Timeline For IVF Treatment

The timeline for IVF treatment usually goes something like this:

• Ovary stimulation. For eight to 14 days near the beginning of your menstrual cycle, you take a gonadotropin, a type of fertility drug that stimulates your ovaries to develop multiple mature eggs for fertilization (instead of just one). You also need to take a synthetic hormone like leuprolide or cetrorelix to keep your body from releasing the eggs too early.
• Follicle development. While taking these medications, you visit your doctor's office or clinic every two to three days to have your blood hormone levels checked and ultrasound measurements of your ovaries done. This allows your healthcare provider to monitor development of the follicles – the fluid-filled sacs where eggs mature.
• The trigger shot. When the follicles are ready, you get a "trigger shot," an injection that causes the eggs to mature fully and become capable of being fertilized. About 36 hours after your trigger shot, your eggs are ready to be retrieved.
• Gathering the eggs. Your doctor gives you an anesthetic and inserts anultrasound probe through your vagina to look at your ovaries and identify the follicles. A thin needle is then inserted through the vaginal wall to remove the eggs from the follicles. Eight to 15 eggs are usually retrieved. You may have some cramping and spotting for a few days afterward, but most women feel better in a day or two.
• Fertilization. An embryologist www.pfrcivf.com (a scientist who specializes in eggs, sperm, and embryos) will examine your eggs before combining them with your partner's sperm and incubating them overnight. Fertilization usually happens during this time, but eggs that aren't normal may not be fertilized. (If sperm quality is poor, or if fertilization was unsuccessful during previous IVF cycles, your doctor may recommend using a technique called intracytoplasmic sperm injection (ICSI). With ICSI, a single sperm is injected directly into each mature egg.)
• Developing embryos. Three days after the egg retrieval, some of the eggs that were successfully fertilized become six- to 10-celled embryos. By the fifth day, some of these embryos will become blastocysts with a fluid-filled cavity and tissues that are beginning to separate into placenta and baby.
• Embryo selection. The embryologist selects the most viable embryo or embryos to place in your uterus three to five days after the egg retrieval. Extra embryos, www.pfrcivf.com if there are any, may be frozen and used for future IVF cycles.
• Planting the embryos. Depending on your age and diagnosis, your doctor places between one and five embryos in your uterus by inserting a thin tube (a catheter) through your cervix. You might feel some mild cramping, but you won't need anesthesia.
• Successful implantation. If the treatment works, an embryo implants in your uterine wall and continues to grow into a baby. Keep in mind that if more than one embryo is transferred, your chance of pregnancy is higher, but so are the odds of having a multiple pregnancy – about 20 percent of babies born through IVF aretwins, triplets, or more.

You can take a pregnancy test about two weeks after the embryos are placed in your uterus.

Diabetology

40% of our population are diabetic.
Among pregnant patients women over 35 have a higher risk of diabetes.
Patients undergoing IVF (Test Tube Baby) are at higher risk.
If undetected, diabetes can result in abnormal babies and miscarriages.
Ideal is to control it before planning pregnancy.
During pregnancy if not controlled can lead to preterm delivery, big babies, stillbirths and death immediately after delivery.
Pre Pregnancy counseling, dietary advice, maintaining normal blood glucose levels with insulin, checking on the function of the kidneys is very important to prevent complications.

During delivery maintaining levels is important to prevent problems to mother and baby. After birth babies can have low blood sugar. To maintain sugar levels observation in the neonatal intensive care unit is a must.
In conclusion, a multidisciplinary approach by the obstetrician, diabetologist and neonatal care specialist is ideal.

ONCOLOGY

Oncology is the branch of medicine that studies tumors (cancer). The oncologist often coordinates the multidisciplinary care of cancer patients, which may involve physiotherapy, counseling, clinical genetics, to name but a few. An oncologist often has to liaise with pathologists on the exact biological nature of the tumor that is being treated.

Oncology is concerned with:

• The diagnosis of cancer
• Therapy (e.g., surgery, chemotherapy, radiotherapy and other modalities)
• Follow-up of cancer patients after successful treatment
• Palliative care of patients with terminal malignancies
• Ethical questions surrounding cancer care
• Screening efforts:
o of populations, or
o of the relatives of patients (in types of cancer that are thought to have a hereditary basis, such as breast cancer).

There are several sub-specialties within oncology. Moreover, oncologists often develop an interest and expertise in the management of particular types of cancer.
Oncologists may be divided on the basis of the type of treatment provided or whether their role is primarily diagnostic.

• Radiology: localize, stage and often perform image-guided biopsy in order to obtain the tissue for preliminary diagnosis.
• Anatomical pathology: render the final diagnosis and prognosis of cancer, in order to guide treatment by oncologists.
• Radiation oncology: treatment primarily with radiation, a process called radiotherapy.
• Surgical oncology: surgeons who specialize in tumor removal.
• Medical oncology: treatment primarily with drugs, that is, pharmacotherapy, which includes chemotherapy, hormonal therapy, and targeted therapy.
• Gynecologic oncology: focuses on cancers of the female reproductive system.
• Pediatric oncology: concerned with the treatment of cancer in children

Intra-cytoplasmic sperm injection ( ICSI )

Intra-cytoplasmic sperm injection, commonly referred to as ICSI, is a well-established microinjection technique, which has resulted in additional options for patients in the treatment of their infertility. ICSI involves the insertion of a single selected sperm directly into the cytoplasm of a mature egg, bypassing all the preliminary steps of sperm binding.  

This procedure overcomes many barriers to fertilisation which can include failed fertilisation from repeated use of conventional IVF, severe male factor infertility, very low sperm counts and/or motility, high number of morphologically abnormal sperm, utilisation of surgically retrieved sperm, use of frozen sperm when limited in number and quality.

The first human pregnancy with ICSI was reported in 1992 and since this time thousands of babies have been born as a result of the ICSI procedure, providing many couples with hope previously not available.

ICSI enables fertilisation to happen when there are very few sperm available.

Your clinic may recommend ICSI if:

• you have a very low sperm count
• other problems with the sperm have been identified, such as poor morphology (abnormal shape) or poor motility (not moving normally)
• during previous attempts at IVF there was failure of fertilisation or an unexpectedly low fertilisation rate
• you need sperm to be collected surgically from the testicles or epididymis (a narrow tube inside the scrotum, where sperm are stored and matured); for example because you have had a vasectomy, you do not ejaculate sperm, or because you have extremely low sperm production
• you are using frozen sperm in your treatment which is not of optimum quality
• you are using embryo testing.