- Preparing for the IMF
- Stimulation of the ovaries
- Collecting egg cells
- Obtaining sperm
- Laboratory fertilization and growth of embryos
- Luteal support
- Pregnancy test
PREPARING FOR IMF
Each IVF procedure begins with a preparation and a review at least 1 month before it.
The assessment of therapy involves choosing the mode of stimulation and medication most appropriate for you.
Your doctor will inform you when to come to the exam - usually at 9 -10 day of the monthly cycle, and if your cycle is longer than 32 days around 12-13 days.
Note: The length of the cycle is calculated from the first day of bleeding from the previous cycle to the first day of bleeding in the next month. The first day is the one of a clear bleeding, and if the bleeding occurs in the afternoon or evening hours then the first day is considered the next day.
The review covers ultrasound of genital organs - ovary, uterine lining thickness in an empty bladder.
After the examination, the doctor will give you hormonal examinations, as are usually examined LH, FSH, E2, Prolacetin, TSH. These tests are performed on certain days of the cycle - eg. On the 3rd day, LH, FSH and E2 are examined, and on a pure day (without bleeding) - Prolactin and TSH.
Before starting the procedure, your partner should do:
- Trial of ejaculate-microbiology and spermogram. For the spermogram is important sex abstinence 2-7 days (5 for WHO)
- Studies on HIV, Syphilis, Hep.B & C
Stimulation or controlled ovarian hyperstimulation is done in order to obtain as many eggs as possible. The stimulation is done according to certain schemes - protocols. The choice of protocol is dependent on the particular case.
The protocols are divided into three types:
- Long protocol - starting with injections of 20-21 days per cycle
- Short protocol - the stimulation starts at 3-4 days of the cycle
- In vitro on a spontaneous cycle - no stimulation drugs are applied
The stimulation process will be carefully monitored, through the day the number and size of the follicles, the thickness of the uterine lining, the hormone status will be monitored. Once a sufficient number of follicles reach an appropriate size and maturity, you will be given an injection with hHG (human chorion gonadotrophin) hormone that causes ovulation. From the moment of applying this hormone to ovulation, it takes 40 hours. Therefore, egg cell collection should be performed at the 36th hour of the hHG application.
The function is the process of collecting eggs from the ovaries of a woman using a needle. Under the control of the ultrasound the needle through the vagina is directed toward the ovaries and the follicles are punctured, the follicular fluid in which the egg is collected is also collected. Then this fluid is collected in tubes. The fluid is immediately taught to a biologist-embryologist who has the task of evacuating the eggs, to wash them and put them in a special nutritious environment. At the same time, the spermatozoon obtained from your partner or donor sperm are prepared in the andrological laboratory.
The intervention itself is performed in short-term intra - venous anesthesia, during which time the anesthesiologist - reanimator will monitor your vital parameters.
Important: The day before punctuation you should:
- Stop taking food from 18:00 and fluids from 22:00 h.
- Make a toilet of intimate items (avoid lotions, perfumes)
- To prepare blood counts, haemostasis factors, and results for HIV, Hepatitis B & C
After the intervention you will remain for observation about 2-3 hours. Symptoms such as light bleeding, pain similar to menstrual periods may occur during this time. Your doctor will give you further instructions as to which medicines you should receive, and the embryologist will inform you about the number of fertilized eggs.
- Classically in vitro fertilization (IVF) - the egg is processed in a special way, it is placed in a special nutrient medium, then the spermatozoa are previously purified, concentrated and activated. The purpose is for the sperm to fertilize the egg alone (imitate the physiological process of fertilization). This method is applied in a pronounced female sterility factor and spermogram that does not deviate from the norm.
The next day egg cells are checked for signs of fertilization, and in the coming days our embryologist will monitor the proper cell division and the quality of the embryos themselves.
- An intracytoplasmic injection of a sperm (ICSI) is a method in which only one sperm is injected inside the egg. Before the manipulation itself, the embryologist checks the quality of the egg, its maturity, and then with the help of a micro needle and a micro manipulator, the fertilization itself is performed. Then the fertilized egg is placed in a special nutrient medium and an incubator and the development of the embryo is monitored.
This method is applied when spermatozoa in your partner are very few in number, are not mobile enough, have an irregular structure (morphology)
After the follicle puncture, you will be given instructions for receiving medicines - these are progesterone preparations that will prepare your uterine embryo. After evaluating your doctor, you may also be prescribed folic acid, as well as other medicines that you should receive continuously until the pregnancy test, and if necessary longer.
Embryo-transfer is a procedure for transmitting embryos into the cavity of the uterus. It may be the most exciting part of the whole in vitro procedure. If the embryo develops normally in laboratory conditions and reaches appropriate maturity (usually for 48 hours) then the embryo transfer is accessed. Sometimes the transfusions are done 4-5 days after fertilization. With the help of a thin catheter, embryos are transmitted to the uterus. The procedure is absolutely painless. 1-3 embryos can be transmitted at once. The chances of pregnancy becoming larger when transplanting multiple embryos, on the other hand, the more emollient and healthy the embryos increase, and the chance of a prolific pregnancy that in itself hides risks as premature birth or complications in the mother.
After the transfer you will stay on the gynecological chair for about 30 minutes. Then it is recommended that you are not physically active, rest, limit coffee reception, do not smoke, do not bathe very hot water.
The moment of truth, the moment when we need to understand whether together we have achieved our goal - PREGNANCY.
Two weeks after the embryo transfer, a blood or urinary pregnancy test can be performed. The blood test uses venous blood and determines the titre of βHCG (human choriongonadotropin) or the so-called. pregnancy hormone. The urinary test can be done at home, with the first morning urine that is concentrated.
If the pregnancy test is positive then please contact your doctor and he will schedule an ultrasound examination term to confirm your pregnancy.
If the test is negative, inform your doctor and he will invite you to to discuss possible reasons for the failure of the procedure, as well as a plan for further action.