Infertility & Gynec Consultancy

[Kunjan]

In Vitro Fertilization (IVF)

IVF was the first procedure used to fertilize eggs outside a woman's
body. In 1978, the first "test tube baby," was conceived through IVF.
Most assisted reproductive technologies (ART) are derived from the IVF
procedure.

In an IVF Procedure, the doctor:
v prescribes hormonal medications to stimulate the ovaries,
v gathers the eggs,
v fertilizes the eggs in vitro (outside the body),
v transfers the resulting embryos through the cervix into the
uterus

Follicular Stimulation and Monitoring

At the start of the woman's cycle, the physician prescribes hormones
or other medications. These control the timing of the cycle and
stimulate the development of multiple follicles, sacs of fluid in the
ovary that may contain an egg. Usually, the patient can take these
medications at home. After several days, the patient returns to the
clinic for a vaginal ultrasound and blood tests that help determine
the cycle's progress and the number of follicles. More than one visit
may be required.

When the doctor is satisfied with the progress of the cycle and the
number of follicles, the patient is instructed to administer an
additional injectable medication. This ensures that the eggs will
mature on schedule for the retrieval. A minimum number of follicles
must develop to make the retrieval worthwhile.

Oocyte (Egg) Retrieval

Egg retrieval is normally performed under anesthesia or intravenous
sedation. Guided by ultrasound monitors, the doctor inserts a needle
through the vagina and into the ovaries. The doctor then draws back
the needle to remove the eggs from the follicles. Not all follicles
contain eggs. Following the procedure, patients recuperate in a
recovery room.

Patients usually receive intravenous antibiotic therapy during the egg
retrieval process. Certain patients will be asked to take additional
antibiotics by mouth for 3 to 4 days following retrieval.

Fertilization and Incubation

Once the eggs have been retrieved, an embryologist prepares the eggs
and sperm from the partner or a donor. The eggs and sperm are mixed in
the laboratory to promote fertilization. In cases of severe male
infertility, the embryologist can inject a single sperm directly into
an egg - this technique is called Intracytoplasmic Sperm Injection
(ICSI)

The fertilized eggs, called embryos, are incubated for several days.

Embryo Transfer Procedure

If the embryos develop normally, the embryologist selects the best
candidates to transfer into the woman's uterus. Based on the
individual situation, the physician and the patient determine the
number of embryos to transfer. The physician uses a small catheter to
pass the embryos through the cervix and into the uterus. After the
transfer, which requires no anesthesia, the patient must rest in a
recovery room.

If more good embryos than are needed for the transfer, they can, in
some cases, be frozen for use in another treatment cycle.

The physician will prescribe hormonal therapy after the transfer to
improve the chances for conception.

If one or more of the embryos implant in the uterus, the woman may
become pregnant. However, as in the natural reproduction process,
there is a risk that pregnancy will not occur.

Variations on the IVF Procedure

Transfer of cryopreserved embryos
This procedure uses embryos that were salvaged from a previous IVF
cycle and frozen. The embryos are thawed and transferred into the
uterus.

Gamete intra-fallopian transfer (GIFT)

Based on IVF, but this procedure does not involve fertilization
outside the body. The eggs are mixed with sperm, then surgically
placed into the fallopian tubes to allow natural fertilization. GIFT
requires anesthesia as well as time in the recovery room.

Intracytoplasmic Sperm Injection (ICSI)

Based on IVF, but the eggs are not merely mixed with sperm in a dish.
Instead, a single sperm is directly injected into each egg. ICSI is
particularly useful when the man has an extremely low sperm count.

Assisted hatching

A microsurgical procedure in which the embryologist chemically
dissolves a small area of the zona pellucida, the shell surrounding
the embryo, to facilitate hatching of the embryo and implantation.

Donor services

Any of these procedures, but using sperm, eggs, or embryos from a
donor.

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