In Vitro Fertilization (IVF) means fertilization outside the body in a “test tube”.
The indications include:
- Blocked /damaged Fallopian tubes, Inoperable tubes or where the tubes have been removed due to ectopic pregnancy.
- Mild- moderate male factor infertility.
- Unexplained infertility.
- Failure to conceive after 5-6 cycles of Intra Uterine Insemination.
At all our IVF clinics in Nigeria, we attempt to individualize your treatment regimen by the development of various protocols to suit the characteristics of the particular client. Based on the history, physical examination and investigations, your peculiarities can be identified and that will guide us in the choice of protocol to use for Ovulation Induction e.g. presence of polycystic ovaries.
Drugs used are usually a combination of GnRH analogues (agonist or antagonist) and FSH plus hCG (gonadotropins). The former temporarily suppresses the woman’s natural hormones (down regulation) allowing better control of treatment cycle and the latter stimulate the ovaries to achieve multiple ovulation. The cycles are monitored with repeated transvaginal scanning.
We sometimes need to adjust the dose of FSH, depending on response. If fewer than three mature follicles develop, the outcome of treatment is likely to be poor, we will try to adjust the dose of FSH but if despite adjustments, the response remains poor, the treatment cycle may sometimes be cancelled and rescheduled. Conversely, some women over respond producing many follicles and are at risk of developing ovarian hyperstimulation syndrome (OHSS). Since the development of this complication can be potentially life-threatening, we sometimes have to cancel treatment cycles in such women in whom the onset of OHSS is imminent.
We prefer to have the presence of the male partner at the egg collection procedure, this takes place approximately 36hours after the hCG injection. The procedure is usually done under sedation with Vaginal Ultrasound guidance.
You will be advised to rest during the first 24hours following the Egg collection and you will also be forbidden to drive. It is advisable that a responsible adult looks after you during this period. You may also experience some abdominal / pelvic pain (for which regular pain killers will suffice), Nausea or vomiting can also be experienced and it is usually due to a side- effect of the drugs given for sedation.
Embryo replacement, though a simple procedure, is one of the most important steps in IVF, as successful pregnancy is related to the ease with which embryos are transferred into the Uterus. We are therefore careful with this procedure, sometimes a stylet may be needed to negotiate the cervical canal and rarely the transfer procedure may need to be rescheduled while the embryos are frozen.
At St. Augustine Medical Centre & Assisted Reproduction Technology Unit, Edo State, we grade embryos and choose the best quality embryos that have a higher chance of implantation for replacement. We usually replace two or three embryos.
Following the embryo transfer, any remaining viable embryos are then Cryo preserved (frozen) for later transfer, this avoids the need to go through ovarian stimulation and egg collection each cycle. Embryos can be stored for many years.
We give hormone supplement for luteal phase support to all patients for the two weeks before pregnancy testing. This is usually in form of progesterones, hCG is rarely used due to the risk of OHSS.
Pregnancy testing is done two weeks after embryo transfer for all patients and Ultrasound scanning after five weeks, in cases where the pregnancy test is positive. The scan will check the location of the pregnancy (whether inside or outside the uterus), the number of fetus and viability. Luteal phase support is then continued for 6-8weeks.
Successful treatment and occurrence of pregnancy: This commonly occurs, when, the identified problems are successfully treated with either the drugs…