In order to develop more than one egg during the cycle you will need to medically stimulate your ovaries. The controlled ovarian stimulation is the first stage of the IVF treatment that involves injections of hormones. The type of medication and dosage will be carefully prescribed by your doctor, who will control your stimulation progress every 3-4 days. You will regularly come for check-ups and ultrasounds while you are taking medicine for approximately 12 days. If you have no possibility to spend so much time in Ukraine we can arrange the stimulation process distantly. Therefore, you will need to do several ultrasounds and send them to us.
Here are the most widespread reasons why IVF treatment with your oocytes would be the best option:
- you have been diagnosed with an unexplained infertility
- your fallopian tubes have been damaged or removed
- in case of ovulation disorders
- in case of endometriosis
- in case of uterine fibroids
- in case of low sperm count or male infertility
This step is carried out according to several common protocols. With all the standardization process protocols of treatment are calculated individually and depend on many factors (age of the patient, the results of hormonal studies, data from previous cycles of treatment, etc.). The main protocols used are as follows:
- “Long protocol” The main protocol under which about 85% of IVF cycles are undergone.
- “Short protocol” At the present moment, the appointment of the “short” protocol using antagonist is considered as critical, the prescription of antagonist for more than 3 days is limited. After reaching the diameter of 16-18 mm by a “leading” follicle, a patient takes medications that promote oocyte maturation. These medications should be injected for 32-36 hours before the expected puncturing of follicles.
- Antagonist protocol. Practically it is a variant of short or ultrashort protocol without using antagonists.
- “Natural cycle” It is usually used for patients with bad evocation of an ovary on controlled hyperstimulation of ovaries, but with preserved natural folliculogenesis, it means patients who can produce 1-2 eggs whether using medications or without it. We do ultrasound and hormone monitoring from 7-8 day of the cycle. Medications which promote egg maturing should be injected for 28-32 hours before the expected follicular puncturing.
- Cryo-cycle. In the case of the presence of cryopreserved embryos obtained in previous cycles, it is advisable to carry out their transfer. Transfer of frozen embryos avoids additional controlled ovarian hyperstimulation and follicular injection. Standard protocol for endometrial preparation for the transfer of frozen embryos is similar to a “long” protocol and starts with an injection of an antagonist on days 19 to 24 of the cycle.
The next step will be egg retrieval. When the stimulation is over you will need to come to us for the egg collection. This surgical procedure is done under general anesthesia and takes up 30 to 40 minutes on average – the doctor uses needle under the ultrasound monitoring to aspirate each possible follicle. After that you are having a rest for one-two hours and leave the clinic.
At the same day your partner needs to provide his sperm sample which will be used in subsequent IVF procedure. The process in which a certain amount of sperm is added to the culture medium with oocytes obtained is a classic IVF. ICSI (Intracytoplasmic Sperm Injection) and PICSI (Physiological Intracytoplasmic Sperm Injection) procedures can also be used during IVF treatment. In the first case, a single sperm is injected right into the egg, one for each egg. In the second case, sperm is placed into the dish with hyaluronic hydrogel which unites to biochemically active sperm. In this way, embryologist can select sperm not only visually but also check the quality. In 17 hours we will be able to see whether the egg has been fertilized.
ICSI ( Intracytoplasmic sperm injection) is used even with minimal changes in sperm. There are additional indications for this manipulation – obtaining small amounts of eggs (5 or less), the failure of the previous cycle, etc. In any case, sometimes doctors are reinsured to achieve the maximum amount of fertilized eggs. Naturally, the question of the need for ICSI is desirable to decide at the start of IVF cycles, but sometimes there is a need for the appointment of this procedure, the actual day of the injection. The doctor informs you about this after the husband’s sperm preparation for fertilization.
The pregnancy test is done fourteen days after the embryo transfer in order to confirm pregnancy.