IVF treatment steps:
Once the patient is screened, informed, and admitted
and the category of infertility is established,
ovulation induction is started which accomplished
by one of the different protocols. The final aim
of ovulation stimulation is to recruit a synchronized
cohort of follicles, which, in turn, will, allows
us to retrieve several preovulatory Oocytes of
a good quality.
Careful
follicular growth and development monitoring by
endocrine determinations, Ultra – sound examinations
Is necessary to obtain optimal results.
The
next step is Oocyte retrieval by a special device(
figure 8)under local anaesthesia by transvaginal
Ultra-sound guided puncture .
Oocyte
retrieval is done in the operating room which
is near the IVF – lab, in which Oocyte collection
and semen preparation (eitherejaculated or surgically
retrieved sperms) are done, the intracellular
sperm injection is done by a special micromanipulator
and fertilization and division are monitored.
When
the process succeeds, embryo transfer is done
in the operating room without anaesthesia.
Careful
monitoring continued until pregnancy occurs or
a new menstrual period starts which means that
the implantation is not occured . (Success rate
in the ideal cases equal about 47%) & the
percentage increased in repeated trials.
Methods, which increase the success
rate:
Assisted hatching :
This method helps the embryo to hatch from its
envelop which facilitates the implantation through
the uterine endometrium & this way is useful
in the aged women or in some cases that have a
thick zona.
This
method helps in increasing pregnancy rate without
increasing the baby abnormalities .
Preimplantaion genetic diagnosis (PGD) this
method is done for the cases, which suspected
to have hereditary diseases & it also helps
in sex determination of the embryo.
Embryos
& sperms freezing: to be used in another time.
The presence of many embryos does not mean to
transfer them all. Because that will leads to
multiple pregnancies & increase the percentage
of its complications (abortion, intrauterine growth
retardation, Intrauterine death, anemia, …. Etc).
So
embryo freezing in a special freezing machine
is necessary. To be transferred in another cycle
which will decrease the physical, Psychological
burden, also the operation cost becomes low. (the
freezing is done in a special stores under liquid
nitrogen
The
semen freezing process is important when the husband
is absent. Or in cancer cases because the chemotherapy
& x – ray affects fertility in males. Also
the surgically retrieved sperms are better to
be frozen for further trials.
The
percentage of having successful pregnancy from
frozen – thawed embryos is 10-50% & there
is no difference between the frozen embryos &
the fresh one.
Viability test: a hypo-osmotic swelling test,
which discriminates viable from non-viable sperms,
this technique allows the reusable of the viable
sperm after the test.
It’s a very useful test for patients who has a
necro-spermia samples.
