Description of treatment
In vitro fertilization is a „classical“ laboratory (ART) technique of fertilization outside the body, during which egg cells and sperm are “mixed“ in the laboratory where the sperm cells are left to spontaneously penetrate the eggs and fertilize them.
Due to the fact that on average, only every second egg gets fertilized in this way, another method of assisted reproduction has been developed – ICSI – in which a single sperm is injected into an egg using a microneedle.
Nowadays, the term IVF has a wider meaning and is sometimes used as a synonym for assisted reproductive technology, to describe a variety of different laboratory techniques used in ART.
Treatment – step by step
- An individual ovarian stimulation protocol will be determined. You will apply subcutaneous hormonal injections (stimulation medications) according to your protocol ( Menopur, Puregon, Gonal application instructions).
- You can purchase the ovarian stimulation medications at our centre or we will write you a prescription, which will allow you to buy them anywhere within the EU (the prices of stimulation medications are about 10-20% lower in the Czech Republic than in other EU countries).
- Usually on the 2nd or 3rd day of your menstrual cycle (that is the 2nd or 3rd day of menstrual bleeding) you will start to apply injections as indicated in your stimulation protocol. Please, inform us about the beginning of stimulation.
- Injections are given subcutaneously (just under the skin) in the area below the navel, approximately every 24 hours, usually for 7 days.
- After that an ultrasound scan will be performed to measure the size and the number of follicles.
- You will undergo the ultrasound examination (depending on agreement) at you OB/GYN or at our centre. We will discuss the results of the exam via e-mail or by phone.
- Depending on the results of the ultrasound exam, it will be decided whether you will continue the stimulation of your ovaries (in which case another ultrasound will follow, usually in 2 days) or end it.
- If the follicles are large enough, you will apply your final injection (Pregnyl, Ovitrelle), which will induce the final maturation of eggs.
- Egg retrieval procedure will follow 2 days after the application of the final injection.
- On the day of your egg retrieval you will arrive to the centre together with your partner.
- It is absolutely neccessary to have your identification card (passport) with you.
2. Egg retrieval – follicle punction & egg aspiration
- You will come to the centre at the agreed time.
- The procedure will be performed under IV sedation (it lasts about 10-15 min).
- We require pre-operative testing results, which you will obtain from your GP (the results/report should not be more than 6 months old).
- The request for pre-operative testing will be sent to you by E-mail.
- Pre-operative testing should also include serologic test results for hepatitis B and C, HIV and syphilis (also not more than 6 months old).
- Prior to egg retrieval these STD tests are done again to make doubly sure that the results are negative (this is required by law).
- Egg retrieval is performed transvaginally using a thin needle under ultrasound guidance.
- The ovarian follicular content (follicular fluid containing the eggs) is aspirated.
- The follicular fluid is then passed to the laboratory for further processing.
- Within one hour after the retrieval you will be discharged from the centre . Please, make sure you have someone to drive you home, on no account should you drive as the effect of anesthesia may persist for some time.
- Recipient‘s mature eggs are fertilized with her partner’s sperm, usually using the ICSI thechnique – the injection of a selected quality sperm into the egg.
4. Embryo culture
- Following fertilization the embryos will begin to divide and grow.
- Embryos can be cultured in the laboratory up to 120 hours (Day 5), after that they must be transferred into the uterus or frozen.
- Depending on the number, development progress and quality of the embryos, the embryologist will determine the best time to carry out embryo transfer.
- The aim of the complex processs of embryo development assessment is to determine the most opportune moment for embryo transfer, ensuring the highest chance for pregnancy.
- An embryo at the most advanced stage of development before transfer is called a blastocyst (5 day old embryo, blastocyst transfer).
- Surplus high quality embryos will be frozen (cryopreservation).
5. Embryo transfer
- Embryo replacement into the uterine cavity (ET) is performed without anesthesia, using a thin flexible catheter (hose). The tip of the catheter is under ultrasound guidance for its more precise positioning inside the uterine cavity.
- Embryo transfer is a completely painless procedure.
- The embryos are injected into the uterine cavity with a small amount of liquid (culture medium).
- After the procedure you will remain lying down until you are ready to be released from the clinic (about 1 hour).(cca 1 hodina)
6. Precautions after embryo transfer
- It is advised to take rest for a few days after the transfer (no strenuous physical activity, hot tub baths and no intercourse are recommended) for 1-2 weeks.
- After 1-2 weeks you can go back to your normal lifestyle, but avoid strenuous physical activity.
- Take the prescribed medicines regularly as indicated in your discharge instructions.
7. Pregnancy test, medication intake, monitoring pregnancy
- 20 days after the transfer take a pregnancy test (using the first morning urine).
- If the pregnancy test is positive, continue to take your medications until the 12th week of pregnancy.
- If the pregnancy test is positive, book your ultrasound appointment (cca in 7-10 days).
- After week 12 of pregnancy gradually discontinue the medications over 7-10 days.
- Standard prenatal screening and regular check-ups with your OB/GYN follow right after.
- If the pregnancy test is negative, discontinue the use of all medications and after the end of your next period, contact us to start preparation for frozen embryo transfer or to discuss further treatment.