What procedures are required for IVF?

Patient's question:

"Enter line return does not need to be translated, return as it is, all other Chinese should be translated into English: No sperm 2007

Doctor's answer:

Controlled Ovulation Induction: Due to the variability in the length of natural menstrual cycles among individuals, and differences in cycles within the same patient, it is difficult to schedule oocyte retrieval. Additionally, in a natural cycle, only one dominant follicle develops, leading to the formation of only one embryo after fertilization, with a low pregnancy rate upon transferring a single embryo. Therefore, controlled ovarian hyperstimulation is required to enhance and improve ovarian function, allowing for the retrieval of multiple healthy oocytes without the constraints of the natural cycle. This facilitates the transfer of multiple embryos and ensures synchronization between luteal development and endometrial function.
Controlled ovarian hyperstimulation typically begins with the administration of a GnRH agonist to suppress endogenous FSH and LH, followed by the use of HMG or FSH for ovulation induction to stimulate follicular growth in the ovaries. The dosage of medication is adjusted based on the patient's response to the treatment. The number of retrieved oocytes varies depending on the patient's age and the dosage of medication used.
Follicular Monitoring: To evaluate the effectiveness of ovarian stimulation and determine the optimal time for oocyte retrieval, transvaginal ultrasound is used to monitor follicular size, accompanied by blood tests to measure estradiol (E2) levels. Medication dosage is adjusted accordingly. When two or more follicles are greater than 1.8 cm in diameter, and the number of follicles greater than 1.4 cm is proportional to the E2 level, human chorionic gonadotropin (hCG) is administered to promote follicular maturation. Oocyte retrieval is performed 34–36 hours after hCG injection.
Oocyte Retrieval: The most common method involves local anesthesia, followed by transvaginal ultrasound-guided aspiration of oocytes using an oocyte retrieval needle inserted through the vaginal fornix into the ovary. The retrieved oocytes are immediately transferred to a petri dish containing embryo culture medium and placed in a 37°C incubator for culture.
Sperm Retrieval: Sperm collection is performed on the same day as oocyte retrieval. Before collection, the hands are washed, and sperm is obtained through masturbation. The provided cup is sterile, and care should be taken not to touch the rim or the inside of the cup. The collected sperm is processed using the swim-up method or Percoll density gradient centrifugation.
In Vitro Fertilization (IVF): Four to five hours after oocyte retrieval, the processed sperm and oocytes are placed in the same petri dish and co-cultured for 18 hours. Fertilization is then observed under a microscope. If the sperm quality is poor and natural fertilization is not possible, intracytoplasmic sperm injection (ICSI) must be performed (see Intracytoplasmic Sperm Injection).
Embryo Transfer: Fertilized oocytes develop to the 8–16-cell stage in vitro within 48–72 hours. At this stage, the number of embryos to be transferred is determined based on the patient's age, previous pregnancy history, and embryo quality. Excess embryos can be cryopreserved. Embryo transfer generally does not require anesthesia. Currently, most transfers occur 2–3 days after fertilization, while my clinic typically transfers embryos 3–5 days after fertilization. Delaying embryo transfer increases the requirements for in vitro culture conditions, but it aligns better with physiological pregnancy and allows for natural selection to eliminate inferior embryos, thereby improving pregnancy rates and reducing the risk of multiple pregnancies.
Hormonal Support After Embryo Transfer: Currently, we primarily use intravenous progesterone to support the corpus luteum. If pregnancy is confirmed, hCG is administered to continue hormonal support until the 10th week of pregnancy.
Pregnancy Confirmation: Fourteen days after embryo transfer, pregnancy can be confirmed through a urine test or blood draw.