The ART Procedure
How to Begin an IVF Cycle?
An IVF patient should call advanced fertility services on day 1 or 2 of her period. A nurse or a doctor will relay instructions as to when to come to the office for the first IVF visit and at which time she will receive instructions regarding her specific treatment plan. The second visit of protocol treatment is started on day 20thof the menstrual cycle.
IVF Medications
Each patient's medication plan is individualised, but most IVF regimens include one or more of the following
Lupride / Triplog / Suprifact
Lupride is used to help create equally mature eggs. Some statistics indicate that these drugs Lupride / Triplog / Suprifact may be associated with higher success rates and lower IVF cycle cancellation rates. Lupride is usually started on Day 21 of the patient's previous cycle and is injected subcutaneously (under the skin). However, in some instances, Lupride may be started on cycle Day 2.
Pergonal / Humog
HMG (Human Menopausal Gonadotropin), which consists of 75 units of FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone), is administered by intramuscular (into the muscle) injection and is usually given in the evening or morning. Some of the patients will receive pure FSH or Recombinant FSH.
Recombinant FSH (no trade name as of yet)
This ultra-pure FSH product, currently available in India, is made by genetic engineering. From a treatment point of view, it will be similar to pure FSH in all respects.
A KIC staff member will teach the patient and her partner to reconstitute the different medications and administer the injections at their places from a doctor, if the patient is from out of station. Most of the patients and their partners have little trouble getting used to the shots. Placing an ice pack on the injection site before and after the injection is given, will help reduce any related discomfort.
Patients must have their visit between 10:00 AM to 4:30 PM on weekdays and from 11:00 AM to 12:30 AM on Sundays to ensure consultation with the infertility specialist.
Patient Monitoring
Patients are usually asked to come in to KIC for blood tests and sonograms to determine the maturity of their developing eggs beginning on cycle Day 3, 5, 7 or 9. Further monitoring will be carried out as needed until the eggs are determined to be mature. Occasionally, some patients will need to be monitored on a daily basis near the end of the ovarian stimulation phase of the cycle.
Blood Tests
Patients usually receive 2 or 3 blood tests during the course of the monitoring process: estradiol (estrogen) and progesterone. Estradiol allows us to approximate the relative maturity of the eggs. Generally, the tests will show between 100 and 200 units of estrogen for every matured egg. Progesterone tells us if the eggs are becoming overripe, the patient's progesterone level, which depends on the number of egg follicles created, should be below 2 units.
Sonograms
The maturity of the follicles developing in the ovaries is monitored via vaginal ultrasound. During this painless procedure, a sonographer inserts a small probe into the vagina. This enables her to visualise the ovaries and the uterus, to evaluate the maturity of the endometrium (the inner lining of the uterus), and to count and measure the follicles developing in each ovary. A mature follicle measures from 16 to 22 millimeters. An Advance technology of colour Doppler study is used at KIC to monitor the blood in the follicle and endometrium.
The Final Step to Egg Maturation
When blood tests and sonograms indicate that the eggs are mature, the patient will be instructed to administer a final injection called HCG (Pregnyl, Profasi) to complete the maturation of the egg. The HCG shot must be taken at KIC, Hyderabad between 9:30 PM and 11:00 PM on the date specified, and the retrieval will be scheduled for some 30-34 hours after the HCG injection. For example, if a patient's Monday monitoring showed her follicles to be of the appropriate size and her estrogen levels were found to correlate with maturity, she would be instructed to take her HCG between 9:00 PM and 11:00 PM Monday evening. Her egg retrieval will then be performed on Wednesday morning.
The timing of the retrieval after the HCG injection is critical, since HCG may cause the egg follicles to release prematurely, making IVF retrieval impossible. Fortunately, this rarely happens.
Before the Procedure
The patient will be instructed not to eat solid foods after the midnight, prior to the procedure. It is advisable to abstain from sexual activity for two days prior to the procedure to ensure the highest possible sperm count from the male.
What are the chances of success with IVF?
Here at Kiran Infertility Centre (P) Ltd, the overall delivery rate per egg retrieval in 1999 is 28%. Now with the advent of new drugs & protocols, the clinical pregnancy rate per egg retrieval for 2000-01 was 33.1%. Our ongoing pregnancy rate for 2002-03 is 35.5%. The specific chance of success varies with a number of factors including the indication for the procedure, the patient's age, the number of embryos transferred and a variety of other factors. Your chances of success with IVF will be discussed on an individual basis with your physician. The success rate with IVF must be viewed considering the normal fertility rate in fertile couples that is approximately 20% per month.
We advice you to undergo a package of atleast 3 cycle, so that finally we can ensure you atleast 85-90% success rate. Appropriate concessions are given in the financial aspect of treatment if you undertake this type of package. | 
