IVF - IN VITRO FERTILIZATION
IVF - In Vitro Fertilization
Choice of Clinic
There is an abundance of clinics to choose from but not all of them offer quality at international standards. IVF and infertility treatment requires close follow up and can be stressful. You will need a clinic that has a warm atmosphere and can comprehensive medical services.
When choosing an IVF clinic, please watch for these
In our clinic techniques in Artificial Reproductive Technology are practiced successfully. These are:
In addition to ART, a variety of procedures are done to ascertain the cause of infertility and, if possible provide, many kinds of surgical treatments (such as use of Laser or electrocauter to open blocked tubes or treatment of endometriosis) can be performed laparoscopically.
This document is to help familiarize you with the procedures associated with ART. Please read carefully and do not hesitate to ask questions.
When should you seek treatment ?
The best time to make an appointment at our clinic is on the second or third day of your menstrual period (if you are menstruating). If you are not menstruating or if your periods are irregular, then come when it is most convenient. For those who live in another city, we recommend that you come on Monday or Tuesday. Please bring reports of any tests that you have had done previously. Couples who have decided to start treatment and have had all their necessary tests done should set aside 2 hours for the initial consultation and instruction.
For Whom is IVF Recommended ?
Normally the egg that is released by the ovary it is ‘caught’ by one of the fimbriae and transported along the fallopian tube to the uterus. Fertilization usually ocurrs in the tubes and then the developing embryo implants in the uterus about one week after ovulation. When the egg is fertilized and cultured outside the body, this is called In Vitro Fertilization (IVF). The most common reasons for IVF are:
For Whom is IVF Not Recommended ?
Women of advanced age or patients with extremely poor quality sperm have a very low chance of pregnancy.
There are no set limits. Provided that eggs that are collected fertilize normally, chances of pregnancy is the same with each attempt. Just as in rolling dice, the probability of getting a six in the first try is low but the probability increases proportionate to the number of tries. One can try as often as 10-12 times.
What are the Stages Of IVF Treatments ?
Suppression of Hormones:
We use Lucrin vials and/or oral contraceptives for this purpose. We will explain the protocol to you. The following is an overview of the drugs used and their side effects.
Stimulation of ovaries :
Recruitment and development of ovaries is stimulated by Gonal-f, Pergonal, Metrodin, Puregon, Merional, Fostimon and Menogon used either by themselves or in combination of two or more. Normally these drugs are used for a period f 8-15 days. When the largest follicle attains 15mm, then close observation is required to prevent premature ovulation. This will be explained when you begin treatment.
Mainly there are 4 types of ovulation induction
GnRH agonist protocols: These drugs are used to suppress ovaries. They normally first stimulate ovaries, because they make the pituitary gland secrete more FSH hormones which stimulate the ovaries. After 5-7 days of injection of these drugs, they desensitize the pituitary glands. Therefore they prevent the secretion of final maturation hormone, LH and prevent spontaneous ovulation.
Antagonist Protocol: These drugs act immediately and their effect usually last about a day. Therefore they can be used in replace of agonist drugs and for shorter time of injections. Their main purpose is like agonists to stop ovulation before the egg collection.
Drugs used during treatment:
The initial dose is taken on different days depending on the type of protocol used:
Injections are done with insulin syringes. The needle is finer and it is easier to measure out 0.5 cc’s.
Egg collection :
This procedure is done 34-40 hours after hCG is administered. For example if hCG is injected on Monday night at 24:00, the egg collection procedure will start at approximately 10 am on Wednesday. Since we use general anesthesia during egg collection, we ask that you come to the clinic after a 6 hour fast. The procedure lasts 5-30 minutes. The procedure causes very little discomfort to the patient because we use general anesthesia or local anesthesia in conjuction with sedation. This procedure involves using a needle attached to a vaginal probe which pushes through the vaginal wall to reach the follicles and aspirate their fluid. We ask the husband to collect sperm at this time. This procedure is simple and carries very little risk of complication, but in the event that there is a complication such as heavy bleeding, surgery may be required. Normally the patient can go home a few hours after the procedure.
Embryo Transfer :
Eggs are inseminated with the partner’s sperm. Fertilization is verified two days after insemination. Please do not try to get information before the second day. For example if egg collection was done on Wednesday, the embryos will be examined on Friday and the embryo transfer day will be decided upon. The transfer procedure is painless and does not require anesthetic or sedation. Normally it takes about 10 minutes. Depending on the number of embryos and their quality, the day of transfer may vary from the 2nd day to the 5th day. Patients usually rest for about 20 minutes after the procedure. Sexual intercourse is not allowed for two days after the procedure. The patient can resume her normal daily activities a day after the procedure.
You will be asked to use certain drugs on the day of Embryo Transfer until the pregnancy test. The drugs prescribed will vary according to the patients’ needs. You will use one or more of Progesterone in oil ampule, Pregnyl ampule veya Progestan tablet, Duphaston tablet, and Proluton-depot ampule. If the pregnancy test is positive, you will continue using the drugs until the 8-10th week of pregnancy. If the pregnancy test is negative, you will be asked to discontinue the drugs.
A pregnancy blood test will be done 12-14 days after egg collection. If the test is positive, the pregnancy must be confirmed by ultrasound 10-15 days after the pregnancy test. Using the egg collection day as reference, 28-30 days afterwards, doctor’s can see the baby’s heart beat in ultrasound scan.
When Multiple Pregnancy Occurs ?
Increasing incidences of multiple pregnancies are seen as a result of ART. The goal of recent studies is to reduce the number of embryos while maintaining a high pregnancy rate. We have succeeded in keeping the number of transferred embryos low without compromising our high pregnancy rate. Fetal reduction is done under ultrasound guidance and is used for multiple pregnancies of 3 or more. The procedure is usually performed at 10-12 weeks of gestation.