Course of Treatment
The steps leading up to your planned child
Example of a typical treatment
The history of both partners will be raised during a personal interview with the couple. At this stage it is of advantage to bring with you all the previous diagnostic findings of both partners. This first interview is aimed at providing a plan for the diagnostic measures required. If pertinent diagnostic findings do exist at this stage, already then a plan for treatment can be initiated. All aspects of the prospective therapy will be fully discussed, and once all the initial diagnostic tests have been collected, treatment can be started.
Diagnostic tests for IVF/ICSI can also be carried out by your general practitioner or your gynaecologist. You will receive the relevant instructions for either your GP or Gynaecologist from us.
The initial test phase provides the basis for all further treatment. The procedure outlined above is typical for a IVF/ICSI treatment.
Stimulation of the ovaries (Ovarian Stimulation)
IVF treatment can also be effected on the basis of a normal, spontaneous cycle. Nonetheless, it is recommended to stimulate the ovaries hormonally. During a normal cycle, only one oocyte matures. As a consequence the chances for an embryo-transfer are rather slim. Stimulation increases the likelihood of success, as several follicles will be stimulated to mature. Through a punction, using an ultra sound guided needle to reach the ovaries, several oocytes can be retrieved. Thereby the likelihood of success increases severalfold.
2 - 3 ultra-sound examinations will be required to monitor follicle growth, and potentially a few blood samples need to be taken to control hormonal readings. You will receive a detailed plan outlining the dosis of the required medication. All the necessary stimulation inducing medication will be injected subcutaneously (under your skin). These injections can also be administered by yourself or your partner, in which case the method will be shown exhaustively, using dummies. According to the reaction of the ovaries, the dosage will be adjusted as advised by controlling examinations.
If requested the specialists effecting treatment will take part in the monitoring process. In this case the dosis and any recommendations pertaining to control procedures will be communicated per telephone or fax.
Triggering of Ovulation
In a cycle that has been stimulated for IVF/ICSI Treatment, the natural ovulation will be suppressed through medication. Once an ultra sound examination has found that the follicles are sufficiently mature, ovulation will be triggered through the administration of a "triggering injection" (hCG Injection). This is the only safe way to determine the optimal moment for aspiration of the follicles.
This injection is of extreme importance and has to be administered at the exact point in time, since exactly 36 hours after the injection the retrieval of the oocytes will take place.
Ovum pick-up (Ultra sound guided oocyte retrieval)
Retrieval of the mature egg is guided by ultra sound. Right before the procedure takes place, you will be administered an analgesic and seadative medication. If requested, the punction will take place under a brief anaesthesia. Under this option you will be completely free of any sensory perceptions during the procedure. The fluid in the follicles will be extracted and immediately checked for eggs.
Semen retrieval and Semen processing
On the day of the oocyte retrieval, the partner will dispense of a test sample of his semen in a specially designated room. To achieve maximum semen quality the partner should refrain from ejaculation three to five days before the semen will be taken. Too short and even too long waiting periods can have a negative effect. The sample will be recovered in a sterile, named, cup. Immediately afterwards the sperm will be processed in the lab, and incubated with the recovered eggs.
Depending upon the quality of the semen, the sperm cells will be processed and either be directly incubated with the oocyte in the culture media (IVF), or through use of the technique of micromanipulation (Intracytoplasmic Sperm Injection or ICSI), they will be injected directly into the egg. The next day the eggs will be examined under the microscope, for signs of a successful fertilisation. Depending upon the number of fertilised eggs and the development process, the transfer date (2./3.day, or on the fifth day in a Blastocyst stage) will be decided.
Selection of Embryoes
Before the transfer takes place, the quality and number of embryos will be discussed, and then a mutual decision will be made as to which embryo shall be transferred. If the development of the embryo is satisfactory, it is advisable to transfer only one embryo into the uterus, even if several embryos of good quality are available. Spare embryos can be cryopreserved. They will then be available in the future for a further embryo transfer, without the need for a stimulation and punction procedure.
In a careful and painless procedure, a thin catheter will be introduced into the uterus through the cervix, and will be attached to the mucous membrane of the uterus. To ensure optimal position of the catheter this is usually controlled through ultra sound. The patient can leave the clinic right after the procedure has been completed. To facilitate acceptance of the embryos in the endometrium mucuous uteral membrane, progesterone will be administered in form of capsules that will be inserted into the vagina. Additionally various injections of hormones can be given, with an aim to improve the chances of implantation.
If the procedure was successful, the pregnancy hormone ß- HCG can be detected roughly after 15 days.