New IVF Cycle
At Ashvini IVF Centre each patient is taken care of and treated individually and with special plans to make the treatment a success. But one can learn about a generalized treatment cycle in this section. The medical professionals will provide the patients with specific timeline. Following is a standard IVF cycle -
Workup and Counselling -
When you are ready to start treatment you should fix an appointment with our consultant to confirm that all tests have been conducted and to get your special treatment plan. Screening tests will be checked and sometimes repeated. A short video film will be shown on the entire IVF procedure for additional information.
The tests that are done and may be repeated to re-confirm are -
For Female partner -
- Complete Hemogram, Urea, SGPT and Blood Sugar.
- Hepatitis B [ HBsAg ]
For Male partner -
- Sperm test within 6 months
- Hepatitis B
Occassionally the male partner may be unable to produce semen sample at the point of time of the IVF cycle, which may lead to cancellation of the cycle. To aviod this, the sperm can be oryopreserved, i.e. collected and stored in advance and can be used in the future for months together.
The Female partner is generally put on a low dose oral contraceptive pill period after her menses. This is done to help in planning the treatment cycle and to avoid unnecessary delays.
Couples with infertility problems are seen to be are under stress as they face many frustrations and disappointments. IVF treatment can itself be emotionally and physically taxing and the uncertainty while waiting for result can be very stressful. We recognize this and assure you of making your treatment at Ashvini IVF Center stress free. The Counselor will be available to help you at any stage of treatment.
Controlled Ovarian Stimulation -
To stimulate the ovaries to produce several eggs than the normal one, drugs are used. Several eggs are needed to increase the chances of pregnancy. Many variations are used depending on the patient. After examining the patient and based on the various reports the patient will be advised the drugs and its dosage. Commonly there are three types of protocols, viz., Long, short and Antagonist. There are two types of drugs, viz., Recombinant and Urinary. The cost of the treatment and to some extent the success rate depends on the drugs used.
Long Protocol -
Female patient undergoing the Long Protocol are given the injections on the 21st day of the previous cycle, i.e. when about 4 - 5 oral pills are left. Patient is asked to visit IVF center on the 2nd or 3rd day of her next period for starting the actual ovarian stimulation. Sonography and sometimes a blood test is done and then the actual stimulation is started.
Short / Antagonist Protocol -
All the injections are started on the second day of the period in case of female patients on the Short or antagonist protocol.
Drug Treatment -
The injections are given from the 2nd day of the cycle and lasts for about 9 to 12 days daily till the eggs become mature as determined by ultrasound examination and if required, a blood test. Slight discomfort and some mid side effects may occur. The main serious side effect is over stimulation, which is severe in about 1 in 100 stimulated cycles.
Monitoring of Ovarian Response by Sonography -
During the ovarian stimulation by injections, sonography and blood test are done every 3rd or 4th day to judge the response of the ovary. As such about 3 sonographies are required. It helps to judge the injection dosages and confirm the day of ovum pickup.
Final HCG Injection -
HCG injection helps to keep the ovum finally ready for collection and these are generally given ready for collection and these are generally given 36 hours prior to egg collection. When the patient comes for admission for ovum pick-up, the male partner can simultaneously give the semen sample .
Egg Collection -
You will be asked to get admitted early in the morning on the day of egg collection and be fasting for 6-8 hours.
The procedure of collecting the eggs would take 20 - 30 minutes and is done under a short anesthesia. The ovum pickup is done by an ultrasound through the vagina and the eggs are kept in a special media in a sophisticated incubator at body temperature.
Semen Collection -
Just before or just after egg collection, a fresh sperm sample is collected. In case, the male partner requires the presence of his female partner, the embryologist should be informed, so that arrangements can be made for the same. The sperm sample is best produced by masturbation and the male partner is provided with a room for this purpose. Use of lubricants should be avoided as it can affect fertilization. It is difficult for some males to produce a sperm sample on request. If this a cause of worry, male patient should discuss it with us before starting treatment, so that arrangements can be made to freeze some semen, which can be used if necessary. If you live close to the hospital, it may be possible for you to produce the sperm sample at home. Unless advised otherwise, it is better not to ejaculate for 2 days before the egg collection. However, more than 4 or 5 days without ejaculation may reduce sperm quality. Sexual activity may continue during the treatment cycle.
Post Egg Collection -
In the post egg collection process, the eggs will be fertilized either by standard IVF or by ICSI. The the next day, the embryologist will examine the eggs for fertilization. In 15% of cycle no eggs fertilize, however the patients need not worry. The day after egg collection, the patients will be informed and guided at Ashvini IVF Center.
Embryo Transfer & Post Transfer Care -
Embryo Transfer is done two or three days after egg collection. It needs no medication as it is a simple procedure. It takes only a few minutes and is usually only as uncomfortable as having a pap smear. The female patients's legs are rested in stirrups and the embryo is passed through the cervix into the uterus through a very fine soft plastic tube. No rest taking is advised to the patient. The patient can continue her routine life at home or at work. Patients can indulge in all normal activity including sexual activities. But patient will be advised to strictly avoid activities where body is stressed like heavy work, lifting weights, climbing staircase, workout at gyms, etc. The female patient is advised to take some injections along with some tablets after Embryo Transfer to support the luteal phase.
If there are more than three good quality embryos, it may be possible to freeze them for later transfer. This is discussed with the patient and a separate consent form is also signed for embryo freezing before Embryo Transfer.
Patients will be advised about the dos and donts in post transfer care.
Pregnancy Test -
About 15 days after embryo transfer, the patient will be given a date for a pregnancy test. Even if the patient gets her period, it is important to get the test done as there is a small chance of pregnancy. If it is positive, ultrasound examination will be done about 7 – 10 days later. In case the test is negative, further treatment will depend on whether the patient has frozen embryos stored or not.
Intra-Cytoplasmic Sperm Injection (ICSI)
ICSI involves the injection of a single sperm into the egg using a sophisticated micromanipulator. Patients with male factor infertility can successfully use the powerful technique called intra-cytoplasmic sperm injection (ICSI) to realize their dreams of parenthood.
ICSI is mainly used for couples -
- With extremely poor sperm count or
- Where there has been poor fertilization in previous IVF cycle or
- Where there is reason to believe that ICSI will be the only way to achieve fertilization.
- It is also used in patients with Azoospermia, where sperm are obtained by testicular biopsy or epididymal aspiration.
In the process of ICSI, a single sperm cell is injected directly into the egg. The procedure is carried out in our laboratory under a microscope while the eggs are kept on a warm stage at 30°C. During thee injection procedures, micromanipulators are used to reduce hand movements to microscopic movements. The sperm injection pipette is used to immobilize and then to inject the sperm into the egg while it is kept stationary using a holding pipette. A small percentage of the eggs may be damaged by the ICSI procedure. After egg retrieval, about 80% to 100% of the eggs are expected to be mature for sperm injection. Not all eggs will fertilize after ICSI and some fertilized eggs may not divide into a cleavage stage embryo. Overall, however, the live birth rates with ICSI equal those achieved by conventional IVF. ICSI is the only option available to achieve parenthood with their own gametes, for most couples with severe male factor infertility.
Microsurgical Epididymal Sperm Aspiration (MESA) - -
In cases where the ejaculate does not contain sperm, MESA - Microsurgical Epididymal Sperm Aspiration is performed by a urologist specializing in infertility on the same day that the eggs are retrieved or in advance of the ICSI-IVF cycle. Epididymal and testicular sperm require ICSI for fertilization. During the MESA procedure it is common to obtain more sperm than needed for the ICSI treatment and the additional sperm can usually be frozen for future attempts.
Embryo Freezing & Frozen Embryo Transfer Cycle
During the IVF treatment cycle, there are usually additional or more than required embroys which are fertilized and growing. Only a few of these are required in that particular cycle. The remaining can be frozen. This is called 'embryo freezing'. The additional fertilized embryos can be frozen and stored for replacement in the future. There are chances that embryos may not survive the freezing process and/or may be incapable of resuming growth after thawing. When damage occurs during the freezing process, the pregnancy usually does not ensue. Offspring born from frozen embryos have the same rate of congenital abnormalities as the general population. The likelihood of establishing a pregnancy following transfer of frozen-thawed embryos is near about 15-20% per transfer.
Treatment procedure for transfer of frozen embryos is very simple. The female patient is put on estradiol valerate tablets from the 2nd day of her periods for proper development of the lining of the uterus. Female patient undergoes sonography once or twice to monitor the response. When the lining is developed properly, then progesterone tablets are added and embryo transfer is carries out 2 or 3 days later. Male partner's presence is not required during this protocol.
Donor Recipient Cycle
In patients in whom the sperm or the egg cannot be produced or is not of good quality, can benefit from using these donated by other couples.
In the Donor Recipient Cycle, the donor and the recipient under go different type of drug therapy. In the previous cycle, both the donor and the recipient are put on oral contraceptive pills, some times for different duration to synchronize their cycles. Afterwards, the donor under goes stimulation similar to a new IVF-ICSI cycle. The recipient is managed similar to a Frozen Embryo Transfer Cycle. To give a fresh semen sample, the male partner of the recipient is needed on the day of egg collection from the donor.
In this procedure, the eggs are taken from another patient with their consent and the sperms can be either of the husband or a donor.
The female patient who is going to be the recipient of egg or embryo donation, requires to take prescribed drugs for proper development of the lining of uterus. Female patient is treated in the same way as done in the case of Frozen Embryo Transfer Cycle. However, to give a fresh semen sample, the male partner of the recipient is needed on the day of egg collection from the donor.