Stimulation of Egg Growth
Spontaneously a cycling woman will ovulate only one egg each month. To increase the chance of obtaining pregnancy, an effort is made to recruit as many eggs as possible. This goal is achieved by fertility drugs (Gonal-F(R)). The growth and development of the eggs is closely monitored by repeated ultrasound studies and blood tests for hormone levels (Estradiol and Progesterone). Based on the information obtained from these tests, the optimal timing for ovulation is determined. Ovulation itself is triggered by an injection (Human Chorionic Gonadotropin), after which the egg retrieval is scheduled.
Egg retrieval is scheduled some 36 hours after triggering ovulation using Injection HCG-Human Chorionic gonadotropin. The procedure itself is performed at the hospital by a Transvaginal route. A needle guided by ultrasound imaging, is inserted through the vaginal wall into the ovaries, where the follicles containing the eggs are punctured and aspirated. The released eggs are transferred to the lab where their developmental stage is assessed. General anesthesia is usually used for this simple and minimally invasive day care procedure. The procedure takes about 10-15 minutes,and
the patient can return home a few hours after it.
The IVF /In Vitro Fertilisation procedure
Sperm is obtained by masturbation. It then undergoes a series of lab procedures to prepare it for interaction with the egg. Fertilization Eggs are kept in dishes to which sperm is added at the proper concentration. The dishes are kept in an incubator where the environment (temperature, humidity, gas composition) is carefully monitored. In given time intervals the eggs are assessed for fertilization, and subsequent divisions. The fertilized egg divides into two daughter cells, which continue to divide rapidly as shown in the adjacent photographs. This assessment is based on morphology.
Hence the detailed chromosomal composition of the embryos
cannot be addressed without further tests.
Embryos that have satisfactorily divided are transferred to the uterus 2-3 OR 5 days after fertilization. This simple and painless procedure does not require sedation or anesthesia. The embryos are loaded on a small plastic catheter, which is gently introduced through the cervix into the uterus. Once in the uterine cavity, the embryos are gently released and the catheter is withdrawn. The patient can return home after a couple of hours of rest.
Generally, we recommend that following embryo transfer the patient should refrain from physical exertion, however complete bed rest does is not needed and infact maybe counter affective. Just take it easy and hope for good news. Given the nature of cycle stimulation, we prescribe medications to support the young embryos hormonally. The presence of pregnancy is established by using a sensitive test for Human Chorionic Gonadotropin (HCG), which is the hormone secreted by the placenta. If pregnancy is established, monitoring is continued, until ultrasound imaging allows a direct visualization of the developing fetus and heart beat at day 28 following embryo transfer.
Advanced Artificial Reproductive Technology
Recent years have witnessed a rapid advancement in the treatment of the "male factor infertility", that is, those couples where the husband cannot produce good quality sperm in the required concentration. Novel techniques have been developed with which a single sperm is injected into the egg. This procedure, referred to as ICSI (Intra Cytoplasmic Sperm Injection) can accomplish fertilization with only minimal number of viable sperm. ICSI has been one of the scientific finds of the century and has helped millions of infertile couples from across the globe to become parents.