Types of Ovarian Stimulation

In a natural cycle, a woman forms one egg, but during IVF we amplify the body’s natural process of egg production in order to make multiple eggs available. There are several different types of ovarian stimulation protocols that can be used to accomplish this task. Choosing the correct protocol can be the single most important step in achieving a successful outcome for IVF. Dr Richa Katiyar uses her vast experience and training to choose the appropriate protocol for each individual patient.  

Some general categories of stimulation protocols include:

Long Protocol with Lupron Down Regulation

Short Protocol with GonRH Antagonist

Mini Protocol

Natural Protocol

Ultra Long Protocol

If a woman does not release mature eggs on a regular basis, gonadotropins or clomiphene may be used in conjunction within IVF to induce ovulation.

STEP 2. Clinic Visits for Monitoring

Each protocol requires a regimen of daily injections of medication (gonadotropins) to stimulate the ovaries to produce eggs. While on these medications, you will undergo monitoring and your number of visits will vary depending on the protocol and your response to the medication. You can take the injections yourself, after being trained by our staff, or you can take them close to wherever you stay. Using ultrasound and blood tests, Dr. Richa will monitor the effectiveness of the protocol and adjust the doses of the injections, if needed. When it appears that the egg follicles are at an appropriate, mature size, you will be instructed to take a “trigger” injection of human chorionic gonadotropin (hCG) or leuprolide (lupron) to induce the final maturation of the eggs and to prepare for the egg retrieval.

STEP 3: Oocyte retrieval (Egg Retrieval)

After successfully stimulating the body to produce eggs, a simple outpatient procedure is performed to remove the eggs from the ovaries, this is known as an egg retrieval procedure. The egg retrieval procedure is performed under general anesthesia, anaesthesia is given by an experienced and specialized anesthesiologist to ensure your comfort and safety. Assisted by vaginal ultrasound guidance, a needle will be inserted into the egg follicles and the eggs will be extracted safely. The egg retrieval process generally takes about 15-20 minutes, but you will be kept in the hospital for around three hours. After you are completely comfortable, have had some water to drink and a light snack to eat, and once you have passed urine, you can go home.

STEP 4: Fertilization of the Egg

After the egg retrieval procedure is complete, the next step in the IVF process is insemination of the eggs

Traditional IVF vs. Intracytoplasmic Sperm Injection (ICSI)

In traditional IVF, eggs are exposed to sperm when they are combined in a specially designed culture dish and left to incubate overnight in the laboratory. In some circumstances, simply mixing the eggs and sperm outside the body will not result in fertilization and the production of an embryo. When there is reason to believe that fertilization may not occur with mixing, ICSI (intracytoplasmic sperm injection) is utilized to improve the chance of fertilization. In ICSI, our Embryologist choses the best sperm and injects one sperm inside each egg using a micromanipulator

Laboratory Events & Milestones

After the egg has been successfully fertilized, a series of embryonic milestones unfold:

Day 1: Pronuclear Stage

Day 2: 4 Cell Stage

Day 3: 8 Cell Stage

Day 4: Morula

Day 5: Blastocyst

These are the same steps that normally occur in nature (within the fallopian tube) and similarly, these events take place in the Incubator.

STEP 5: Embryo Transfer

The transfer of viable embryos most commonly occurs 5 days following the egg retrieval, when the embryos are at the blastocyst stage but sometimes day 2 or day 3 transfer may also be  done. Dr. Richa will discuss with you the best day to transfer the embryos and the number of embryos to transfer. Deciding on the day and the number of embryos to transfer depends on several variables. Age of the egg source, embryo quality, preimplantation genetic diagnosis (PGD) results, transfer day, medical history, patient preference and more, all go into the decision. Further, the American Society of Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) have published guidelines recommending the appropriate number of embryos to transfer based on patient age and history. With this in mind, Dr. Richa ultimately strives to work with her patients to decide on a safe and appropriate number for each individual circumstance.

The embryo transfer is an elegant and simple procedure that is designed to place the embryo(s) into a receptive endometrial environment. It is done under ultrasound guidance to ensure that the embryos are positioned into the perfect place in the uterus. To begin the transfer, the patient is positioned on a specially designed bed with a full bladder. The optimum filling of the urinary bladder ensures easy transfer of the embryos and perfect vision of the uterus is ensured, by the trans abdominal view by an Assistant. The embryos are loaded in the transfer catheter are then gently advanced into the uterus where they will eventually implant and begin to grow. Approximately 9 to 12 days later a pregnancy test called Beta HCG is done to confirm that the patient is pregnant.

Who should get IVF done?

IVF (test tube baby) is useful for patients with blocked fallopian tubes, pelvic adhesions, previously ligated fallopian tubes, endometriosis, advanced age of the female partner, multiple failed IUI’s, unexplained infertility and male factor infertility.

What is Assisted Hatching?

Assisted hatching is a procedure that helps the embryo make contact and implant into the uterine endometrial lining. The procedure of assisted hatching involves using a precise laser to create a tiny opening in the outer membrane of the embryo moments before it is transferred into the woman’s uterus. That tiny hole in the embryo’s membrane allows the embryo to more easily emerge from its outer covering (a normal part of the embryo development process), and implant in the uterus.

What is Embryo Freezing (cryopreservation)

Dr Richa may recommend freezing some or all of a patient’s embryos. The freezing process involves rapid cooling, in liquid nitrogen, to a temperature that perfectly preserves all of the delicate structures and material within the embryo. Once frozen, an embryo can remain perfectly preserved for many years until the patient is ready to use it. At that time, using a specific thawing protocol, the embryo gently brought back to body temperature and then transferred it into the uterus.  

History Of IVF

IVF (in vitro fertilisation) was pioneered in the 1980’s by Dr. Edward and Dr. Steptoe, and it has come a long way since then. IVF (test tube baby) is among the most successful infertility treatments and gives good successful results.  Children born from IVF (test tube baby) are as normal as normally conceived children. In fact, the first IVF child ever in the world, Louise Brown, got married, conceived naturally,and a son was born to her in 2006, laying to rest all doubts about the fertility of children conceived by IVF (test tube baby).

With so many different types of treatments available for various possible disorders, most couples are able to realise their dreams of having a baby using IVF (test tube baby).

Emails to Dr. Richa Katiyar regarding IVF

Good Morning Dr,

I am Asaf Zardoi. l want information about ivf. Its been 8 years of marriage. We could not blessed with a baby. We have gone through many tests once laproscopy and once IUI have done. Could not get success. I have read a lot about you. Seeking hope. Please tell me the total cost because i do not have to much money but i will do anything. Because without a baby we can not survive in this society. My wife is 28 years old and i am 32 years old. Please suggest me.

Regards,

Asaf

Hello Mr. Asaf,

Sorry to learn that you and your wife are having difficulty in having a baby.

You are welcome to come to New Delhi to get IVF-ISCI treatment done.

The IVF treatment starts on day 1-2 of the periods so you will need to plan to come accordingly.

The charges for IVF depend on the no. of injections we use and that depends on the ovarian reserve of your wife. We can test this by doing a blood test called AMH. Please get this test done and let me know the report.

Feel free to contact me for any further queries.

Best regards,

Dr Richa Katiyar

IVF and Infertility Specialist