Oral or injectable ovulation medications are started on day 3of the menstrual cycle and tracking of ovarian follicle size and endometrial thickness by vaginal ultrasound are started on or about day 10 of the menstrual cycle. When follicle size is about 18-20mm, human chorionic gonadotropin (HCG) is given to facilitate ovulation. Within 24-36 hours, the husband collects semen and after screening, removal of sperms with poor motility or abnormal shapes, white blood cells, bacteria, and some chemical materials, a concentration of good and active sperms are injected into the uterine cavity through the cervix, allowing the sperms to swim to the egg and achieving fertilization in the “normal course of events”.
The course of treatment is approximately 2-3 weeks with an average pregnancy rate of 15%.
Who is suitable for the IUI treatment?
Mild male infertility
Presence of cervical lesions
Presence of ovulatory dysfunction
Presence of mild endometriosis
If success is not achieved after 2-3 treatment courses, a test tube baby should highly be considered.
In Vitro Fertilization (IVF) refers to the extraction of mature eggs from the ovaries under the guidance of ultrasound, followed by fertilization with pre-treated spermatozoa in petri dishes until the formation of embryos and continued to be cultured in vitro for several days, then depending on personal circumstances, embryos can be transferred into the uterus or cryo-preserved until appropriate conditions when embryos can be thawed and transferred.
Procedure: Blood tests are done on day 2 of the menstrual cycle to aid in the choice of the most suitable medications to stimulate ovulation. While being given medications, ultrasonic and blood tests are used to track follicular maturation; when deemed mature, patient is given human chorionic gonadotropin (HCG) to trigger the final maturation of eggs. After 34-36 hours, ova extraction is done under the guidance of vaginal ultrasound. Two to 5 days after ova extraction, embryo transfer is done and medications are given to assist in implantation. Seven to 9 days after embryo transfer, blood tests are done to check for pregnancy.
There are 3 different courses of treatment to stimulate ovulation: long-acting, short-acting or antagonists. You can discuss with your physician in charge to choose the most appropriate course of treatment to start realizing dreams of parenthood.
Who is suitable for the IVF treatment?
Fallopian tube obstruction
Those with severe endometriosis
Those with severe male infertility
Several failed IUI treatment
Advanced maternal age or early aging of the ovary
2-1) Ultrasound-guided Transvaginal Oocyte Retrieval (TVOR)
The entire process is done aseptically and will be guided by ultrasound to ensure safety and accuracy of egg retrieval. Depending on the number of follicles, the procedure may take 10-30 minutes. After being observed in the recovery room until fully awake and without discomfort patient can go home. During TVOR, an intravenous injection type of anesthesia will be used and the patient will be asked to fast for 6-8 hours prior to the scheduled office procedure. There may be some pain or vaginal bleeding after TVOR, appropriate medications may be used for relief. Patients are advised to keep in touch with us for close follow-up and any associated problems.
2-2) Embryo Transfer
Embryo transfer is done under ultrasound guidance for accuracy and precision of placement and patients are usually requested to drink until the bladder is full before this procedure.
Strict patient identification is confirmed before transfer and embryo is made sure to place back in the uterus. Usually the process of embryo transfer is painless and does not require the use of anesthesia, but the entire process is done aseptically.
After fertilization, the embryo develops until the blastocyst performs zona hatching wherein the zona pellucida degenerates and decomposes so that implantation can occur. If the zona pellucida is too thick or too hard, it will not be conducive to the hatching of the blastocyst and uterine implantation. Our reproductive health center uses laser in the “assisted hatching” technology to make a small hole or slit in the zona pellucida to make it easier for the embryo to hatch out and increasing the implantation rate. Precise lasers do not harm the embryos and this technique can increase the pregnancy rate for those who have many failed IVF attempts or for those more advanced in age.