We discuss the course of your treatment during your first talk with the gynecologist, who together with you will plan when to start hormone stimulation so it can fit in with your plans concerning ovum pick-up and replacement. During hormone stimulation the woman must be scanned so as to monitor the development of the ovum, and the hormone stimulation can be adjusted. If you do not live near Vitanova you can be checked by your own gynecologist. It is very important that either you or your gynecologist is in contact with us, so that we can see whether the ovum develops as it should.
Partner sperm or donor sperm
If the partner’s sperm is to be used to fertilize the ovum we already know in good time whether his sperm is of good enough quality for in vitro fertilization or whether ICSI must be used. ICSI is a method whereby the bioanalyst injects the sperm cell directly into the ovum. This method is commonly used with low quality sperm.
If the first examination of the sperm quality shows that it may be inadvisable to use it, we will discuss the possibility of using donor sperm during our initial conversation with you. Sperm quality can fluctuate and it may be difficult to determine whether it is good enough for fertilization. For this reason it is important that before starting treatment you are willing to use donor sperm if the partner’s sperm cannot be used. It is unpleasant to have to make this decision on the day of ovum pick-up and it turns out that the partner’s sperm cannot be used, and donor sperm is the alternative. We will of course discuss this with you before fertilizing the ovum with donor sperm. The decision lies ultimately in your hands.
Ovum pick-up, aspiration, the woman
When a suitable number of follicles have formed, an ovulation stimulation injection is given and ovum extraction normally takes place 36 hours later. During ovum pick-up it is possible for the nurse to administer a painkiller through a hypodermic in the arm. A local anesthetic is also given in the vagina to make the process as pain free as possible. Many women feel almost nothing whilst others experience discomfort or pain. The nurse can administer further painkillers during the process, which can cause drowsiness though the patient is awake the whole time.
The gynecologist scans the ovaries and inserts a thin needle via the vagina into the ovaries. The ovum is then sucked out, the whole process taking 15 – 20 minutes. It is now possible to go into the rest room and relax during the half hour or so it takes for the anesthetic to wear off. A feeling of lethargy and being dazed might persist for the rest of the day.
Most women have a slight ache, feel puffed up in the abdomen or have a slight pain in the small of the back, but this is quite normal.
We recommend resting for the rest of the day and driving a car is not acceptable due to the influence of the painkillers given during the extraction. A normal life can be led in the days following.
Ovum pick-up, aspiration, the man
If the ova are to be fertilized with your sperm, you must be at the clinic very early in the morning to deliver the sperm on the day of ovum pick-up. You can make the sperm sample at the clinic or at home and then come to the clinic with it. It must not be more than one hour old when we receive it. During transport the sperm glass must be held close to the body so the sample can retain body heat, but no more.
As to obtain the best possible sample it is important that you have not had an ejaculation during the 3 days leading up to ovum pick-up. Sperm cells can become too old if they remain too long in the testicles, so it is advisable to have an ejaculation on the 4th day before pick-up and none on the following three days.
Embryo replacement, transfer
After pick-up the ova are fertilized in the laboratory. The bioanalyst adds the sperm cells to the ovum or injects one sperm cell into each ovum. This method is called ICSI or micro insemination. ICSI can be used if there are only a few good sperm cells in the sample. The ova and sperm cells remain in a warming cabinet until the following morning when we can see how many ova have been fertilized. We monitor the ova regularly through a microscope until they are replaced in the uterus again. This is done 2 days after extraction.
One or two fertilized ova are normally replaced in the uterus. Ovum replacement or transfer is carried out as an insemination. We place a thin catheter into the uterus and the fertilized ovum is injected. This only takes a few minutes, and afterwards life can be lived as normal. The ova cannot come out of the uterus again, and the vagina is treated with a hormone stimulating cream for the next 14 days.
A pregnancy test is made 14 days after an embryo transfer. The urine test can be made at home. If it is positive, a further test must be made either by us or by your own doctor. You must inform us of the result whether it is positive or negative.
We would like to do a pregnancy scan about three weeks later, during the 8th week of pregnancy. The scan can also be carried out by your own gynecologist, but we would like you to fax or mail the result to us. The next menstruation can be delayed relative to the usual cycle, and it is very important that we are in contact with you whether you are pregnant or not, so we can plan the next steps to take.