IVF

Step 1

Ovarian stimulation

In a normal menstrual cycle, only one follicle (sac containing an egg) usually reaches maturity and releases an egg each month. However, in an IVF cycle, we aim to stimulate the growth of several follicles so that many eggs are available for fertilization and this increases the chances of success.

being the leading & the best IVF center in Hyderabad, we use the most secure and commonly used injections to develop a good number of follicles in the ovary. From the first or second day of periods, they are given daily till the follicles reach a diameter of 18 mm or more. The stimulation injections are usually given for between 10 to 14 days. Some of the injections are given subcutaneously by the infertility doctor of the IVF hospital in Hyderabad, which means it is injected under the skin and other injections into the muscle.

The most common side effects noted are a little inflammation at the injection site, transient fever, and joint pains.

Step 2

Monitoring Follicle Growth

On average, 3-4 scans will be carried out by the preeminent IVF center in Hyderabad, while you are taking the stimulation injections to monitor the growth and number of follicles in the ovaries. When at least 3 follicles reach 18mm in size, the egg collection procedure can be planned. Monitoring the follicle growth is very important to adjust the dose of medication and also to identify excessive stimulation of ovaries which may result in potentially serious side effects known as ovarian hyperstimulation syndrome (OHSS). Hormonal assays in the blood might be performed if there is evidence of excessive response to guide management.

Step 3

Ovulation trigger

HCG is given once the follicles reach the desired size, which is necessary for the final maturation of the egg. This injection will trigger the process of final maturation of the egg and the next step i.e. oocyte retrieval is then scheduled at 36 hours after administration of HCG. This injection is given late in the evening 2 days before the day of egg retrieval.

Step 4

Egg collection procedure

The collected multiple eggs are kept in special culture media in the incubator in the laboratory. The incubator mirrors as closely as possible the body environment in terms of temperature and pH. Most women find the process of egg collection uncomfortable rather than painful. There may be mild cramps (pain) or slight bleeding from the vagina which usually subsides in a few hours. Oral antibiotics are given as prophylaxis against infection. You are allowed to go home 2-3 hours after the procedure.

Step 5

Sperm preparation

On the day of egg collection, the husband is required to produce a semen sample by masturbation in a clean wide-mouthed container supplied by the lab. Though a fresh sample of semen is ideal, if the husband cannot be present at the scheduled time a semen sample can be collected in advance and the semen is frozen for use during the IVF treatment.

If the husband has difficulty in producing the sample please inform us in advance so that we will be able to freeze a few samples prior to starting the IVF cycle. This is called back up sperm freezing. The semen sample is processed by the expertise IVF team of IVF clinic in Hyderabad to obtain a clean concentrated highly motile sperm which is used to inseminate the eggs. It is only necessary to add a relatively small but a decent amount (number) of sperm to inseminate the eggs.

Step 6

Fertilization

A measured volume of the prepared sperm suspension is added to the dish containing the eggs 3-6 hours after egg collection. The following day the dish is checked for fertilized eggs. They are then placed in fresh dishes of culture medium and replaced in the incubator. ICSI (IntraCytoplasmic Sperm Injection) is a procedure where a single selected sperm is injected into the cytoplasm of the egg to fertilize the egg. This is usually advised for male factor subfertility and in a few other indications as well such unexplained subfertility. the designated doctor at IUI hospital in Hyderabad will advise you if you need this procedure in order to obtain fertilization of the egg.

Step 7

Embryo transfer (ET), Implantation and Outcome

• ET is carried out on any day, between the 2nd day and 5th day after oocyte retrieval. ET is a simple and straightforward procedure done under aseptic conditions.
• No sedation is required. The embryos are gently placed in the uterine cavity through a fine cannula introduced directly into the uterus via the vagina and cervix.
• Normally 2 -3 embryos are placed in the uterine cavity. You do not need complete bed rest for the following two weeks and you can carry on with your routine activities and regular diet as usual. You are advised not to have sexual intercourse during this period. In order to support conception, progesterone in the form of vaginal gel is given.
• Once the embryos are transferred, it should follow the natural event of implantation. The embryo hatches out of its shell covering (zona pellucida) and implants into the endometrium by burrowing into it. It then continues to develop to the fetus.Once implanted, the embryo starts producing the hormone hCG revealed in a pregnancy test.
• Detection of this confirms the presence of a pregnancy. A blood test indicating Beta hCG levels to confirm pregnancy is done the 12th day after embryo transfer. If Beta hCG is positive, we advise you to visit two weeks later for an ultrasound. However, if it is lower than the ideal value, we repeat Beta hCG values to monitor the pregnancy. In cases of a failed outcome, normal menses will usually resume within a day or two after the negative result.