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In-Vitro Fertilization Process


IVF process typically extends over a period of 2 months. The first month is the pre- IVF evaluation and pre-treatment month. In this the doctor will check and evaluate you and your partner and start you on some medicines. For this, ideally you should report to the doctor on the second or third day of the start of your periods. The first day of your period is your LMP or Day-1.
Your first doctor visit is on day-2/3 of menses. You should bring all your previous treatment records along with you on this day. It would be great if you come along with your partner.
You will be required to undergo an internal/ vaginal ultrasound also called as TVS, in which doctor will check the condition of your uterus, its size, shape, endometrium, presence of any fibroids etc. and condition of your ovaries, their shape, size, presence of any cyst etc. and most important, the number of small follicles present in both ovaries which is also called the Antral Follicle Count (AFC) which determines your ovarian reserve and predicts your response in IVF treatment.
The doctor will then advise some blood tests for you, which include routine tests as well as hormone tests. Your partner will also be advised some basic blood tests and semen test. You and your partner will then be started on some medicines to optimise your body and get it ready for IVF next month.
You are then advised to undergo Hysteroscopy after your menses are over. Hysteroscopy is a short procedure in which the doctor evaluates your uterus from the inside by introducing a camera from below into the uterus. In case any pathology is found like any polyp/ adhesions/ septum etc., it can be corrected in the same sitting, which will optimise your success rate later in the IVF procedure. If needed, an endometrial biopsy (small tissue from the uterus lining) is taken at the same time, which is sent for testing for infection etc. This procedure is done under complete anaesthesia, and hence is not at all painful. It is a day care procedure which needs you to be in hospital from morning till evening. Overnight admission is generally not required. You have to be fasting for at least 8 hours prior to the procedure.
Your next follow up is approximately 7-10 days after hysteroscopy. At this time, you are required to come full bladder to the clinic. A small procedure, Mock- ET is done at this time. This is a trial of the actual Embryo Transfer procedure which would be done later in IVF. This is an OPD procedure in which doctor will introduce a thin plastic cannula inside your uterus under Ultrasound guidance and note various parameters like length of cervix (mouth of uterus), direction of cervical canal, obstruction/ difficulty if any. This prepares the doctor for a smooth embryo transfer procedure later and optimises your chances of conceiving in the actual IVF cycle. On this day, your case booking is done, all your relevant documents collected, your file is made and your consents taken. So you need to bring all your documents as told on this day.
You are next called on DAY-2 of your menses. Your actual IVF cycle starts from this day. You are required to abstain from sexual intercourse from now on. The doctor does a TVS ultrasound and assesses the condition of the uterus, endometrial lining and ovaries. You are started on gonadotropin injections/ stimulation injections from day-2/3 of menses. These injections are required to be taken on the same time every day. Injections should be kept in the refrigerator and temperature maintained at 2-8 degree. This is important to maintain the efficacy of injections and optimise your results. These injections are given to attain Controlled Ovarian Hyperstimulation, i.e. ensuring multiple follicle development from both the ovaries so that we get optimum number of eggs (oocytes) for fertilization in IVF. These injections are continued for around 10-11 days. Doctor will do TVS ultrasound in between 3-4 times to check on the growth of follicles. Some blood tests may also be done during this time to check the response. You are also prescribed some medicines to take during the stimulation phase.
On the last day of stimulation, a trigger injection is given at a fixed specified time that will be informed to you. This injection is very important as this help in releasing the eggs from inside the follicles, which will be retrieved during ovum pick-up. OVUM PICK-UP/ OOCYTE RETRIEVAL is done 35-36 hours after the trigger injection. This is a day-care procedure. It is done under complete anaesthesia and hence is not painful. You are required to be fasting for at least 8 hours prior to the procedure. You should remove all jewellery and not use any cosmetics/ perfume/ powder etc. on this day. Husband is required to give semen sample on this day. In this procedure, follicles in the ovary containing the microscopic eggs are aspirated using a fine long needle connected to a suction pump through the vaginal route under ultrasound guidance. This aspirated follicular fluid is then examined under microscope by the embryologist to identify the eggs/ oocytes. ICSI (Intra Cytoplasmic Sperm Injection) is then done in the IVF LAB in which each egg/ oocyte is injected with sperm and then kept in the incubator for further growth. Fertilization is checked the next day by embryologist. Then growth/ cleavage of embryos is checked on subsequent days and embryo transfer planned accordingly.
On the day of Ovum pick-up, you are kept under observation for 4-5 hours post procedure in the hospital. Thereafter you are prescribed progesterone medicines and antibiotics for few days. You are informed about the date of embryo transfer telephonically which is generally after 3-4 days of ovum pick-up. Sometimes, under some circumstances, like in case of suspected OHSS (Ovarian Hyper Stimulation Syndrome), thin endometrial lining, deranged hormone/ progesterone levels or very high Estradiol levels, doctor may decide to freeze all your embryos and decide not to do fresh embryo transfer. You will be counselled and informed regarding the same by the doctor.
EMBRYO TRANSFER is done generally after 3-4 days of Ovum pick-up. This is also a day care procedure. You are not required to come empty stomach as this procedure is not done under anaesthesia. You should take all medicines on time as prescribed even on that day. You need to be full bladder before the procedure. Embryo transfer is done using a thin plastic cannula introduced from below inside the uterus cavity through which embryos are dropped inside the uterus under ultrasound vision. You will be informed regarding the number, stage and grading of embryos being transferred. Extra embryos, if any, can be frozen for future use on the same day. You are required to rest in the hospital for 3-4 hours post procedure.
LUTEAL SUPPORT starts after embryo transfer. It means giving medicines to support the growth, implantation and support of baby. It is a very important phase during which the transferred embryos implant and grow inside the uterus. As in IVF, there is no support to the baby from inside the body, pregnancy is sustained with the help of medicines and injections given from outside. Hence taking them in a correct way regularly helps in giving you optimum results. This luteal support is continued for 15-16 days after which Beta HCG TEST (A blood test) is done to confirm whether you are pregnant or not. Luteal support is continued for the next 3 months of pregnancy if beta HCG comes positive and stopped if it comes negative.