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Determining the causes of infertility can take time, which may delay the start of treatment. Every course of treatment needs to be planned carefully. In particular, IVF and ICSI cycles require meticulous timing.
It is important to think in the long term to avoid disappointment and frustration.
The IVF cycle consists of several phases, which we will describe in detail. We ensure treatment is tailored to your needs, which is why variations may occur in the process outlined below.
In most cases, treatment starts in the second half of your cycle before stimulation. The administration of a GnRH- Analogue temporarily reduces your body’s production of fertility hormones.
This procedure is known as “down regulation” and allows for a controlled stimulation cycle. Down regulation on the one hand prevents premature ovulation and, on the other, helps us decide on the optimal time for triggering ovulation. This method has been used worldwide for many years and has led to a significant decline in aborted treatment cycles. We also frequently use the oral contraceptive pill for cycle planning, because it prevents cyst formation and helps shut down the ovaries.
The use of GnRH Antagonists is a recent development. Having started on the contraceptive pill, stimulation begins on the 2nd day of your cycle. When the follicles reach a certain size, the antagonist is then injected according to our instructions.
After consultation with your doctor, you should telephone the surgery at the beginning of your cycle to arrange an appointment for down regulation. Down regulation usually starts between the 18th and 23rd day (long protocol) or the first day of menses (antagonist protocol) of your stimulation cycle. Please call at the start of your stimulation cycle, even when there is no bleeding. To monitor the success of your down regulation, it is sometimes necessary to use ultrasound or a hormone test.
A follicle-stimulating hormone (FSH) is used to stimulate the ovaries, which begins on a specified day in the cycle. Hormonal stimulation encourages the growth of several follicles and more eggs are released to maximise the chances of fertilisation.
Stimulation lasts for about 11 to 13 days. During this time we inject a certain amount of hormones. When pure FSH is used, then you or your partner can administer the shots yourself and you don’t have to come in on a daily basis.
The drugs must be injected daily, preferably at the same time. After about 7 days of stimulation, we start monitoring the maturation of follicles by ultrasound, and if necessary also by blood test, to determine the best time for recovering mature egg cells for fertilisation.
Every 10th woman is a so-called „low responder", which means that she only produces one to four follicles despite a high dosage of hormones. The woman's ovarian reserve is therefore poor.
Rather than administering even higher levels of hormones and in vain forcing the ovaries to produce more follicles, it makes more sense to take a step back and try and harvest at least one egg in an unstimulated or lightly stimulated cycle.
This egg is often superior to the fertilising capacity of eggs harvested in high-dosage cycles. Scientific studies have further indicated that the genetic and developmental competence of eggs aspired from spontaneous cycles are improved.
34 to 36 hours later, i.e. two days after the HCG injection, the follicles are usually aspired from the vagina with the help of ultrasound and a fine needle (follicle puncture). To reduce any discomfort, you will receive a small dose of painkillers, a sedative or a weak aesthetic.
Please arrive with an empty stomach (no food or fluids for 6 hours) and bring your partner along to the surgery appointment. We usually carry out this procedure between 8 to 12 am. Your partner will be asked to provide a semen sample obtained by masturbation. It is possible to bring the semen sample along with you, but it should arrive within an hour after collection and transported in a plastic cup provided by us. Should there be difficulties, please tell us. We will find a solution that is acceptable for your partner. After the puncture, you remain in the surgery for an hour before going home. The next day, depending on the fertilisation results, we will call you to arrange an appointment for the embryo transfer.
As soon as we have determined the best time for inducing ovulation, usually between 11 and 13 days of stimulation, FSH treatment is stopped. Injecting a high dose of hCG then triggers ovulation.
The HCG injection is due at a certain time. You will find the exact details in the stimulation plan. If you have any doubts, you can calculate 36 hours back from your egg aspiration appointment to determine the precise time for triggering ovulation.
If you have any questions, please call us asap. The hCG injection is crucial for successful egg retrieval at puncture.
You can administer the injection yourself but make sure you inject the needle deep into the muscle to avoid discomfort.
We will ask the male partner to provide a sperm sample collected by masturbation. It is possible to bring the sample from home, when a quick transport to our clinic can be guaranteed.
Sterile cups for transportation are available in our surgery. In case of any difficulties please talk to us frankly and there will be a solution.
After the follicle aspiration, the egg cells are fertilized by IVF, ICSI or IMSI technique.
The embryos are cultivated in 2 different culture mediums. After 18 hours, the embryologists do the first check under the microscope to see how many oocytes have fertilized. When the embryos arrive at the 8-cell-stage (day 3), either the transfer is done or they are moved into a new culture medium until they grow to blastocysts.
If at least one embryo has matured inside the culture medium, it is transferred into the uterus or fallopian tubes using a thin, flexible catheter.
This procedure is generally quite painless. A maximum of two embryos can be transferred per cycle. The couple decides whether both partners are to be present during the transfer.
The great goal of all IVF clinics is to reduce the amount of twin and particularly triplet pregnancies, as they are high risk. The Australian NHS (National Healthy Service) also expressed particular concern regarding the costs involved and urged IVF clinics to avoid them.
In the early days of IVF, transferring at least two embryos was the norm. This, however, had little effect on pregnancy rates.
Ongoing research and development, on the other hand, has increased pregnancy rates. Improved medication, better knowledge and experience in reproductive medicine and, in particular, improved laboratory culture conditions have enhanced the selection process of embryos before transfer.
The embryo deemed to have the best chances is selected according to developmental and morphological criteria. Blastocyst cultures, which are legal in Austria, improve the selection process.
But it is also important to note that freezing surplus embryos with good morphology is just as likely to lead to a sustainable pregnancy.
If the transfer using a fresh embryo is not successful, it is almost always using a cryo-embryo. The pregnancy rate of fresh and cryopreserved embryos is called "cumulative" pregnancy rate. This rate is comparable with (if not higher) than the pregnancy rate derived from the transfer of two fresh embryos. However, in this case it is likely that both embryos lead to ongoing pregnancies.
The disadvantage of SET is the increased time it takes to get pregnant, as a cryo-cycle is also performed.
But a single pregnancy takes the burden of mother and child reduces the risks associated with multiple pregnancies.
This time can mean a long wait, which is often hard to bear due to the inevitable inner tension and restlessness accompanying treatment.
Even so, you should try to keep calm and carry on life as normal.
You should avoid physical exertion, high temperatures and anything that strains your cardiovascular system, such as sauna visits, hot baths, prolonged sunbathing and extreme sports.