Stage 1: Preparation stage
1. Patients who intend to undergo IVF should not have intercourse after menstruation and go to the Reproductive Medicine Center of Guizhou Provincial People’s Hospital (No. 52, Shi Dong Road, Guiyang City) (Monday to Friday) to complete various examinations.
Female examination items: Tan Zongjian, Reproductive Center, Guizhou Provincial People’s Hospital
(1) Iodine oil imaging of the uterine tubes and, if necessary, laparoscopy or hysteroscopy (all in 3-7 days after menstruation, no intercourse before the examination).
(2) Infertility immunological examination: including anti-sperm antibodies, anti-endometrial antibodies, anti-cardiolipin antibodies.
(3) Chromosome (patients with a history of recurrent miscarriage, fetal malformation, stillbirth, etc. should have this test).
(4) Basal endocrine tests including E2, P, FSH, LH, T, PRL, drawn on an empty stomach on the second or third day of menstruation.
(5) Torch: including rubella virus, toxoplasmosis, herpes virus, cytomegalovirus screening.
(6) CT of cervical secretions, UU i.e. (Chlamydia, Mycoplasma) screening.
(7) Routine leucorrhoea.
(8) Infectious disease screening: including hepatitis B, hepatitis C, AIDS, syphilis screening.
(9) Blood and urine routine, coagulation function (PT, APTT), liver and kidney function, fasting blood sugar, electrocardiogram, chest X-ray.
Note: Sex hormone complete set, liver and kidney function, fasting blood glucose for fasting blood.
Male side examination items:
(1) Semen routine analysis, anti-sperm antibodies, sperm acrosome reaction, morphological examination (abstain from intercourse for 2-7 days before examination).
(2) Chromosomal (for patients with severe oligospermia and azoospermia, and for patients with a history of recurrent miscarriage, fetal malformation, stillbirth, etc.).
(3) Infectious diseases: including hepatitis B, hepatitis C, AIDS, syphilis screening.
(4) Blood group.
(5) Prostate fluid CT, UU, gonococcal.
2. If there are any problems with the above test results, treatment and rehabilitation are required before proceeding to the next stage.
3. Prepare documents for both parties (including ID card, marriage certificate, family planning certificate within validity, such as birth certificate) and prepare copies for the hospital to keep. Leave your phone number to keep in touch at all times.
Stage 2: Ovulation promotion stage
1. It lasts about 20 days. Both parties pay attention to rest, nutrition and hygiene, and abstain from intercourse.
2. The treatment program is divided into two types: the long program starts one week before menstruation and the short program starts on the second or third day of menstruation. The doctor will check the original ID card, marriage certificate and family planning certificate and collect a copy.
3. For patients using the long regimen, please contact your doctor as soon as your menstruation starts or if your menstruation does not start 10 days after the start of the regimen.
4. Come to the hospital for follicle monitoring (vaginal ultrasound) and blood test for hormone level after the start of the medication, the doctor will adjust the ovulation medication according to the follicle growth.
5. The follicles are usually mature by day 12-14 of the cycle and the ovulatory medication is stopped once the follicles are mature.
6. The husband should masturbate once at the appropriate time (usually 2-7 days before the expected egg retrieval).
Stage 3: Egg retrieval and transfer
Please arrive at the hospital on time on the day of egg retrieval, as spontaneous ovulation may occur after the doctor’s appointment, resulting in fewer or no eggs being retrieved. You may experience pain and discomfort during the egg retrieval, and you will be given the appropriate amount of sedative and pain medication. It is best to take a shower beforehand, but no perfume, lipstick or other cosmetics should be used.
2. On the day of the egg retrieval, the husband should bring his ID card, marriage certificate and valid birth certificate to the hospital for verification.
3. If the eggs can be fertilized and split into embryos ready for transfer, the embryos will be returned to the uterine cavity on the third day after egg retrieval. Patients undergoing blastocyst stage transfer will be transferred 5-6 days after egg retrieval. On the day of the transfer, the bladder is filled with moderate amounts of water, bed rest for 2 hours, activity is restricted for 24 hours, and sexual intercourse is avoided for half a month. Post-transplantation intramuscular injection of progesterone/ or HCG for fetal preservation.
4. 2 weeks after transplantation, keep morning urine or draw blood for pregnancy test. If positive, conception is successful. Ultrasound will be performed 4-5 weeks after transplantation to understand the fetal condition. Continue to keep the fetus until 10-12 weeks after transplantation; if the blood HCG test is negative, the embryo has not been implanted, stop the medication and wait for the menstrual flow.
5. Precautions.
During and after the implementation of this technique, there are several situations that may occur, please understand in detail:
(1) The current clinical pregnancy rate is about 40%, and the fee will not be refunded regardless of success or failure. Please be prepared for this.
(2) Cancellation of the cycle due to poor ovarian response to superovulation medication (less than 3 follicles in total bilaterally).
(3) Failure to retrieve eggs due to pelvic adhesions, high ovarian motility or empty follicles.
(4) No embryo implantation due to inability to fertilize the eggs or poor quality of embryos due to non-division after fertilization
(5) The ovarian hyperstimulation syndrome occurs when there are many follicles, mainly manifesting as abdominal distention, and in severe cases, ascites and pleural fluid, requiring hospitalization and cancellation of the cycle if necessary.
(6) The risk of miscarriage, ectopic pregnancy, preterm delivery, fetal malformation and other abnormalities after pregnancy is the same as that of natural conception.
(7) In case of multiple pregnancies (3 or more), selective reduction is required.
(8) The remaining embryos in the cycle can be cryopreserved. The success rate of transferring frozen embryos after thawing is about 20%. There is a very small risk of bleeding, allergy, infection, and shock during and after the egg-piercing procedure.