In the case of In Vitro Fertilisation, the treatment starts with exogenous hormone administration, which will cause development of multiple follicles (development of eggs) in the ovaries, rather than just one as happens in natural cycles or in most cases of insemination.
The start date of the treatment depends on the menstrual cycle and at the same time on the protocol to follow, which can be of two types: long or short.
The criteria for choosing the type of procedure are: the age of the patient, response to ovarian stimulation, the weight…
Patient’s monitoring and follow-up
Once the hormone treatment has begun, periodic ultrasounds are performed in order to control the follicular growth and the correct evolution of the patient.
The dose of the medication given may be modified depending on what the ultrasounds show and the patient’s levels of estradiol (obtained through blood analysis).
During the treatment, the patient’s partner will be asked to provide a sperm sample, which will be analysed and frozen, in order to assess its quality and prevent possible problems when collecting it the day of the egg collection. If that is the case, the frozen sample would be used.
The treatment can last approximately between 10 and 15 days, depending on the age of the patient, a good response to medication, cycle times…
Process of egg extraction or funicular puncture
Once the patient is prepared, funicular puncture is performed.
This minor intervention, which lasts 10-15 minutes, takes place in an operating room, under sedation, in order to remove eggs from the patient. It is planned two days in advanced after having verified, via ultrasound and estradiol levels, that follicles are the right size and have reached the right maturity.
The same day of the puncture, the patient will be asked again to provide a sperm sample which will be used for the fertilization of eggs.
In vitro fertilization laboratory
The tubes obtained through aspiration during the puncture are transferred to laboratory for oocyte retrieval and quality and maturity assessment.
Once identified, they are cultured until the moment of fertilization (joining of the egg and sperm).
After finishing the sperm sample treatment, it is analysed and, depending on the sperm count as well as other clinical criteria, it is decided which technique should be used for oocyte fertilization: IVF (In Vitro Fertilization) or ICSI (Intracytoplasmic Sperm Injection).
The next three days after the follicular punction, embryos are monitored in order to evaluate how many of them have been correctly fertilized and their quality.
– Day +1: It can be determined whether fertilization has been successful.
– Day +2: Cell division and presence or absence of anomalies can be seen.
– Day +3: Embryonic evolution is observed and the best candidates for the transfer are selected.
Embryos can be transferred to the patient in day +2 or +3 (and up to +5 depending on the quantity and their quality, the patient’s current condition…).
The transfer is an easy and painless technique. Thus, it can be performed without sedation.
Fifteen days after the embryo transfer, a blood test is carried out to establish if pregnancy has been achieved (through analysis of the HCG values).
If so, within two weeks ultrasound control will help evaluate the presence of the gestational sac, when pregnancy will be confirmed.
The main indications for an IVF procedure are:
1) Female factor (tubal pathology, endometriosis, age of the patient…)
2) Male factor (either minor or very severe)
3) “Failure” in previous AIC/AID cycles
4) Infertility of unknown origin