Through the administration of gonadotropins and agonists or antagonists of the gnRH subcutaneous, intramuscular, the combination of both and spray. The most common way is the subcutaneous use. With this medication is achieved that in both ovaries develop multiple follicles (ovarian hyperstimulation controlled).
You can follow different protocols:
Protocol ultrashort, short, long, with agonist, short with antagonists, all in accordance with each case in particular, since treatment customization, is one of the keys to success in the treatment.
The development of the cycle is evaluated by ultrasound controls and hormone measurements and based on these parameters the doctor adjust the drug dose.
The duration of treatment is usually 10-13 days, according to the response of the patient to reach the appropriate size of the follicles.
It is important to follow-up the cycle in order to avoid potential complications:
Ovarian hyperstimulation syndrome (at present we have several guidelines to avoid or minimize it).
Cancellation of the cycle for various reasons (10%):
Poor appearance of follicles (slow response).
Low hormone levels or with irregularities (it indicates that the oocytes that are going to get, will not be of good quality)
Advanced ovulation which does not allow us to determine with precision, the best time for removing the oocytes.
In most cases, the use of a new protocol or the modifications in the use of the already employed, allow us to try a new cycle, after a rest period of 2 or 3 months.
Obtaining the oocytes
When, by ultrasound, the follicles have reached the appropriate size and number we shall proceed to the oocyte retrieval.
36 hours before of the puncture, administration of HCG or agonists is needed, in order to induce the oocyte maturation.
The transvaginal oocyte retrieval is performed in the operating room, under sedation for approximately 10 minutes, during which the patient does not feel any discomfort.
This transvaginal oocyte retrieval is guided by ultrasound and with a fine needle connected to a suction system.
All follicles are aspirated from both ovaries, obtaining the oocytes that are inside the follicular fluid and that are going to reach a special tempered culture media.
All of this content is collected in tubes or syringes that are delivered as quickly as possible to the laboratory for the count and assessment of the oocytes (it is worth mentioning that not all follicles that we aspire will have suitable oocytes).
After this procedure, the patient will be under observation by approximately two hours and can go home afterwards.
The inability of obtaining oocytes is exceptional, but it could happen that the follicles are not accessible, or that the quality and maturity of them is not suitable. The empty follicles syndrome may occur in which case you will have to do an additional tests, before starting a new cycle of IVF.
Fertilization of the oocytes
After the retrieval and assessment of the oocytes, we proceed to fertilization. To do this, on the same day of the puncture, a sample of semen (from the couple, testicular biopsy or donor) will be used.
Fertilization process can be done in two ways:
Conventional IVF: consists in placing oocytes in a culture plate with the sperm sample in certain concentration.
ICSI: Introducing a selected spermatozoa in each oocyte through injection.
The next day, fertilization is checked for correct fertilization, in that case each fertilized oocyte will lead to an embryo in the following days.
The rate of fertilization is the number of embryos fertilized compared to the number of oocytes inseminated, and oscillates between 60 and 70%.
Once fertilized oocytes are obtained, they spend several days in a special culture medium to asses their development and morphology.
Not all embryos are going to develop properly, even some will stop and neither will be eligible to be transferred.
Depending on each case, the embryos can spend between 2 and 5 days (prolonged cultivation of embryos) in the laboratory to choose the best ones for the embryo transfer.
In the event of a good response to treatment a good quality of embryos will be obtained, as not all will be transferred, they will be vitrified for later use in the case of not obtaining gestation or for a second pregnancy.
Once the embryos have been chosen, they will be transferred into the uterus through a special cannula.
It is a painless procedure, fully ambulatory and must always be performed under ultrasound control.
The number of embryos to transfer will depend on the number and quality of the embryos that we have. As maximum 3 embryos could be transferred.
“According to our personal opinion”, is one of the most important stages of the procedure, and must be extremely careful when performing. Any excessive handling or bleeding, would wreck all the work done and the result would be the failure of the cycle.
After a time of rest the patient may go home with treatment and instructions. A blood pregnancy test must be performed in 15 days.
In the event of a positive test you will schedule an appointment for an ultrasound check.
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