Stages of IVF treatment
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Hormone injections are administered to stimulate multiple egg production.
In most cases, one of the following stimulation protocols is chosen:
• Long protocol with agonist
Treatment lasts approximately 20 days. During this time, mild activities and work, a healthy diet and no smoking is recommended.
Once treatment commences, patients are advised to take a daily dose of folic acid.
• Short protocol with antagonist
Treatment lasts approximately 10 days with 1 – 2 subcutaneous injections daily. At the same time, the patient is monitored by ultrasound and blood tests, 2 – 4 times in total. During the course of treatment, mild activities and work is recommended, a healthy diet and no smoking.
Patients are also advised to take a daily dose of folic acid once treatment begins.
• Elonva
Treatment lasts about 10 days. During this time, the patient is subject to a total of 2 subcutaneous injections, 2 ultrasounds and 2 blood tests in total. During the course of treatment, mild activities and work, a healthy diet and no smoking is recommended.
Patients are also advised to take a daily dose of folic acid once treatment begins.
All injections are usually subcutaneous (under the skin) and may be carried out by the patient herself.
The progress of ovulation induction is monitored with regular ultrasounds and blood tests.
Step 2: Egg Collection
Egg collection is a minor procedure during which the Gynaecologist, with the guidance of a transvaginal ultrasound and mild suction, collects the oocytes from the ovaries with a special needle. This procedure lasts approximately 15 minutes.
Mild sedation is usually provided, although egg collection is sometimes performed with local or no anesthesia at all (e.g. natural cycles).
Step 3: Fertilization and Embryo Culture
The Embryologist fertilizes the oocytes using the partner’s sperm a few hours after egg collection, either with conventional IVF or intracytoplasmic sperm injection (ICSI).
During conventional IVF, hundreds of thousands of spermatozoa are placed in a culture dish together with the oocytes and fertilization takes place.
In the case of ICSI, the Embryologist selects a single spermatozoon and injects it into the cytoplasm of the oocyte with the aid of a specialized microscope and very delicate techniques.
ICSI allows couples with very low sperm count or bad quality sperm, to achieve fertilization in the laboratory.
ICSI is also recommended to couples who previously underwent conventional IVF and failed to achieve fertilization.
Special urological procedures, such as testicular biopsy, are available in cases where it is difficult to obtain sperm or there are no spermatozoa in the ejaculate.
The following day, the oocytes are checked for fertilization and thereafter for cell division.
The embryos are incubated under ideal conditions in culture media for 2 to 5 days.
Step 4: Embryo Transfer
Embryos may be transferred to the patients’ uterus anytime between Days 2 and 5 after egg collection.
They are placed in the uterine cavity using a soft catheter and with the visual guidance of an ultrasound scan.
Usually, no sedation is required for this procedure.
Step 5: Pregnancy Test
The patient will do a blood pregnancy test, measuring the hormone human chorionic gonadotropin (β-chg.), two weeks after egg collection.
If the test is positive (β-hCG > 20 IU / l), it is repeated 2 – 3 days later for confirmation and, in another 2 weeks, an ultrasound scan is carried out.
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