Our skilled physicians and laboratory staff at Reviva has helped many couples overcome their fertility issues and has enabled them to realise their dream of becoming parents.
We understand that ivf cycle is associated with lots of anxiety for the couple so we are trying to explain the whole procedure step by step.
This is your first IVF cycle appointment with us and is usually day-21 of your previous cycle. History taking done and all your previous reports are reviewed by the IVF counselor.
Following the completion of pre–cycle details you move to IVF Specialist room to review the details of your case history and plan the protocol of treatment. The important things to be done today are:
- The protocol to be decided and followed.
- Treatment timeline is decided and you are given the tentative dates of next visit so that you can block time in your schedule.
- Cost factors involved.
- Mock embryo transfer- it is painless procedure and takes few minutes. We measure the distance where we have to place the resultant embryos.
- Trans vaginal ultrasound for pelvic details.
- If you are taken for the agonist cycle (Lupron protocol) than injections to be taken subcutaneous daily are started and are not very painful. These suppress the secretion of intrinsic gonadotrophin hormones and prevent premature LH surge. These are ice – packed and given to you for daily administration at your local place.
- Prenatal vitamins are prescribed.
- Any of your queries regarding the procedure are settled.
Your second visit with us is on day 2 or day 3 of your periods. Your baseline ultrasound and blood tests are done to confirm down regulation and once this is done we start stimulation drugs.
The aim of stimulation drugs is to form many mature eggs as this will increase your chances of success. The stimulation drugs usually used at Reviva are the recombinant FSH which are genetically engineered and most potent and the least painful as they are subcutaneous and can even be self administered .These are used for approximately 8-12 days.
In between your monitoring,when dominant follicle is -14mm another set of injection are added in the antagonist protocol. These are either cetrorelix or ganirelix and prevent premature LH surge and is also known as soft stimulation protocol as number of days and number of ampoules is lower than the long protocol.
The end of stimulation is decided by the size of the follicle and the level of estradiol hormone. When the leading follicles (2 or more)are 18 mm or larger, that is the day of trigger. The trigger that provides final maturation to the developing follicles and sets ovulation in motion. During 34-36 hours after the trigger injection (HCG) oocyte retrieval procedure is scheduled. Timing is crucial as retrieval must be performed prior to expected time of ovulation.
- You come to clinic fasting in the morning during time slot given to you
- Your partner gives us his semen sample either on the same day of retrieval or if he is not able to come, as occasionally the case for overseas patient than the previously frozen sample (freezing is routine in all IVF cases) is thawed and used.)
- is routine in all IVF cases) is thawed and used.
- You will be walking into the ovum pickup theater adjoing the IVF lab. The anesthetist doctor will review your medical history and start the I/V cannula through which he delivers anesthesia medications. This is for sedation, the effect which lasts till the procedure 15-30 minutes and makes oocyte retrieval painless and comfortable.
Ovarian follicles are aspirated using a needle guided by Trans vaginal ultrasonography. Follicular fluids are scanned by the embryologist to locate all available eggs. The eggs are placed in a special media and cultured in an incubator until insemination.
After proper preparation of eggs and sperms the embryologist is ready for the fertilization process which occurs by two ways
In cases of normal semen parameters motile sperms approx 50,000 to 1, 00,000 are transferred to dish containg oocyte and re incubated expecting natural fertilization.
In this embryologist picks up single sperm using a fine needle attached to micromanipulator and injects it directly in the oocyte Cytoplasm. If no sperms in ejaculate than obtained surgically and then used for ICSI , so we go ahead another step.
This is done either at day-2, day-3 or day-5. Grading of embryo is done on day of transfer. It is a simple procedure and requires no anesthesia. It hardly takes few minutes. The embryologist will show the embryos on the IVF lab monitor and inform you about the grading. The number of embryos to be transferred is decided. The embryo transfer takes place through a soft catheter which is placed into the uterine cavity through cervix. You are made to rest in the clinic for few hours after which you are discharged with instruction and best wishes.
14 days after embryo transfer, the result is checked by doing the blood test (Beta HCG) and UPT (Urine Pregnancy test). If embryo implantation has occurred, beta HCG hormone will be detected. In general, the HCG level doubles every 2-3 days in early pregnancy. The first ultrasound scan is performed about 2 weeks later in order to confirm the presence of gestational sac and yolk sac.