During treatment, IVF medications are administered to stimulate follicular development. Monitoring is performed by vaginal ultrasound and hormone blood testing, every 2-3 days in order to adjust the medication dosage. Serial ultrasound monitoring is performed to determine follicular development, where oocytes are matured. Our target is to achieve multiple growth of follicles with a mean follicular diameter over 18mm, in order to determine oocyte maturation and commence ovulation induction. Moreover, endometrial thickness is assessed. The endometrium is the inner lining of the uterus, where the embryos will be transferred. Measurement of estradiol, produced by follicles, determines oocyte maturation. When one or more follicles reach 18mm in mean diameter, the endometrial thickness is adequate and good estradiol levels are measured then hCG is administered to induce ovulation and 34-38 hours later oocyte recovery is programmed.
Oocyte recovery (Egg retrieval or Pick - Up)
Oocyte recovery or pick up, lasts about 15 minutes and patients are offered light sedation. The doctor aspirates follicular fluid with a needle inserted transvaginally, under ultrasound guidance. The embryologist examines the follicular aspirates, under a microscope, to identify the oocytes.
At the end of oocyte recovery, oocytes are washed and transferred immediately to culture medium. Oocytes are then inseminated with husband’s sperm, already processed with special techniques. Next morning, fertilization is scored and normally fertilized zygotes are returned for further culture.
Embryo transfer is a simple procedure that doesn’t require sedation. It is performed on days 2 or 3 after egg retrieval. In some cases, blastocyst-stage embryo transfer may be performed, 6-7 days after egg retrieval. Embryos are placed into the uterine cavity, using a thin plastic catheter inserted through the cervix. The number of embryos to be transferred is discussed with the couple. In case of surplus embryos, they may be cryopreserved for future use.
About 12 days after embryo transfer, a pregnancy test is ordered. Blood is tested for the presence of ‘b- HCG‘. If the test is positive, the first ultrasound is programmed two weeks later when the gestational sac of the embryo or embryos appears in the uterus. If the test is negative, medications are stopped and an appointment is programmed with your doctor to discuss the possible factors that led to failure and decide on the next step.