In-Vitro Fertilization - IVF Treatment Mumbai

Since both the man and the woman have essential parts to play in the IVF process, the first step is a detailed medical examination of both partners. You can help to avoid unnecessary repetition of tests by bringing with you the results of any previous examinations, e.g. X-rays, ultrasounds, blood tests, previous operation or treatment details. Further tests will be advised at this time if required.

The results of all the tests will be now be available. The doctor will now be able to discuss these results with both of you and propose a specific approach and timetable for your treatment and give you any information and guidance you may require. The doctor will explain precisely what your personal IVF treatment will involve and will give you clear answers to your questions. For example, women often ask if they can continue working during their IVF treatment. “Some men are embarrassed at the thought of having to provide semen samples ‘single-handed’ during the course of the treatment.” Perhaps you are both concerned about the stress involved in IVF. Please feel free to discuss these and any other problems you may have, openly and without any embarrassment. Both partners are required to sign consent forms agreeing to certain procedures. You are not limited to just one meeting with your doctor. You may consult the doctor for help or advice throughout the course of your IVF treatment.

Your treatment will include hormonal stimulation of your ovaries to mature several eggs simultaneously.

In IUI cycles, HMG injections, which replicate the follicle stimulation action of the natural hormone Follicle Stimulating Hormone are used. This is followed by HCG, which has a similar action to the natural hormone LH (luteinizing hormone) in encouraging follicles to mature and triggering ovulation (release of the eggs). After the HCG injections, IUI is performed at specific time intervals.

In IVF (and ICSI) cases, your natural LH and Follicle Stimulating Hormone production will be suppressed temporarily by the administration of GnRH analogues. This procedure allows the hormones administered as part of your treatment to work in a controlled way so as to avoid unpredictable events such as spontaneous ovulation and consequent loss of the ripe eggs needed for IVF. The effect of these GnRH analogues is to simulate a temporary menopause. You may experience typical menopausal symptoms, such as short temper, irritability and headaches, and there may be some irregular vaginal bleeding. These side-effects may cause a small amount of discomfort, but fortunately they are benign and will disappear when HMG administration begins. You must continue to administer the GnRH analogues daily throughout the stimulation period, i.e. until the HCG injection.

In IVF cycles, HMG injections are started after assessing the suppression of the ovarian status by ultrasound. Stimulation usually lasts between 10 and 16 days, and involves an injection of HMG (human menopausal gonadotrophin) or r-Follicle Stimulating Hormone (recombinant Follicle Stimulating Hormone) every day. The injections are given (intramuscular), usually on the buttock. You can ask a general physician or a visiting nurse to give you these HMG injections. Alternatively, you may visit the Hospital to have these injections. The HMG dose will be specified in the instructions you will receive and may vary from 1 to 12 ampoules. Regular ultrasound tests are carried out to enable this dose to be adjusted as necessary.

HMG causes several follicles to mature simultaneously and so it is quite normal for the ovaries to grow significantly larger. This may cause some back pain and your stomach may become swollen. The sites of your injections may also be rather tender for a short while. These effects are usually self limiting and do not interfere with routine activities or affect the treatment. You will need to have one or more ultrasound scans as the process of ovarian stimulation continues. This gives the doctors a visual check of the growth of the follicles and enables them to determine the optimum time for pick-up of your eggs. The number of ultrasound scans will depend on how your body reacts to ovarian stimulation.

HCG injection: When the ultrasound scan shows that a sufficient number of good follicles have grown, this is the signal to give an HCG (Human Chorionic Gonadotrophin) injection to complete the process of maturing the eggs. Your HMG injections and GnRH analogue injections will also stop at this time. Ovulation occurs about 40 hours after the HCG injection, and so the pick-up is made just before this happens. This allows the eggs to be gathered for fertilization in our laboratory. To ensure that the egg pick-up can be performed during the daytime, the HCG injection is given during the evening or at night. The doctor will tell you the precise day and time.

After the IUI or IVF/ICSI, you will be required to take progesterone tablets. This encourages thickening of the lining of your uterus and makes it easier for an embryo to implant. You may be prescribed oral tablets to swallow or vaginal tablets to be inserted for the next few weeks. To reduce the risk of vaginal infection, you should always wash your hands thoroughly before inserting the tablets. The progesterone tablets will inevitably cause a small amount of vaginal discharge, so we recommend that you use panty liners during this time.

The doctor specifies the precise time for your egg pick-up. You need to come fasting for the procedure. Please take great care to arrive at the hospital in good time. Once you have been allocated a bed, you should remove all makeup and any contact lenses, undress and change into a gown.

You will then be taken to the Operating Theatre, where an intravenous infusion will be set up to maintain proper -fluid equilibrium and ensure effective treatment of any problems which may be caused by nausea or bleeding, etc. during the pick-up procedure. Anesthesia will be administered by intravenous injection.

Egg pick-up is monitored by means of an ultrasound scanner. As for your previous ultrasound scans, this will involve passing a small probe into your vagina to enable us to obtain a picture of your ovaries. The doctor then inserts a fine hollow needle via the vagina, taking great care as it passes the wall of the vagina, up to the ovaries. The mature follicles are picked one by one and the fluid sucked into the needle.  The follicular fluid is taken immediately to the laboratory, where the eggs are retrieved , placed in a container and stored in a special incubation unit to await in vitro fertilization.

You will be taken back to your bed after pick-up, where you should rest for a few hours. Your infusion set will be removed and you will be told how many eggs have been retrieved. You will be able to return home that same afternoon, just a few hours after the pick-up.

Fresh sperm are preferred for in vitro fertilization, since they offer the greatest chance of successful fertilization of the eggs. The man should therefore provide a semen sample on the pick-up day. Discrete facilities are available for this purpose in the Hospital. The semen should be provided in the morning in order to enable our laboratory to separate out the most motile sperm that same day. If the man does not have any sperms in the sample or if the sperms in the sample can not be useful, sperms may have to be retrieved by a small surgical procedure on him. This is usually performed under local anesthesia and is quite painless. It does not require any hospitalization and the man can resume most normal activities immediately. The sperms which are retrieved in this way are used for fertilizing the eggs by a procedure called ICSI (Intracytoplasmic Sperm Injection).

The sperm and eggs are mixed together in the laboratory just a few hours after pick-up. The dish containing both types of cell is then placed in an incubator which replicates the temperature and atmospheric conditions found in the Fallopian tube. Examination under a microscope the next day confirms whether fertilization has been successful. If it has, then a further examination is carried out one day afterwards to check that the fertilized eggs have developed into embryos. These embryos will be transferred into the womb a short while later.

There is a possibility that fertilization or embryo development may not be successful enough to allow transfer to proceed. Should this happen, you will be informed and your doctor will arrange to meet with you without delay, so that you can discuss what has happened.

Total reliability is our priority. Positive identification procedures are maintained during fertilization procedures in the laboratory and subsequent embryo transfer. Thus you can be certain that all eggs, sperm and embryos used in the course of your IVF treatment are really your own and/or your partner's.

If the fertilization is successful, you will have to return to the Hospital for the embryo transfer. You will be informed as to what time you should arrive. Embryo transfer is a short procedure. It is both painless and without any risk. No anesthesia is required. A speculum is inserted into the vagina to facilitate access to the womb while the doctor inserts embryos via a fine tube. This is done under ultrasound guidance.

There are advantages and disadvantages to transferring multiple embryos at a time. While this increases the chances of at least one embryo implanting successfully, it also increases the chance of a multiple pregnancy, resulting in twins or triplets. The number of embryos to be transferred will be discussed beforehand. Factors influencing the number of embryos include the woman's age (fertility declines as you grow older), the quality of the embryos and the number of embryos available and the results of previous IVF attempts will also be taken into account.

After embryo transfer, you should rest in bed for an hour before returning home. For the first week after transfer, you must avoid sexual intercourse, hot baths, saunas and intensive sporting activities. You may resume all other aspects of your normal life the day after transfer: most activities have no effect whatsoever on the chance of successful implantation.

After the IVF, you will be required to take progesterone supplementation. This encourages thickening of the lining of your uterus and makes it easier for an embryo to implant. You may be prescribed oral tablets to swallow or , vaginal tablets to be inserted or intramuscular injection of progesterone for everyday for the next few weeks until we test for pregnancy. To reduce the risk of vaginal infection, you should always wash your hands thoroughly before inserting the tablets. The progesterone tablets will inevitably cause a small amount of vaginal discharge, so we recommend that you use panty liners during this time. You will also be asked to take an injection of Progesterone everyday until we test for pregnancy.

The period immediately after embryo transfer is a difficult one. You will have to wait about two weeks before the results of the IVF treatment reveal themselves in either pregnancy or the onset of menstruation. You will be instructed to carry out a blood test 15 to 18 days after the embryo transfer. If your IVF treatment has been successful, as we and you all sincerely hope, a further ultrasound scan will be taken. If pregnancy does not result or if you start your period, you will meet the doctor to discuss the further course of treatment. This meeting provides a good opportunity to reflect on progress so far and to plan for the future.