It is a method of assisted reproduction that involves combining an egg with sperm in a laboratory dish. If the egg fertilizes and begins cell division, the resulting embryo is transferred into the woman's uterus where it will hopefully implant in the uterine lining and further develop. IVF bypasses the fallopian tubes and is usually the treatment choice for women who have badly damaged or absent tubes, blocked tubes. IVF/ET was first successfully used in human over 25 years ago. Since then, more than 100,000 children have been conceived using this technology. IVF is a procedure designed to enhance the likelyhood of conception in couples from whom other fertility therapies have been unsuccessful or are not possible.
It is a complex process involving multiple steps resulting in the insemination and fertilization of oocytes (eggs) in our laboratory. The embryos created in this process are then placed into the uterus for potential implantation.
BFC is a centre creating IVF. At this centre, all couples will discuss with a consultant and staff about the timing and plans for their treatment which will be tailored to suit their convenience as much as possible.
We give general information to patient about treatment details, treatment purpose, side effects and risks of treatment, fitness for treatment (i.e. weight , BMI ), alternative treatment, duration of therapy, effect of cigrettes, alcohol and drugs, need the screening for HBV, HCV, HIV, VDRL, risks of OHSS, cost, implication, freezing of surplus embryos, risk of failure to thaw, incidence of abnormal birth (natural background risk ), chances of success, detail of the cost, comparative cost of different treatments and cost of embryo storage. We also discuss about consent forms and get the patient's consent.
1. Place of treatment
Treatment shall take place at BFC.
2. Time of payment
Payment must be received by installment at BFC.
About 2-3 weeks (individual variation may take place depending upon individual response and regieme, etc.)
4. Clinical procedure for HIV, HBs Ag, HCV Ab, VDRL
Present policy at BFC dictates that all couples preceeding to procedure such as IUI, IVF must be tested HIV, HBsAg, HCV Ab, VDRL. The policy states that both partners must test negative for HIV at the start of the procedure. For HBs Ag , HCV Ab and VDRL positive cases, all couples will be explained about the chance of having a baby with Hepatitis B or C or VDRL and risks of the procedure.
5. Procedures for Ovarian Stimulation for IVF
The aim of this revised procedure is to achieve a more gradual follicular response and endometrial development. Base-line hormonal assessment will be done for woman over 37 years on the day 2 i.e. serum FSH, LH, Prolactin, estradiol tested preferably in the cycle before the treatment is started.
We used Antagonist protocol. Day 2 USG and hormone assessment are made and 0.25µg of Cetrorelix is given daily by subcutaneous injection on follicle sizes at least 14mm and continued until the day of HCG and r-FSH or HMG will be started on Day3 of cycle. Dosage of r-FSH or HMG must be based on
(1) Age ( Dosages are adjusted depending upon response )
(2) Weight - with increasing BMI, there may be need to increase the dose of Gonadotrophin/menotropin and so we advise loosing weight before ovarian stimulation.
(3) Antral follicle count - The number of antral follicles before ovarian stimulation are noted . They may be measured by USS(Ultrasound) scan. We aimed for 9-10 days of stimulation + / - 2 days. If we consider hyperstimulation, we stopp gonadotrophin, and only continued buserelin.
(4) Serum Estradiol Level -Serum E2 Level need to be tested on Day-6 and Day-10 of the menstural cycle during the stimulation period to adjust the dose.
The dosage may be 5,000 - 10,000 IU . The timing of HCG should be flexible. HCG will be given when the size of follicles are between 16-22 mm in diameter.
7. Retrieving the oocytes ( egg retrieval )
For IVF, collection of eggs ( OPU = ovum pick up ) is usually performed with TVS(Transvaginal Scan) guided procedure under intravenous sedation. It usually takes 20-30 mins with day care procedure.
8. Collecting and preparaing the sperm
This is usually obtained via ejaculation or testicular biopsy while the retrieval of eggs is being performed.
9. Insemination of eggs.
10. Embryo culture.
11. Embryo transfer (ET)
ET takes place within 2-5 days after oocyte retrieval that depending upon the stage of development of the embryo.
12. Luteal support
It is to be started 24hr after oocyte retrieval. This may be with progesterone pessaries that may be started 24 Hour after OPU. Also indicated I.M gestones that may be started after embryo transfer. Oral estradiol tablets may or may not be added that depending upon the condition of the endometrium.
13. Pregnancy Test
Pregnancy test will be performed 14 days after the embryo transfer. Patient may come to the centre for urinary HCG and also for serum beta- HCG level.
For remaining embryos,
Uncleaved and degenerated embryos are disposed of. Remaining embryos (cleaved) are frozen if there is a sufficient quality for freezing.