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Stages in an IVF Cycle

One round of IVF treatment can be explained as an IVF ‘cycle’. Typically the treatment would start with the 2nd day of your menstrual period. At ACIMC, depending on your fertility plan you may even start certain medications before the first day of your period.

 

STAGE 1 – Day 2 of your Period

At ACIMC the first day of your IVF treatment cycle is day 2 of your period. Should you require any assistance our expert Team of IVF Coordinator Doctors would be able to help you understand how to identify days 1 or 2 of your cycle.

STAGE 2 – Stimulating the Ovaries

Involves stimulating the ovaries from day 2 of your period. During a natural cycle without any stimulation, the ovaries normally produce only one (1) egg. The stimulation stage lasts about 8 to 14 days and primarily aims at encouraging the in your ovaries to produce a maximum number of eggs. Your ACIMC specialist IVF Consultant would prescribe stimulation medication suitable to your body, weight, hormones and treatment plan. The medication includes Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH). Usually, this medication is given to you in the form of injections and or a combination of 1 or 2 types for a period of 8 to 14 days. ACIMC has trained nursing staff to ensure the dosage is properly administered and at the right time.
ACIMC Stimulation Protocols
At ACIMC, we follow international IVF treatment/stimulation protocols and guidelines prescribed by international bodies such as ASRM, ESHRE and IFFS. In addition, all our IVF Consultants are trained and experienced in this process. It is important to note that both LH and FSH are produced naturally in the body. The medication works as a booster to encourage more eggs to develop.
During the stimulation stage, we take your blood samples every alternate day and check estrogen levels in your blood and also conduct Transvaginal TVS ultrasound to track how the follicles are developing. The TVS is done by female Consultant Sonologist who is experienced and trained thoroughly to ensure you are as comfortable as possible.
The final part of this stage is the trigger injection. This injection will get your eggs ready for ovulation. The IVF Consultant would schedule your egg retrieval or egg “pick up” accordingly.

STAGE 3 – Egg “Pick Up” or Retrieval

Egg “pick up” or retrieval is a day procedure where the eggs are collected from your ovaries. This is also known is Transvaginal Ovum Pick-up (TVOPU). This procedure is done under general anaesthesia therefore an experienced anaesthetist will get you ready for the procedure. You’ll be asleep while the IVF Consultant will drain follicles from your left and right ovaries and this procedure may take around 20-30 minutes.
For peace of your mind, your IVF Consultant would use guiding needle technology supported through ultrasound to find tiny follicles. This is a very delicate part of the procedure and this is where experience really matters. ACIMC can proudly say that across our IVF Consulting Team of Specialists, collectively we have over 20000 “pick-ups” experience. This procedure involves removing fluid from the follicles where their size is large enough to indicate an egg inside.
Generally, your IVF Consultant would have a good idea regarding the expected number of eggs to be retrieved based on the ultrasound done during the stimulation stage. The recovery process may take between 1-2 hours and you will be able to go home on your feet the same day.

STAGE 4 – Sperm Sample – Fresh, Frozen or Testicular Biopsy

Our IVF Consultants and Embryologists care about the best success rates and therefore they generally recommend that the husband gives fresh sperm sample on the day of the egg pickup. According to the guidelines from World Health Organization, there must be a minimum of 2 days and maximum of 7 days of abstinence in order to obtain a reasonable sperm sample for testing, analysis and fertilization of eggs.
However, in case you are not able to be physically present on the day of the egg pickup, then you have the option to get your semen sample frozen in advance. The scientists in the lab will thaw the frozen sperm sample and prepare it in time for the Intra Cytoplasmic Sperm Injection.
Semen analysis is a complex process where the sperm is graded on various parameters and properties. For e.g. sperm count, sperm morphology, sperm tail, sperm head, sperm mobility etc. Our scientists always select the best sperm to ensure the eggs have a maximum chance of fertilization.
Finally, in case you are not able to give your sample, the Male Infertility Specialist Consultant would have identified you as a potential Biopsy patient. Some patients have no sperm when they ejaculate while others struggle simply to give a sample. In either case, we have the Male Infertility Specialist on standby for previously flagged patients needing potential Biopsy of their testicles in order to retrieve the sperm sample. The Biopsy is done under General Anaesthesia and the patient is able to go home the same day. We have a large number of positive patients having healthy babies born through sperm sample obtained through the Testicular Biopsy procedure.

STAGE 5 – Fertilisation of Eggs

Once the eggs are collected by the IVF Consultant, the dishes containing the eggs in the fluid form are handed over to the Embryologist who starts with stripping and cleaning the eggs and preparing for sperm injection. This is done under a powerful microscope so that the eggs are clearly identified and prepared.
Once the eggs are prepared the Embryologist would perform the Intra Cytoplasmic Sperm Injection. This process involves selecting the best sperm and catching it from its head using a hitting needle and injecting it into the egg which is being held using the holding needle. This is a very delicate procedure and requires absolute concentration and optimum lab and microscope environment.

STAGE 6 – Embryo Growth and development

After the Intra Cytoplasmic Sperm Injection, each egg starts to fertilize. The Embryologist would place the injected eggs into an incubator where the optimum environment is available for the healthy growth and development of the embryo. After 24 hours, the Embryologist return to the incubator and use special tools like Primo Vision / Time Lapse machine which provides in-depth growth detail and information regarding the embryo development.
Most eggs that are progressing towards healthy embryos would show the signs of cleavage within the first 24 hours and by Day 3 they develop into 6 to 8 cell embryos. On Day 5-6 the embryos convert into Blastocyst which is the ideal embryo quality benchmark for transferring back into the Uterus.
Research indicates that blastocyst stage embryos boost the chances of success in IVF. However, unfortunately, not all eggs always fertilize and not all embryos develop into a blastocyst. There is a range of factors that determine the fertilization of eggs as well as the growth of embryos including genetic disorders and lab environment.

STAGE 7 – Embryo transfer or “ET”

Your IVF Consultant would discuss with the Embryologist for the ideal embryo that should be transferred depending on the quality to maximize your chances of success. This procedure does not require anaesthesia and you are awake during this procedure.
The Embryologist would load the embryo into a plastic tube called a catheter and the consultant would ensure there is not damage caused to the embryo during the transfer. The catheter would pass through your cervix into the uterus where they gently push and drop the embryo which is expected to attach to the uterine wall. In fact, the uterus has three layers which combined together form the uterine wall. Starting from the innermost to the outermost these layers are known as:
• Endometrium
• Myometrium
• Perimetrium
The actual procedure may only take 15 minutes in total, however, you would be called in early to prepare yourself for the procedure and you are kept in the daycare for some time after the procedure.

STAGE 8 – Embryo Freezing

At ACIMC, we usually transfer one or two embryos and the rest of your embryos would be frozen for future use after consultation with you. Frozen Embryo Transfer procedure is less than half the cost of a Fresh IVF Cycle, therefore it is worthwhile going for the freezing of embryos.

STAGE 9 – The final blood test or “Pregnancy Test”

When you leave our clinics after embryo transfer “ET”, as part of the counselling you will be informed to conduct a beta HCG test 2 weeks after the ET. This test simply measures the levels of human chronic gonadotropin in your bloodstream which is the first indicator of pregnancy.