Shesmedi Hospital -IVF Procedure
Step 1. Controlled Ovarian Hyperstimulation (COH)
Naturally, the female body produces one mature
egg a month. One egg has a lower chance of becoming fertilized or well
developed. Thus, fertility medications are prescribed to control the timing of
the egg ripening and to increase the chance of collecting multiple eggs during
one of the woman’s menstrual cycles.
The method of COH is to inject a female patient with hormones (gonadotropins) that stimulate the growth of the immature follicle for 7 to 10 days from the second or the third day of her menstruation. A periodical ultrasound will take place to monitor the growth of the follicle. When the follicles are estimated to be fully grown (generally more than 3 follicles that are over 17 mms), the patient will be given another injection (hCG hormone) to trigger the ovulation at night, and 34 to 35 hours after the injection, multiple eggs will be retrieved from the patient.
In the case of a patient who is not responding to this method (if the patient only produces one or two follicles after the ovarian hyperstimulation injection), a single egg which is produced naturally every month will be retrieved for in-vitro fertilization. This natural period method of taking out the egg is inexpensive and can be repeated every month. However, the successful rate of pregnancy is low compared to the method of ovarian hyperstimulation.
When the female patient is old or has
decreased ovarian function, premature follicular rupture often occurs.
Therefore, some protocols used to prevent spontaneous ovulation and allows the
control of ovulation to the rest exclusively on administration of medications.
The long
or down regulation protocol
From 7 days before the expected
menstruation date, a female patient will be injected with hormone (GnRH agonist)
that suppresses premature ovulation into her shoulder or lower abdominal area
every day. When her menstruation period starts, on the second or third day of
the menstruation, the additional other hormone (gonadotrophins) will be
injected until the follicles are fully grown and ready to ovulate of egg.
1)
Short (flare) protocol
In this protocol, the patient is injected
with GnRH agonist (it suppresses premature ovulation) concurrently with
gonadotrophins on the second day of the menstruation until she is given a hCG
injection.
2)
GnRH antagonist Protocol
This is the latest protocol for superovulation in IVF. Patients start on the gonadotriopins
injection from the second or third day of menstruation and when the follicles
have grown 12 to 14 mm, then GnRH antagonist is injected in addition, which suppresses
the premature ovulation. Both injections will be given until she is ready for
the hCG injection.
