Once the procedure of IVF-ET is recommended to a couple the actual procedure innolves induction of ovulation followed by egg retrieval, the eggs are then inseminated in lab. With semen & the resulting embryos are transferred to uterus after 48-72 hours.
Induction of Ovulation :- -A woman is born with millions of egg follicles each of which contain an immature egg at its center. Each month, multiple follicles begin to develop, but only one dominates & matures & finally release into the peritoneal cavity. In order for IVF to be most effective more than just one mature egg needs to be retrieved. There are special medications that help stimulate the development of multiple follicles together. The most common stimulation protocol uses gonadotropine with GnRH analogies. Either GnRH anlagonista or GnRH agonists.GnRH agonists are started few days prior to the periods & continued afterwards (Long Protocol) Gonodotropens are started from D2 or D3 of periods & on an average nine to ten days stimulation is required. Repeated ultra sonography & estradist levels when follicular do monitoring of ovulation established levels when follicular maturation is judged to be adequate.
Oocyte retrieval :- HCU would lead to ovulation about 36/42 hours after injection, but just before that time retrieval procedure is done to recover the egg cells from the ovary. The eggs are retrieved from the patient using a transnational ultrasound-guided needle piercing the vaginal wall to reach the ovaries. Through this needle follicles can be aspirated, and the follicular fluid is handed to the IVF laboratory to identify ova. The retrieval procedure takes about 15-20 minutes and is usually done under anesthesia.
Insemination :-The embryologist looks for eggs in fluid aspirated from the follicles. The eggs are assessed for maturity and incubated. The male partner is asked to collect a semen sample if fresh sperm is used. A semen analysis is performed and the sample is washed with a special solution of nutrients to isolate the more motile sperm. Fertilization is done in the lab. The exact process used depends on the type of infertility problem and clinic preferences. In standard IVF, the sperm is placed into the dish containing the egg. ICSI is a remarkable technique that has revolutionized infertility treatment for severe male factor infertility. One sperm is drawn up in a needle and then injected into the egg. The actual injection process takes less than 60 seconds.
The sperm and eggs (oocytes) are placed in growth media containing special nutrients that allow them to live outside the body. The egg when fertilized by sperm becomes an embryo that is allowed to grow and divide in the laboratory for two to five days in the special culture media.
Embryo transfer:-
Embryo quality is a critical factor affecting the success of IVF. The best embryos are transferred to the uterus based on grade and cell number.
Embryos are transferred into the uterus through a small tube or catheter. This procedure does not require anesthesia, as it is usually painless. The embryos are placed in a small amount of fluid inside the catheter, which is threaded through the cervix during a speculum examination. The embryos are implanted so that they reach the top part of the uterus. Abdominal ultrasound is used to confirm the correct placement. Depending on the patient's wishes, one to four embryos may be transferred in one treatment cycle.
Post Transfer :-
The patient has to wait two weeks before she returns to the clinic for the pregnancy test. During this time she may receive progesterone - a hormone that keeps the uterus lining thickened and suitable for implantation. Many IVF programs provide additional medications as part of their protocol.
