Step 1: Control Ovarian Hyperstimulation (COH)

Control Ovarian Hyperstimulation (COH) is a critical initial step in the IVF in Zirakpur, designed to stimulate the ovaries to produce multiple eggs. The GnRH Antagonist protocol is commonly used for COH, where GnRH antagonists are administered to prevent premature ovulation by suppressing gonadotropin hormone release. After achieving this suppression, the ovaries are stimulated with gonadotropins to encourage follicle growth. Throughout this phase, ultrasound imaging and hormone tests are employed to monitor follicular development. Once the leading follicles reach the appropriate size, HCG is administered to complete egg maturation. Egg retrieval is then scheduled to occur 34 to 36 hours after the HCG injection. At Carewell 360, we meticulously manage each step of this process to optimize the chances of a successful IVF in Zirakpur.

Step 2: Egg Retrieval

Egg retrieval is performed in a surgical room under intravenous sedation. Ovarian follicles are extracted with a needle guided by trans-vaginal ultrasonography. An embryologist then scans the follicular fluids to identify all available eggs. The eggs are placed in a specially prepared medium and incubated until fertilization.

Step 3: Fertilization and Embryo Culture

If sperm parameters are normal, 100,000 to 50,000 motile sperm will be transferred to the dish containing the eggs, a process known as normal insemination.

The ICSI (Intracytoplasmic Sperm Injection) method is used for fertilizing mature eggs when sperm parameters are suboptimal. This procedure is carried out using a powerful microscope. The embryologist collects spermatozoa with an ultrafine glass needle and injects it directly into the egg’s cell. ICSI can increase the likelihood of fertilization when sperm count is low, morphology is poor, motility is inadequate, or development is suboptimal. If no sperm is present in the ejaculate, sperm can be obtained through surgical extraction. ICSI is the only method available when sperm is extracted surgically.

Fertilization is assessed 16 to 18 hours following insemination or ICSI. Fertilized eggs, referred to as zygotes, are cultivated in a specially designed medium that supports their growth. They are analyzed on the second or third day following retrieval. If sufficient embryos show excellent progress, they may be selected to advance to the blastocyst stage in a specially designed culture medium. Blastocyst culture offers several benefits. Early embryos are more likely to implant, so fewer embryos are transferred on the fifth day to reduce the risk of multiple births. If there are few embryos or their quality is poor, day 3 transfer is recommended for cycles with limited numbers or poor-quality embryos.

Step 4: Embryo Quality

Embryo quality is assessed using various criteria, which are crucial for selecting the best embryos for transfer. On the morning of the transfer day, embryos are inspected and photographed by an embryologist. Based on the embryos’ development and appearance, the embryologist and physician will decide how many embryos to transfer.

Embryos are typically transferred at either the cleavage stage (day 3 post-egg retrieval) or the blastocyst stage (day 5). In the laboratory, a grading system is used to assess embryo quality.

Day 3 Transfers

Day 3 embryos, also known as cleavage-stage embryos, contain about 4-8 cells. When analyzing these embryos, factors such as cell number, symmetry, and fragmentation are considered. Fragmentation occurs when cells divide unevenly, resulting in cell-like structures around the embryo. Some fragmentation is acceptable, but excessive fragmentation is not. In our laboratory, embryos are graded from 1 to 4, with Grade 1 being the highest quality.

Day 5 Transfers

Day 5 embryos, known as blastocysts, are more mature and larger, with a fluid-filled cavity. The embryos are graded on a scale from 1 to 6, with Grade 6 being the highest quality. Larger and more expanded embryos are generally in better condition.

Step 5: Embryo Transfer

Embryos can be transferred on day 3 (cleavage stage) or day 5 (blastocyst stage). The transfer procedure is straightforward and does not require anesthesia. The embryos are placed in a catheter, which is inserted into the uterine cavity through the cervix under ultrasound guidance.

Additional IVF in Zirakpur Procedures

Laser Assisted Hatching

Before implantation, the embryo must hatch from its outer shell (zona pellucida). In some cases, the zona pellucida may be unusually thick. Laser-assisted hatching creates a small gap in the zona pellucida to facilitate the embryo’s escape and implantation. This procedure is used before embryo transfer and during trophectoderm biopsies. Assisted hatching is recommended for patients over 37 years old, those with low ovarian reserve as assessed by FSH levels or small antral follicle counts, or patients who do not respond to gonadotropin stimulation or have previously failed IVF treatments. Studies show that assisted hatching can improve IVF success rates for both fresh and frozen embryo transfers.

Cryopreservation

Cryopreservation (freezing) of embryos is an option for patients with surplus high-quality embryos after transfer. Embryos can be frozen at the zygote stage (the day after egg retrieval) or at the blastocyst stage (day 5 or 6).

Microsurgical Epididymal Sperm Aspiration (MESA) or Testicular Sperm Extraction (TESE)

In cases where semen samples lack spermatozoa due to obstructions or primary testicular failure, sperm can be collected surgically from the epididymis (MESA) or testis (TESE). The collected sperm is then frozen for fertilization through ICSI.

Embryo Biopsy and Preimplantation Genetic Testing (PGT)

PGT is performed as part of IVF to detect genetic abnormalities or inherited genetic diseases in embryos before implantation, minimizing the transfer of affected embryos.

Preimplantation Genetic Testing – Aneuploidy (PGT-A)

Human cells contain 46 chromosomes, with each parent contributing 23. Errors in chromosome number result in aneuploidy, which can lead to conditions like Down’s syndrome (trisomy 21), trisomy 13, trisomy 18, or Klinefelter’s Syndrome (XXY). PGT-A is recommended for patients with a history of repeated miscarriages, older maternal age (≥38 years), repeated IVF failures despite high-quality embryos, unexplained infertility, severe male-factor infertility, or genetic diseases. Over 1000 gene-specific mutations have been identified.

Procedure

PGT involves removing cells from the trophectoderm layer on days 5-7 of embryo development, known as an embryo biopsy. The cells are analyzed by Cooper Genomics or Ingenomix, and the embryo is vitrified. When results are available, normal embryos can be transferred.

Benefits of PGT

PGT helps prevent the transmission of single gene mutations to offspring and reduces the risk of miscarriages by screening for aneuploidy. It also helps select embryos that are more likely to implant and lowers the likelihood of detecting abnormal fetal development later in pregnancy. PGT is beneficial for patients with multiple IVF failures and those with known genetic translocations.

Risks

There are some risks associated with micromanipulation procedures, but they are generally minimal. Trophectoderm biopsy requires embryos to develop to the blastocyst stage, which may not always occur. Additionally, results from genetic testing may not always be clear.

Conclusion

Understanding the step-by-step IVF procedures–from control ovarian hyperstimulation to embryo transfer and additional techniques like laser-assisted hatching and cryopreservation–can provide valuable insights into the complexity of the IVF process. Couples and individuals looking for the highest quality care and best chance of success, choosing the best clinic is vital. When you’re looking for the highest-quality IVF treatments, think about the best IVF in Zirakpur with experienced experts and the latest technology working together to assist you in your journey towards the birth of your child. Picking a clinic with an impressive track performance and customized treatment can be the key to achieving the fertility objectives you have set.