In Vitro Fertilization
In vitro fertilization refers to a procedure where the woman’s eggs are removed and fertilized with the man’s sperm outside the body, in a laboratory. The embryos, thus formed are then put back into the uterus to achieve a pregnancy.
1
Before commencing the treatment
Before starting any treatment, it is necessary to discuss any issues or concerns you may have with a Santaan Fertility counselor. Consent forms must be signed and screening tests will be verified. These tests will be for:
Women
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Hormone assay
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Ultrasound
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Complete Hemogram, Blood Sugar
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Hepatitis B (HBs Ag)
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HCV
Men
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Semen test within 6 months
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Hepatitis B (HBs Ag)
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HIV
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HCV
2
Commencement of the treatment
You must come for a check up on the second day of your menstrual cycle between 9 am to 12 pm.
3
Ovarian stimulation
Medications will be administered to stimulate the ovaries to produce several eggs in order to increase the chances of pregnancy. There are two protocols available under the IVF treatment at Santaan and your doctor will advise you of the appropriate protocol for you.
I. LONG PROTOCOL:
Injections will be started on the 21st day of the previous menstrual cycle. A sonography and blood test is conducted before the actual stimulation is started. You will be asked to come to the Santaan Fertility center on the second or third day of your next menstrual cycle to start the actual ovarian stimulation.
II. ANTAGONIST PROTOCOL:
This protocol requires fewer injections and the injections for ovarian stimulation are started from the second day of the menstrual cycle.
In both protocols, injections are to be taken at approximately the same time every day. While it is advisable to come to the hospital for your injections, sometimes when this is not be possible, you can take the injections at home in order to minimize the disruption in your medication. Our medical staff will provide instructions on how to administer the injections. It is common to experience some discomfort and mild side effects, while taking these medications.
4
Ultrasound examination
A vaginal ultrasound examination is conducted five days after the administration of medications to measure the response of your ovaries with regard to the number and size of the follicles. If the response is poor and only one or two eggs are expected, or when the chances of pregnancy are low, we might suggest cancelling the IVF cycle.
5
hCG injection
hCG injection is given to trigger the final maturing of the eggs when they are ready for collection. Egg collection is planned approximately 36 hours after the hCG injection. The embryologist will inform you when your husband/partner is required to give his semen sample.
6
Ovum pickup (Egg Collection)
The procedure of removing the eggs from the ovaries is carried out with the help of transvaginal sonography under general anesthesia. The procedure takes about 15 –30 minutes and on an average 8 – 10 eggs are collected from each ovary. You will be able to go home, three hours after the procedure is completed. It is common to have some vaginal bleeding after this procedure, but that settles down in a day or two. Discomfort as a result of the swelling of the ovaries is common.
7
Sperm collection
Fresh semen sample should be collected on the day of the ovum pick-up (egg collection). However, if a fresh sample cannot be produced on the same day, a previously frozen sample can be used.
The following points must be followed while giving the semen sample:
– The semen sample is best produced by masturbation – Lubricants should NOT be used as they can affect fertilization – It is sometimes difficult for some men to produce a semen sample on request. In this case, you may collect the sample at home/elsewhere and bring it to Santaan Fertility Center within an hour of collection. – Unless advised otherwise, abstinence is recommended prior to two days before the egg collection. However, an abstinence of more than four or five days will reduce sperm quality.
8
After ovum pickup
Following ovum pick-up, the eggs will be fertilized in the lab either by standard IVF or by ICSI. On the next day, the embryologist will examine the eggs for fertilization.
9
Embryo transfer
It is performed two or three days after egg collection. The embryo is transferred through the cervix into the uterus via a thin, soft plastic tube guided by sonography. You will be asked to take some injections and/or tablets after the embryo transfer to support the luteal phase. It takes only a few minutes and causes no discomfort.
You can resume all normal activity including sexual intercourse, after the procedure. However, heavy work such as lifting weights or climbing stairs is not advised.
Embryo Freezing:
If there are more than three well-developed embryos, it is possible to freeze them for a later transfer, if necessary. This procedure will be discussed with you before the embryo transfer. Separate consent forms must be signed for embryo freezing.
10
Pregnancy test
Approximately two weeks after the embryo transfer, you will undergo a test for beta-hCG to check if gestation has been achieved. If the test is positive, a vaginal ultrasound scan will be performed to confirm this and view the gestational sac. If the beta-hCG test is negative, further treatment will depend on whether you have frozen embryos or not.
Precautions after an IVF treatment:
Avoid intercourse – This helps prevent vaginal infections.
No heavy lifting – Avoid lifting heavy weights. Heavy lifting may strain abdominal muscles that have been stressed by the IVF procedure. Woman should stay away from any tough household work.
No baths – Many fertility doctors caution women against taking baths during the two-week wait. A bath may introduce a foreign substance into the vagina and potentially cause infection that may lead to miscarriage. Patients are encouraged to take showers instead.
No strenuous exercise – Women are advised not to do any heavy exercise or aerobics after the IVF procedure. Light exercise such as walking is recommended rather than running.
Take progesterone – After ovulation, it is necessary to have a proper amount of progesterone to maintain pregnancy. Though a body produces progesterone, doctors will prescribe artificial progesterone in suppository or injection form to make sure that appropriate levels of the hormone are maintained during this time. The injections usually continue until the twelfth week of pregnancy till when a woman’s body begins producing enough the hormone on her own. Apart from these, a woman is advised to avoid caffeine, alcohol, other medications, and smoking.