In Vitro Fertilization (IVF)

On the third day of menstruation, a regimen of fertility medications is provided to the patient in order to stimulate the growth of multiple follicles of the ovaries. Under close monitoring, patients are provided with an injectable like gonadotropins for approximately 10 days. The monitoring is focused to check the estradiol level as well as the follicular growth.

At the stage of adequate follicular maturation, human chorionic gonadotropin is given, which acts as an analogue of Luteinizing hormone causing ovulation. The eggs are then retrieved from the patient using transvaginal technique. In this technique, ultrasound-guided needle is used to pierce the vaginal wall to reach the ovaries. The retrieval procedure takes around 20 minutes and is done under general anesthesia.

For fertilization, eggs are identified by stripping the surrounding cells and semen is prepared by removing seminal fluid and inactive cells. The sperm and the egg are incubated together in the culture media. When sperm count is low, a single sperm is injected directly into the egg through intra-cytoplasmic sperm injection (ICSI). The fertilized egg is then placed in a special growth medium so that the embryos reach 6-8 cell.

Embryos that reach the 4-6 cell stage are transferred 2-3 days after transfer. At the stage 6-8 cell stage, oocyte and embryo quality is judged. The grading of embryos is based on the cell number, fragmentation degree and growth evenness. Number of embryos to be transferred depends on many factors-age and embryo quality being the most important. However, we do not transfer more than 3 embryos. The embryos are transferred into the patient's uterus using a catheter, which goes through patient's vagina and cervix.