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Ivf Basics

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The basics of IVF procedure

The IVF program is made up of four steps : -
  1. Use of fertility medications to develop oocytes or 'eggs'.
  2. Collection of the oocytes (eggs).
  3. In Vitro Fertilization of the egg and growth of the embryo.
  4. Replacement of the embryo back into the uterus.

Step 1: Developing and Monitoring Follicles

To assist in follicle growth, you will be started on a program of medication. Fertility medications are prescribed to control the timing of your egg ripening and to increase the chance of collecting multiple eggs during one of your cycles. This is often referred to as ovulation induction.

Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. Egg development is monitored using ultrasound to examine the ovaries and urine or blood test samples are used to check hormone levels.

This may require 8-12 days of treatment, with several ultrasounds and blood tests. When the follicles are mature, you will receive an injection of human chorionic gonatotropin (hCG) to begin the final maturation of the eggs. Eggs are collected 36 hours after the hGC injection is given.

Step 2: Collection of the Eggs

Mature eggs will be collected by a minor surgical procedure which uses a ultrasound directed needle through the pelvic cavity. This technique is performed under a local anesthetic in conjunction with IV sedation. The eggs are removed from ovaries using the hollow needle, which is called follicular aspiration.

Some women may experience cramping on the day of retrieval, which usually subsides the following day; however a feeling of fullness or pressure may last for several weeks following the procedure.

Step 3: In Vitro Fertilization of the egg

Once the eggs are retrieved, they are placed in a special culture medium (fluid) and allowed to remain there for approximately 2 to 3 hours. A semen specimen collected and given to the lab within one hour of collection is prepared for combining with the eggs. You must abstain from intercourse for 2 days prior to the IVF procedure. This ensures optimal sperm quality.

The sperm are prepared and a small number of active sperm are placed in the medium with each egg. The sperm and eggs are placed in incubators, which enables fertilization to occur, a process called insemination. In some cases where fertilization is suspected to be low, intracytoplasmic sperm injection (ICSI) may be used. With this procedure a single sperm is injected directly into the egg in an attempt to achieve fertilization. If ICSI is to be done, it will be performed approximately 4 hours after the egg retrieval.

The eggs will be examined approximately 18 hours after the time of insemination, to determine if they have fertilized and cell division is taking place. Once cell division occurs the fertilized eggs are considered embryos. You will be informed about the outcome of fertilization the day after your retrieval. If fertilized, the eggs will be kept in the incubator for an additional day or possibly two for further development.

Step 4: Transfer embryos into the uterus

In consultation with your physician, you will decide the number of embryos to be transferred back to you. The risk of multiple pregnancy must be considered carefully in this decision.

The embryos are usually transferred into your uterus anywhere between one to six days, but most commonly it occurs between two to three days following egg retrieval. At this point, the fertilized egg has divided to become a 4-to-8 cell embryo.

You will need to decide before the IVF procedure what will be done with the remainder of the embryos. Your choices include the following:
  1. discarding the extra eggs before fertilization
  2. freezing extra embryos for future pregnancy attempts for yourself
  3. donating the unfertilized eggs to another infertile couple.
The embryo replacement procedure is very simple and requires no anesthesia. The embryos are picked up into a very fine catheter, which is then inserted into the uterus through the cervix, and the embryo(s) are placed into the uterine cavity. This process is often guided by ultrasound. The procedure is usually painless, but some women experience mild cramping.

You will need to stay in a reclining head down position for approximately 2 hours after the embryo(s) have been placed in your uterus. Activities after embryo replacement should be minimal for the first 72 hours. Strenuous exercises such as jogging, horseback riding, swimming, etc. should be avoided until pregnancy is confirmed. Otherwise, the patient is free to return to her regular activities.

After these steps have been followed, all that remains is waiting and watching for early pregnancy signs and symptoms. A quantitative blood test, usually called a beta hCG test and an ultrasound will be used to determine if implantation and pregnancy has occurred.

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