IVF Treatment Provided at Pulse Women's Hospital

IVF Procedure - Step by Step

Previous cycle

  • Course of an antibiotic and vitamin supplement for one or both partners.
  • Oral contraceptive pill from the 3rd or 4th ay of period after a baseline sonography to rule out ovarian cyst & for cycle programming. This is not a must, but helps in cycle programming.

Stimulation Protocols

Drugs are used to stimulate the ovaries to produce multiple eggs to increase the chances of pregnancy. Many variations are used and yours may be different from others. Your doctor will advise you regarding your own drugs and its dosage.

Two types of medications are used in stimulation :

  • Drugs to stimulate the ovaries : Gonadotropins : These are hormones normally secreted by the pituitary glands which control the number of follicles and eggs that  develop. They are of 2 types : FSH and hMG. These are available in 3 forms : urinary [extracted from urine of postmenopausal women and cheapest], HP - highly purified version of the urinary and recombinant [genetically manufactured and cost more].
  • Drugs to prevent premature ovulation : GnRh analogue and GnRh antagonist : these are given to ensure that the ovaries do not release the egg before time.

Long Protocol :

Women receiving the long protocol start injections on the 21st day of the precious cycle.[i.e. when about 4-5 oral pills are left.]. She is asked to come to PULSE on the 2nd or 3rd day of her next period for starting the actual ovarian stimulation. Sonography and sometimes a blood test is done and then the actual stimulation is started.

Short / Antagonist Protocols :

For women on the short or antagonist protocol, all the injections are started on the 2nd day of period and lasts for about 9-12 days till the eggs become mature as determined by ultrasound examination.

Ovarian Stimulation

In both the protocols, you will be given a detailed prescription of the drugs, its dosage and time of administration. You will also be given a time for your next appointment. This varies from patient to patient and may also change  from cycle to cycle. Please ask the doctor or the nurse if you have any doubts.

Many women prefer their husbands / another relative / family doctor to give their injections at home or even do it themselves. We can teach you or your husband to do this. However, if you prefer, we can administer the injections at Pulse. It is common to have some discomfort and mild side effect while taking the drugs. The main serious side effect is over-response, which occurs in about 1-2 in 100 stimulated cycles.

Ultrasound Examination

A vaginal ultrasound examination is done after 3-5 days of drugs to measure the response of your ovaries. This shows the number and size of the follicles growing in the ovaries, which is a guide as to how many eggs to expect and when they will be mature. This is used to decide whether your drug dosage needs any alteration and to plan the day of egg collection. Generally about 3 scans will be carried out during the stimulation protocol. The husband is not needed during this monitoring visit.

Sometimes if the response is very poor and only one or two eggs seem likely, the chances of pregnancy may be low and we may suggest cancelling the cycle.

hCG Injection

hCG injection is given to trigger the final maturing of the eggs ready for collection. Eggs collection is planned, 34-36 hours after hCG injection. The day of egg collection will usually be decided when you have the scan and will depend on the size and number of follicles.

On the day hCG is planned, you will be informed, by your doctor, regarding the the time for injection that night  alongwith details for hospital admission for the egg collection. The embryologist will inform you about the time for sperm collection by your husband.

Egg Retrieval / Ovum Pick UP

When the follicles are ready for egg retrieval, you will be given instructions for admission. You will be asked to get admitted early in the morning on the day of egg collection. You should have nothing to eat or drink from midnight to night before the procedure.

The eggs are collected through the vagina under ultrasound control, using a fine needle, which is passed through the vagina into the ovary. Fluid from the follicles is sucked through the needle into the test tube and is passed immediately to the laboratory next door where the scientist checks for eggs under the microscope. The eggs are then placed in culture fluid in special dishes in the incubator at body temperature. The procedure is performed under general anesthesia, but can be carried out under sedation if you prefer.
  IVF at Pulse Women's Hospital

The procedure takes 15-30 minutes. You can go home about 2-3 hours after the procedure and arrangements will be made for your ET (Embryo Transfer) time two or three days later. It is common to have some vaginal bleeding after egg collection from where the needle passes through the vaginal wall. This usually settles in one or two days and does not affect your chances of pregnancy. Some discomfort from the swelling of the ovaries is common and any painkiller can be safely used.

Semen Collection

A fresh sperm sample is collected on the day of egg collection. This can be done just before or just after egg collection. In case the husband requires the presence of his wife for semen collection, he should inform  this to the embryologist , so that arrangements can be made accordingly.

The sperm sample is best produced by masturbation and there is a room for this purpose. Lubricants should NOT be used as they can effect fertilization. It is difficult for some men to produce a sperm sample on request. If you are worried about these aspect please discuss it with your doctor before starting treatment, so that arrangements can be made to freeze some semen, which can be used if necessary. If you  live close to the hospital, it may be possible for you to produce the sperm sample at home.

Sexual activity may continue during the treatment cycle, unless advised otherwise, it is better not to ejaculate for 2 days before the egg collection. However, more than 4 to 5 days without ejaculation may reduce sperm quality.

Embryo Culture

The processed best quality sperms (Approx 50,000 - 100,000/egg) are added to the COC retrieved from ovum pick up in a 4 well NUNC plate, placed in the incubator to achieve fertilization. The first sign of fertilization is the presence of 2 small dots inside the egg called “Pronuclei” (PN) and the fertilized egg is now called Zygote. It takes almost 18 hours for the egg to fertilize and about 16-18 hours later, the fertilized egg starts dividing into 2 cells, subsequently into 4. After about 48 hours from egg collection, the embryos usually will be at 4 cell stage and ready for transfer back into the uterus.