Various medications are used to stimulate the ovaries to produce multiple mature follicles (controlled ovarian hyperstimulation or superovulation), rather than the single egg normally developed each month. Follicles are cysts in the ovaries in which eggs grow to maturity.
Follicle-stimulating hormone (FSH) is the hormone used to stimulate multiple oocytes. FSH is sold as Metrodin (urofollitropin for injection). Metrodin is a gonadotropin, given by daily injection. The number of days and the dose will vary depending on follicle development. We monitor the ovarian response and time the administration of Human chorionic gonadotropin (hCG), which causes the release of the egg in a woman like Luteinizing Hormone (LH) does in a normal cycle. The response to these medications is monitored by ultrasound and hormone levels.
Ultrasound
Ultrasound uses sound waves to make sonar pictures of the abdomen. We use a series of ultrasound scans to obtain a three dimensional picture of the ovaries and to follow follicle growth in the ovary. Through ultrasound, we can observe follicle growth, number, size, and maturity. This allows us to time hCG administration. Ultrasound may be performed abdominally or vaginally, and is painless. There have been no reported harmful effects on developing eggs or on early pregnancy.
Blood Tests
We also monitor the response to gonadotrophins with blood tests. Developing follicles secrete increasing amounts of the hormone estradiol (E2). Along with ultrasound, E2 levels are used to determine the optimal timing for the administration of hCG which triggers the final maturation of the eggs for ovulation, prior to egg recovery.
Step 2.: Egg Retrieval
Eggs may be recovered by ultrasound-directed procedures, which are performed under narcoleptic analgesia, which is a combination of pain relievers and sedation. Ultrasound allows for accurate aspiration of the egg. We can guide a needle into each follicle and aspirate its contents. The eggs are then transferred to a sterile container to await fertilization. Eggs are recovered via ultrasound-guided aspiration or laparoscopy. Laparoscopy involves placing a telescope into the abdomen through a small incision under the navel. This is done under general anesthesia. Through this telescope with a tiny camera on the end of it, we can observe the uterus tubes and ovaries. The egg along with the surrounding fluid is sucked, through a needle, from the follicle under direct visual control. It is then placed in a sterile test tube. The fluid is immediately examined under a special microscope. The process is then repeated until all the mature follicles have been aspirated.
Step 3: Fertilization
A semen sample is obtained from the male partner and processed using various laboratory techniques to obtain the strongest, most active sperm. This process is called sperm washing with a Swim-up or swim-down procedure.
Once the eggs are retrieved, many prepared sperm are placed with an egg in a laboratory dish and allowed to incubate at body temperature. After approximately 48 to 72 hours, if the eggs have successfully fertilized and are growing normally, they are transferred to the uterus. This is called embryo transfer.
Step 4: Embryo Transfer
Embryo transfer is performed without anesthesia. The embryos are placed in a catheter for transfer into the uterus.
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