IVF procedures vary from time to time and your own treatment may differ in some details from that described here. If you have any questions or want further discussion or guidance, please let us know. Couples with infertility problems have faced many frustrations and disappointments so they are under stress. Before starting any treatment, it is necessary to discuss the issues with the counsellor. Consent forms must be signed before starting the treatment.
1. Before starting treatment
When you are ready to start treatment you should see a doctor to 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, Hormone profile,Ultrasound
Husband: Blood sugar, Semen Analysis
2. Start of the treatment
Fix an appointment with the concerned doctor at a time convenient for both.
3. Ovarian Stimulation
Drugs are used to stimulate the ovaries to produce several eggs to increase the chances of pregnancy. Many different protocols are used and yours may be different from others. Your doctors will advice you regarding your drugs and their usage.
i) Long Protocol: Women receiving the Long Protocol start injections on the 18th day of the previous cycle. She is asked to come to Prasad Infertility Solutions on the 2nd or 3rd day of her next period for starting the actual ovarian stimulation. Sonography and sometimes a blood test are done and the stimulation is then started.
ii) Antagonist Protocol: Injections for ovarian stimulation are started from the 2nd day of cycle. As compared to the long protocol,this requires fewer injections.
In both the protocols, injections are to be taken at approximately the same time every day. To minimise disruption, many women prefer their husbands or another relative/family doctor to give their injections at home or even do it themselves. Therefore, it is not necessary to come to the hospital daily for injections. Trained nurses will teach you how to take the injections.It is common to have some discomfort and mild side effect while taking the drugs. The main serious side effect is a hyper response, which is severe in about 1 in 100 stimulated cycles.
4. Ultrasound Examination
A vaginal ultrasound examination is done after 5 days of taking the drugs to measure the response of your ovaries with regard to the size of the follicles. The drug dosage may have to be altered depending on your response. Sometimes, ultrasound scans will be carried out during the stimulation protocol for monitoring purposes.
5. hCG Injection
hCG injection is given to trigger the final maturing of the eggs when they are ready for collection. Eggs collection is planned approximately 24-36 hours after hCG injection. On the day hCG is planned, the time for injection that night together with details for your hospital admission for the eggs collection will be informed to you by your doctor. They will inform you about the time for sperm collection by your husband.
6. Ovum Pick Up (OPU)
The procedure of removing the eggs is carried out using Trans-vaginal Sonography under general anaesthesia. The procedure takes about 15 to 30 minutes. Sometimes there is a possibility that a fresh semen sample cannot be produced on the day of egg collection, freezing a semen sample prior to egg pick up is a good plan. Use of frozen semen does not reduce the chances of a pregnancy.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 pain killer can be safely used. Although this is a very minor surgery, it is not without risk. You will be able to go home about 3 to 4 hours after the procedure.
7. Semen collection
A fresh semen sample is collected on the day of egg collection. This can be done just before or just after egg collection. The semen sample is best produced by masturbation and there is a separate and private room for this purpose. Lubricants should not be used as they can affect fertilisation. It is difficult sometimes for some men to produce the sperm sample on request. If you live close to hospital it may be possible for you to produce the sperm sample at home. Sexual activity between the couples should not continue during the treatment cycle.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.
8. After Egg Collection
Following egg collection, the eggs will be fertilized either by standard IVF or by ICSI. On the next day, the embryologist examines the eggs for fertilisation.
9. Embryo Transfer (ET)
ET is done 2 or 3 days after egg collection. You will be able to see your embryos before transfer. It is simple procedure needing no medication and is carried out under sonography control and requires a moderately full bladder. The women’s legs are rested in stirrups and the embryo is passed through the cervix into the uterus through a very fine soft plastic tube. It takes only a few minutes.There is no need to rest afterwards, you may go straight to home or back to work and resume all normal works. However, heavy work like lifting weights, climbing staircase, etc., should be avoided. Our good ambience in the clinic will help you in making the period after ET as stress free as possible.If there are more than three good quality embryos left after ET, it may be possible to freeze them for later transfer. This is discussed with you before ET. Separate consent form must be signed for embryo freezing. The wife will be asked to take some injections and/or tablets after embryo transfer to support the luteal phase.
10. Pregnancy Test
A blood test is carried out on the date given after embryo transfer. You should meet the doctor with the results to decide further treatment. If the test 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.