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3. Ovulation Induction and Monitoring:

Blastocyst culture and transfer success rates depend upon the numbers of eggs, fertilized eggs, growing embryos or blastocysts available for transfer. Additionally, the egg retrieval must be carefully timed so as to retrieve mature eggs. To accomplish these two goals, ovulation induction medications and careful monitoring are employed.

Once menses occurs, a sonogram is done to make sure there are no ovarian cysts, and a blood estradiol level is measured to make sure that everything is in control. On a specified day the woman begins injections of Gonadotropins according to a schedule that is provided by the clinic. We arbitrarily call the first day of Gonadotropin administration Cycle Day 1. In order to monitor a patient's response to these drugs, daily sonograms and serum estradiol levels are performed starting on Cycle Day 7. These help us determine when the eggs are ready for collection.

Once the follicles (containing the eggs) are deemed ready, the patient stops taking Gonadotropins. About 36 hours prior to the anticipated egg retrieval, the patient takes an injection of human chorionic gonadotropin (hCG). This hormone replaces the woman's normal LH surge, and is necessary for a final maturation of the eggs so that they can be fertilized.

4. Egg Retrieval:

In almost all cases, egg retrieval is accomplished non-surgically using a vaginal ultrasound probe to guide a needle into the ovaries. The procedure does not require general anesthesia and is performed with just simple intravenous sedation. An anesthesiologist administers the sedation to maximize your comfort and safety. As a result, the experience is not painful and recovery is rapid.

5. Sperm Processing:

Freshly ejaculated sperm must undergo biochemical and structural change called capacitation before they can fertilize an egg. In a Blastocyst culture and transfer cycle, sperm are capacitated in the laboratory and the motile and healthy sperm are isolated prior to inseminating the eggs.
 
6. In Vitro Fertilization:

In-vitro fertilization literally means "fertilization in glass". Follicular fluid removed from the ovaries is examined in our lab for the presence of eggs. These are isolated and placed in culture media where they are allowed to further mature. A few hours later, portions of the processed sperm are placed around each egg. Only 50 to 100 thousand sperms are needed for each egg. This is why men with low sperm counts can often fertilize eggs in the lab.
 

The eggs and sperms are left to incubate together in a carefully controlled environment. Approximately 18 to 24 hours following insemination, the eggs are inspected under the microscope to determine how many have been successfully fertilized. These embryos will be kept in the laboratory as they continue to grow and develop for 5 days until they reach Blastocyst stage at the moment of transfer.

7. Embryo Transfer:

The embryos are transferred via a thin plastic tube through the cervix into the uterine cavity. They are then deposited in the upper part of the uterus and the catheter is withdrawn. This is generally a painless procedure and the patient remains on bed for 2 hours. As implantation will occur immediately, the patient is instructed to rest for a few days after the transfer. Light activities allowed without stress and most sleep well at night.
 

8. Post-Transfer Management:

During the follow-up phase, the woman receives daily vaginal suppository of progesterone with the goal of enhancing implantation. Twelve days after the embryo transfer, blood pregnancy tests are performed. Rising blood levels of the pregnancy hormone, hCG, indicate that implantation has occurred. Confirmation of a clinical pregnancy is made by ultrasound about 2 weeks later.

Cryopreservation:

Freezing extra embryos gives couples an additional opportunity to conceive without going through stimulation cycle and egg retrieval. The success rate with frozen/thawed embryos is improved when the woman uses hormone replacement instead of her natural cycle. About 90% of the frozen embryos at Blastocyst stage survive the defrosting process.

Other related procedures:

1) Intracytoplasmic sperm Injection (ICSI) is a technique where the embryologist captures a sperm in a very small glass pipette and inserts it directly into the egg. Many or all the eggs are treated in this manner and the fertilized eggs are monitored for continued growth. The use of intracytoplasmic sperm injection allows a male with an extremely low sperm count or poor motility to fertilize eggs.
 

2) Assisted Hatching is another procedure which involves removing the layer of cells from around the fertilized egg to help facilitate implantation by the embryo. It is recommended for women, who have had previously unsuccessful cycles, who are older, or who have elevated FSH levels.

3) Testicular Sperm Extraction (TESE) is a simple and minimally invasive procedure where a small amount of testicular tissue is removed via a needle biopsy. It is performed under local anesthesia and mild sedation. A sperm is then inserted into each egg using the ICSI procedure. TESE allows for the retrieval of sperm from men who are unable to produce sperm in their ejaculate because of an obstruction or absence of the vas deferens.

Couple Participation:

We are well aware that infertility exacts a very heavy toll. The emotional, financial, and physical burden is often overwhelming. It is for this reason that we encourage both partners to be supportive of one another, and participate in the treatment process together. The male partner should make every effort to accompany his partner with every visit. We understand this is not always possible, but it is highly recommended. Cooperation and carefully follow the treatment process will enhance the pregnancy rate.





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