A Brief Summary of the Procedures

You are in the process of a novel treatment Protocol known as IVF-ICSI-ET (InVitro Fertilization by Intra Cytoplasmic Single Sperm Injection & Embryo Transfer).The success rate is about 40% with 5-10% chances of abortion and < 0.5% chance of tubal pregnancy, means you have one in 3 chance of getting a baby/pregnancy at the end of one treatment cycle. This is the only treatment Modality, which guarantees such a result even in cases that failed repeatedly with other methods.
IF YOU ARE A SMOKER OR IN THE HABIT OF CONSUMING ALCOHOL, YOU SHOULD AVOID BOTH, WELL IN ADVANCE SO THAT YOUR BODY IS DEVOID OF THE TOXIC EFFECTS.

You can have sexual contact up to 7 or 8 days after the 1-st day of period in the treatment cycle.
The whole process is described below for your information. The instructions are to be followed strictly for the smooth completion of the program. If you have any doubt regarding any matter, you are free to contact any one of us.

This treatment is done in 4 stages:
i) Controlled Ovarian Stimulation:

The aim is to get about 10-12 eggs from the ovaries at the end of the stimulation, which may extend from 10-14 days.

There are two protocols of ovarian stimulation. You may be on either one of these protocols.

a. Long Protocol:

Here the object is to partly suppress (also called down regulation) the ovary over a period of 15 days, following which the ovary is stimulated. The medication for the down regulation starts from 20th day of the previous menstrual cycle.15 days later you are asked to report here, (for blood tests and scanning) and you should have had the next periods as well. If you did not get periods after 15 days, you should contact the doctor in charge. Once the down regulation is complete, you will be given Injections for a few days. The number of days will vary for each patient. Then the rest is same as the Short Protocol.

b. Short Protocol:

In this protocol you have to report to the hospital from the first day of the period itself in the month of the treatment cycle. Your blood for LH will be taken and you will be asked to have down regulating injections, morning and evening continuously. From the third day, the stimulating hormone Injection is started, the dose of which will be modified as and when necessary. After seven days of injections, you are asked to report for the scan. At that time either you can stay back here, or if you are coming from nearby places you can come on alternate days for scanning and blood tests.

ii) Oocyte Recovery (Aspiration of the follicles)

Once the follicles have adequately grown, the female partner has to undergo a procedure known as Oocyte Recovery. The eggs in the mature follicles are collected safely in the sterile tubes with the help of Trans Vaginal Scan. This procedure is done under GA to avoid any pain. So you have to be fasting for at least 6 hrs prior to the procedure. The procedure is usually done around 9 am. On the previous night you will be called for simple cleansing procedure for removing vaginal discharges. After 3 to 4 hours of the oocyte recovery procedure, you will be shifted to the room and can have oral fluids after 6 hrs and then the regular diet. One day of rest is adequate.

iii) Semen Collection, TESA/PESA

If the husband has a minimum count of 1-2 million live sperms with about 1% normal morphology, he will be requested to produce a semen sample into a sterile container provided from the lab. This should be done on the same morning when his wife undergoes the oocyte aspiration procedure. If you require your wife’s presence for the semen collection, you should inform the OT/Lab Staff on the previous day. If the semen is insufficient or does not contain any live sperms, you will have to be prepared for PESA/TESA accordingly. This is a minor surgical procedure by which the sperms are drawn from the epididymis, known as Percutaneous Epididymal Sperm Aspiration (PESA) or a small bit of Testicular tissue is collected from the Testis (TESA). This is usually done under local anesthesia with mild sedation. So you should be fasting and should have shaved in the genital area.

iv) Embryo Transfer (ET)

Your gamates (sperms or eggs) are the most valuable things in the world for you .We give due respect to them and we take all the precautions to prevent any mix up. A notable feature of our A.R.T Programme including IUI is that we never use any third person’s sperms, eggs or embryos even if you wish. This principle has been strictly followed over the years and I can proudly say CRAFT will be the only such Centre, which would like to work with in the boundaries set by the marital contract. The embryos resulting from your gametes will be treated in the A.R.T Lab for about 2-3 days and at the end of the procedure, they will be transferred to the uterine cavity in the most atruamatic way. The best quality embryos are selected for transfer to the uterus. ET is usually done 48 hrs after Oocyte Recovery at about 11-12 Am. ET may be delayed for 1-2 days in some cases. You can have normal food in the morning, but should have a half filled bladder with urine so that transfer can be done with the help of the abdominal scan. About 2-3 hrs of holding of urine will be enough. At the end of the transfer, you will be asked to lay down in the recovery room for about 3hrs and you are free to walk.

Those who are very tensed and apprehensive about this simple and painless procedure can prefer to have it done under mild GA so that you will be quiet and the uterus also will be relaxed. If you prefer GA for ET, you should be fasting for about 5 hrs and should inform the OT/Lab Staff in advance. If more than 2 good quality embryos are left behind after ET, this may be frozen for future use. You will be informed about this from the Lab accordingly.

Post ET Follow-Up:

It is better to avoid long distance travel for at least 3-4 days.

We check E2 on D3, D5, D7, D9 and any drug to be added will adjusted accordingly.

The first result of the procedure will be known from a blood test known as BHCG done at the 12th day after ET. A value more than 10 is to be considered as positive.

This will again be confirmed by Urine Pregnancy Test after 5-7 days. This is the initial confirmation of the pregnancy. These days you will have to take the medicines as instructed from here.

Next You have to undergo a scan after 6 weeks to confirm the viability of the pregnancy by confirming the Foetal Heart beats through scanning. The scan also look for the number of foetuses and the rare presence of Ectopic Pregnancy.

Once everything goes fine, this will continue as any normal pregnancy.

One important thing both of you should keep in mind during this programme is to have a Positive thinking towards a successful outcome. For this hearty prayers to God Almighty is essential, the one who gives life and takes life.

Wishing You Good Luck,

Dr. C. MOHAMED ASHRAF
Medical Director
If you need more information on ICSI/IVF, refer Glossary page.