In Vitro Fertilization (IVF) / Intracytoplasmic Sperm Injection (ICSI)
Written by: Dr. Mohammed Agdi
IVF is the most widely used form of treatment and most effective assisted reproductive technology for both men and women with a range of infertility conditions. It is the primary treatment option for women with damaged, abnormal fallopian tubes, or for men with very poor sperm quality. IVF can be beneficial for patients with:
• Low ovarian reserve
• Age-related infertility
• Anovulation
• Endometriosis
• Male factor infertility
• Unexplained infertility
IVF is the process of stimulating the ovaries, in the women, to develop mature eggs then collecting them and combining them with the sperm from husband in a dish in the lab for fertilization to occur or performing ICSI to help fertilization. Once fertilization has occurred the formed embryos will be cultured in the media and remain in the incubators for further development. After few days, the embryos are transferred back into the woman’s uterus and hopefully implantation and a pregnancy will occur.
We are proud to have our expert consultants in reproductive medicine to discuss with you and design your treatment plan.
The IVF/ICSI protocol will be discussed with you by your physician and will be suggested according to your case that suites your specific condition. There are many protocols, however, the most widely used protocols are:
• Short Antagonist Protocol (the most)
• Long Agonist Protocol (less frequent)
• Short Agonist Protocol (the least among 3)
IVF/ICSI Treatment Process:
It involves the following steps:
• Ovarian Stimulation:
On the first day of your period (normal flow) you have to call our coordinator to schedule an appointment on day 2-3 of your period to have ultrasound scan done and necessary blood work. On the same day of ultrasound, your physician will review your case and, depending on the results, you will start ovarian stimulation using daily Gonadotropins injection starting from day 2-3 and may last for 8-12 days depending on ovarian response. The daily dose of medications will be decided by your physician tailored to your case. You need to be monitored, during this period, for 3-4 times as required. Example of medications:
• Gonal F Pen: is given subcutaneously. Gonal F comes in multi-dose Pen (300 – 450 – 900 - 1200 IU).
• Menopur: is given subcutaneously. Menopur comes in ampule (75 – 600 – 1200 IU).
• Merional: is given intramuscular or subcutaneously. Merional comes in ampule (75 – 150 IU).
• Menogon: is given intramuscular or subcutaneously. Merional comes in ampule (75 IU).
Adverse Reactions and Risks to Ovarian Stimulation:
• Local irritation at injection site
• Dizziness, nausea, headaches, mood swings irritability, hot flashes, breast fullness or tenderness
• Ovarian cyst formation/enlargement and twisting
• Ovarian Hyperstimulation Syndrome
• Multiple pregnancy
• Cycle cancellation
Additional drugs will be added during the process of ovarian stimulation in order to control the cycle. These medications must be taken according to the dates decided by your physician.
Once reasonable numbers of mature follicles are developed, you will be given HCG injection to promote final egg maturation. Around 36 hours after HCG injection, your will be scheduled for the procedure of egg collection. This injection is vital and essential for egg collection and MUST be taken on the correct date and time.
• Egg Collection and Semen Preparation Procedure:
Once you are scheduled for the procedure of egg collection, depending on the timing of HCG injection, you must come (together with your husband) in the morning between 07:30 and 08:00 AM and you must be fasting since midnight. The husband should have abstinence 2-4 day prior to the day of egg collection for his wife. Instruction to how, when and where will be given in advance. The anesthesia physician will evaluate the wife prior to the procedure. Usually, egg collection is performed under conscious sedation. The procedure takes, approximately, 15-20 minutes and recovery monitoring takes about 1 hour before discharge home.
On the day of egg collection, you should start using vaginal progesterone at night, then twice daily from next day through the day of embryo transfer without interruption. Any additional oral or injectable adjuvant therapy prescribed by your physician you should start them based on the instruction given to you by the medical team.
Generally, we advise against sexual intercourse after egg collection and before embryo transfer. We encourage you to go back to your normal activity. If you feel mild pain or discomfort you can use simple pain medications as prescribed for you. For any concern or help, you can call the treatment coordinator on the number provided to you.
Next day (day 1), after egg collection, you will be contacted by our staff to inform you about the number of fertilized eggs and the expected day of embryo transfer and to ensure that everything is going well with you.
• Embryo Transfer:
This procedure is a simple step where the best embryos are transferred back into the uterus using small soft catheter. On this day, you need to come in the morning with full bladder. If there are extra embryos other than the ones for transfer and suitable for freezing, then you will be notified if you and your partner wish to freeze them for future use.
After embryo transfer, we encourage you to go back to your normal activity and 2 days after you can resume sexual intercourse, hence, there is no evidence this would jeopardize pregnancy outcome. You will continue taking all medication as prescribed to you including; vaginal Progesterone and any additional adjuvant medications as usual.
The earliest pregnancy test can be done is 14 days after the HCG was given. Please call the treatment coordinator to communicate your result of pregnancy test.
If pregnancy occurs, you need to continue on the luteal support medications with the same dose and frequency till 12 weeks or otherwise recommended by your physician. Subsequently, a follow-up visit for pregnancy ultrasound will be arranged.
If pregnancy test is negative, you need to arrange a follow-up visit to see your physician for further discussion of future plan and recommendation.
Informed Consent for the treatment is essential and has to be completed by both husband and wife.
