF is performed.
Once all the evaluations are complete a written consent is taken and the couple is again counseled about the complete procedure so that they are well aware of the process and expected cooperation during the process.
This process is started on Day 21 of the previous cycle, i.e. a month before IVF cycle. Injectibles are given which many patients learn to take on their own at home. Blood investigation to check LH, FSH and E2 hormone level is done to confirm down-regulation.
The actual process of ovulation induction varies from patient to patient depending on her age, hormonal problems, and local protocols. Daily injections of FSH or HMG are given till the desired size of follicles is reached.
The cycle is monitored to check the growth of eggs and thickness of endometrium by doing ultrasounds. Sometimes a blood test to check Estrogen level is also done(serum E2 levels).
When the eggs have reached the desired size an injection is given for final maturation which is HCG. After 35-36 hours the process of ovum pick up is planned under short sedation. It doesn’t require hospitalization but the patient is called fasting as mild anesthesia is given. Under the guidance of ultrasound, and with the help of special fine needle eggs are extracted from the follicles with the follicular fluid. The procedure normally takes 20 mins. The patient can go home after a short rest.
Once the eggs are retrieved from the group of cells they are aspirated and they are ready for fertilization after a few hours of being kept in an incubator. The decision to perform fertilization either by IVF or ICSI depends upon how the embryologist evaluates the sperms and oocytes.In case of poor count and mobility, ICSI is performed as it gives better results. In cases where TESA /TESE /PESA is done to remove sperms from testis, ICSI is necessary. The embryos are left to grow in the controlled environment of incubator equivalent to human body temperatures for 2-5 days.
Usually, the embryologist assesses the quality of embryos and decides about the time of embryo transfer which is a simple procedure like IUI requiring anesthesia with the help of soft cathedra embryos are placed in the womb. It is a painless procedure and after some rest, the patient can go home.If blastocyst transfer is planned embryos are allowed to grow in special media and environment for 5 days before transfer.
Extra embryos may be frozen by the embryologist with the help of special procedures in liquid nitrogen where they are safely preserved for many years without affecting their quality. Sometimes embryos are frozen because the transfer is electively planned later as endometrium or the lining of the uterus is not good or the patient has OHSS (Ovarian hyper stimulation syndrome-a condition where too many eggs form and leads to disturbance of hormones, protein levels and fluid collection in the body).
It’s a procedure in which the outer lining of the embryo is treated with either LASER or with certain chemicals to make it more sticky and more adhesive to the lining of the womb. It is particularly useful in older women, in cases of IVF failures and problems of the weak lining of the womb.