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IVF (In-vitro Fertilization)

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NEOM Medical Hub Building (formerly Porto Cairo Medical) - Sadat Axis - in front of Gate 10 Police Academy - First Settlement - New Cairo

IVF (In-vitro Fertilization)

Steps:

  1. Controlled ovarian stimulation
  2. Oocyte retrieval and semen preparation
  3. IVF
  4. Check Fertilization
  5. Check embryo cleavage
  6. Extended culture, if possible
  7. Luteal support
  8. Pregnancy test
  9. Clinical pregnancy

1- COS

The two most commonly used protocols in the world are

  1. Midluteal long protocol
  2. Antagonist protocol

The choice of protocol for IVF is variable from one patient to the other. In Rahem Fertility center, we tailor the optimal stimulation protocol, according to age, ovarian reserve, BMI and previous response. Our early study (published in the journal of American Society of Reproductive Medicine) about anti-mullerian hormone (AMH) was among the earliest studies in the world reporting the superior advantage of this hormone for early and accurate prediction of OR.

  • We strictly follow our patients using transvaginal ultrasound and estradiol levels during COS

– When follicles mature, we trigger ovulation.

 2- Oocyte retrieval and semen preparation: On retrieval day, semen sample is taken from husband (fresh and/or frozen) and prepared to take the best sperm.

3-In vitro fertilization (IVF): The oocytes and sperm are put together with very special concentrations and incubated in the best environment in special triple gas incubators

4- Check Fertilization: After 16 – 18 hours, we check Fertilization (evidenced by appearance of 2 PN and 2nd polar body)

Check

5- Check embryo cleavage : on 2nd to 3rd day to check embryo quality

6- Extended culture: if we have 3 good quality embryos on day 2-3, we consider extended culture to day 5. We donot extend culture if we donot have these criteria. The latest high quality evidence (Cochrane review 2013) report increase cancellation of embryo transfer if we do extended culture for all patients irrespective the quality of cleavage embryos.

7- Luteal support: we start on day of retrieval for 15 days

8- Pregnancy test: 15 days after embryo transfer

9- Clinical pregnancy: we diagnose that with appearance of cardiac pulsations 2 weeks after positive pregnancy test

Related services

For patients who will take drugs that may affect their fertility ( eg. Chemotherapy for cancer) sperm freezing and oocyte vitrification can help them to preserve their fertility.

This is a trans-vaginal procedure, in which the telescope (attached to camera) is passed into uterus. This helps to evaluate uterine cavity. It is of special importance to deal with the following lesions using hysteroscopy

Azoospermia may be due to poor production of sperm, a problem in transport of sperm, or a problem with the ejaculatory process. TESA (testicular sperm aspiration) and TESE (testicular sperm extraction) are indicated when normal motile spermatozoa cannot be produced

This is the best modality of embryo freezing. All studies report better survival and higher pregnancy rates with vitrification than standard slow freezing. By this procedure, couples who have ICSI or IVF can increase their chances of having a child and also decrease the cost they bear.

Intra-Uterine Insemination (IUI) and ovarian stimulation with exogenous hormones is the alternative with the highest probability of pregnancy. The form of AI will be influenced by the effective sperm count, ovarian stimulation and deposition of sperm in the female reproductive tract.

Cases with known chromosomal or genetic defects will benefit from PGD. Cases who have multiple previous failed ICSI trials or who experienced recurrent pregnancy losses due to chromosomal defects may have benefit from PGS with selection of the chromosomally normal embryo(s) for transfer

By  this procedure one cell of the embryo produced  after ICSI or IVF   is taken and examined for the type of sex chromosome ( either xx or xy) and this is beneficial to select the embryo the couples wish to have.

For couples who are candidate for ICSI the husband may not get a semen sample on the day of oocyte aspiration due to anxiety  or get a sample of very poor quality .