IVF (In Vitro Fertilization)
In Vitro Fertilization means “ Fertilization – in- glass “ that is fertilization outside the human body . It was initially developed for fertility in females who had blocked or unfunctional fallopian tubes. At present IVF is recommended to patients who are unable to conceive due to several other causes also.
We try to provide you with the utmost services :
- Your initial consultation : It is an initial visit in which you open up with your doctor and know your doctor and the doctor knows you. A detailed history is taken of the couple.
- Pretreatment preparation and planning management : This will include a detailed blood workup which will include your hormonal assays , a uterine assessment, semen analysis and other tests if required. We review the whole history and all the tests and then only a definitive management is planned for you.
- Start of oral contraceptive pills : You will be put on oral contraceptive pills for a short span of two to four weeks if your cycle needs to be synchronized with that of an egg donor or surrogate . These help the ovaries to be cyst free and help in planning of your cycle.
- Ovarian induction : The IVF cycle begins with ovarian stimulation with injectable hormones on a daily basis and serial ultrasound monitoring. A baseline ultrasound is done before starting the stimulation to assess egg production. The hormone levels will also be monitored . Once the follicles reach the optimal size , you are prepared for egg retrieval.
- Visits : Prior to egg retrieval three to five visits are done in that IVF cycle.
- Egg Maturation : An injection is given 34-36 hrs prior to egg retrieval.
- Egg retrieval : It is a procedure done transvaginally under ultrasound guidance under short general anesthesia . You need to be six hrs. fasting prior to the procedure.A long thin needle is passed through the vagina in the ovary and the follicular fluid is aspirated .The follicular fluid is collected in test tubes under strict temperature control and immediately given to the embryologist in the embryology lab. The embryologist searches for the eggs .The eggs are rinsed counted and placed in an incubator . After few hrs , they are fertilized with the sperm either through IVF or through ICSI.
An anesthesiologist is there to give you pain relief and comfort during the procedure. Chances of injury during egg retrieval is extremely rare .Structures near the ovary such as bladder,bowel or blood vessels could possibly be damaged and may require further surgery. Minimal bleeding from ovaries might occur but the risk of transfusion is extremely rare. Infection during this procedure is also extremely rare. You will be discharged four hrs. after the procedure.
- Embryo Assessment : During IVF embryos are assessed for 2-5 days in a temperature controlled incubator. The embryos are assessed and the day of transfer is determined between day 2-day 5 . We call you to update you about the embryos.
- Embryo Transfer : Embryo is transferred back in the uterine cavity between day 2-day5 when it becomes multi celled /blastocyst . This requires no anesthesia and the female is happy to see her embryos being implanted in the cavity . We discuss the number of embryos and made and the number to be transferred so that you have the highest probability of success keeping in mind the risk of multiple birth associated with it. For embryo transfer you need to come on a full bladder and the procedure is done via an embryo catheter transferred vaginally under ultrasound guidance.
- Pregnancy test : We schedule a pregnancy test 10-15 days after the transfer . If the first test is positive we repeat beta hcg repetitively every 48-72 hrs. and an obstetrical ultrasound is planned two weeks following the pregnancy test when we look for the no. of embryos and fetal cardiac activity.