IVF at SANAGYN Pretreatment Evaluations, Assessment & Acceptance There is computerized data base. Personal details of each couple are stored and an identification number (IDN) issued to show on each visit.
Clinical AssessmentsFirst Visit each couple is interviewed which may last up to two-hour. The views are exchanged and understanding reached. The importance of various circumstances is briefly described, IVF is explained and the success rates discussed. If fertility follow up has already been done at the same center, all the details are reviewed in reference to the IVF schedules and its prognosis. If fertility follow up as described has NOT been already done the detailed personal, social, medical and menstrual and obstetrics history is taken including the previous fertility assessments and the treatments. The factors that influence the IVFoutcome are given special importance; and current medical condition reviewed.
Ultrasound Adequate functional uterus is essential for implantation, therefore important for IVF success. Ultrasound sufficiently evaluates the uterus. If any doubt on its capacity, hysteroscopy is the best means to assess it. Hysterosalpingogram may help.
Ultrasound imaging of the utero-ovarian response to gonadotrophins is a simple, reliable and the most useful method. Monitoring before starting COH may identify poor responders and women at risk for OHSS. Follicle tracking with Transvaginal sonography (TVS) is at times supplemented by the serum Estradiol levels. Endometrial thickness as measured by TVS can be used as bioassay of total follicular estrogen production. Endometrial thickness gives actual state of number & size of growing follicles. In gonadotrophic ovulation induction cycles, monitoring gives us the possibility to decide how far we can go.
Once selected the woman attends the IVF center 7 days before the onset of menstruation (Day-21 of preceding cycle) when down regulation begins. An appointment schedule, with the number and frequency of visits based on individual needs is set up. The schedule of visits is prepared so that the disruption to work and home commitments is minimal. Only few visits during this process require both the husband & wife; however, the husband is welcome to accompany wife on all visits. He is definitely required on the day of ovum pick for sperms collection.
Chronology of IVF-ET events
- Night admission not necessary.
- 1 month taken from the day of down regulation until the day of Embryo Transfer
- >20 days from the beginning of the menstruation
- 7 days before onset of menstruation (Day-21 of preceding cycle), down regulation begins
- Cycle Day (CD)-4 of the cycle Controlled Ovarian Hyperstimulation (COH) begins.
- C-Day-9 (Stimulation Day-6), monitoring begins with TVS for dose adjustments.
- C-Day-14 (Stimulation Day-11), Repeat TVS
- 3-5 days more of COH for FD up to > 17 mm when Inj. hCG given
- C-Day 18-20 (S-Day-15-17) Ovum Pick up 36 hours after hCG injection
- C-Day 20-23 (S-Day 18-21) Embry Transfer.
In-Vitro-Fertilization (IVF) Procedure
- Follicular Development by COH.
- Egg Recovery (ER) by aspiration of follicle is termed in some centers Ovum Pick Up (OPU).
- Collection and Preparation of Sperms.
- Incubation and In vitro Fertilization.
- Embryo Transfer (ET).
- Luteal support