The causes cannot always be found quickly enough for treatment to begin immediately. Each treatment must be carefully planned. Especially the IVF and ICSI treatments require careful scheduling. Therefore you should be thinking in the long term to avoid disappointment and frustration. IVF treatment consists of several phases which we would like to describe below. Each treatment will of course be individually tailored to you. Therefore there may be modifications of the procedures described below.
Preparation phase
In some cases treatment begins with a cycle of taking the pill. Dispensation of a prophylactic in the preparation phase of treatment excludes the possibility of a pregnancy and allows control of the subsequent menstruation. To control the stimulation cycle better, the dispensation of medication – so-called GnRH analogues – reduces the body’s own production of fertility hormones. Possible premature ovulation is prevented. In addition, the ideal time for triggering ovulation can be chosen. To do this, either GnHR agonists are employed from the second half of the menstrual cycle before the actual start of the stimulation, or GnRH antagonists are used during the stimulation cycle proper.
What you must keep in mind
After talking to your general practitioner you should call the office at the beginning of the menstrual cycle. In a down-regulation with GnRH agonists, the stimulation cycle is usually started between the 18th and 23rd day of the pre-menstrual cycle (long protocol) or on the first day of the menstruation (short protocol). To control the success of the down regulation, sometimes an ultrasound test or hormonal assessment is necessary. When GnRH antagonists are used, gonadotrophin stimulation is started right away, and only during the stimulation cycle is the body’s own hormone production suppressed through one-time injection or multiple injections on consecutive days. Please call the office at the beginning of the stimulation cycle, even if there is no menstruation at the expected time.
Stimulation phase
The actual stimulation of the ovaries with a follicle-stimulating hormone (FSH) starts in the first three days of the menstrual cycle (1st day of the cycle = first day of menstruation). By performing the hormonal stimulation we stimulate several follicles to grow, with the goal of obtaining several eggs. This increases the chances of the treatment. Stimulation with gonadotrophins lasts approximately 11 to 13 days, depending on the maturation of the egg. During this time you will receive injections of a certain amount of hormone. If highly pure FSH or biotechnologically produced FSH are used, you or your partner can do this yourself if you wish, in which case you don’t have to see your doctor every day. The same applies to the injection of antagonists.
What you have to keep in mind ...
The medication for the stimulation needs to be injected daily, preferably always at the same time of day. After approximately seven days of stimulation we check the maturation of the egg several times using ultrasound and hormones in the blood to determine the optimum dosage for the egg maturation and the best time for obtaining mature, fertilisable eggs.
Triggering ovulation
As soon as the tests indicate that the best time for triggering the ovulation has come, usually after 11 to 13 days of stimulation, FSH treatment is discontinued. Subsequently ovulation is triggered through hCG injection.
What you have to keep in mind ...
The hCG injection is “due” late at night. You can perform this subcutaneous injection yourself as well or have your partner do it.
Retrieval of eggs
After 34 – 36 hours, i.e. two days after the hCG injection, the follicles are retrieved by way of ultrasound technology and a fine needle through the vagina under slight anaesthesia (follicle puncture).
What you have to keep in mind ...
On the day of the puncture, please arrive punctually at the office at the agreed-upon time together with your partner. Your partner is asked to deliver a sperm sample obtained through masturbation. If there are difficulties here, please talk about them openly with us. We will find a way that is acceptable to your partner. After the puncture you will remain in the office for a few hours and afterwards you can go home. The next day we will arrange a date for the embryo transfer with you over the phone, depending on the result of the fertilisation.
Embryo transfer
If at least embryos have grown in the nutrient medium, they will be transferred into the uter-ine cavity or the intact fallopian tube through a thin, flexible catheter. This transfer is generally painless. A maximum of three embryos are transferred at a time. You should decide together whether your partner is present during the embryo transfer.
Yellow body phase 2 / 2nd half of the menstrual cycle
Now begins the long wait, a time that is often difficult to bear, because it can be full of great inner tension and restlessness. Even if this is difficult, try to be calm and lead a ‘normal life’. Try to be easy on your body and avoid major temperature increases or stress on your circulation; this includes going to the sauna, hot full baths as well as intensive sunbathing and strenuous sport. In terms of drugs, the second half of the menstrual cycle is supported either by hCG injections or progesterone. Two weeks after the embryo transfer a pregnancy test is conducted. If it is positive and you continue not to have your period, two weeks later an ultrasound test will be conducted for clinical confirmation.