Your first visit at our IVF unit will involve a number of medical and non-medical appointments.
These are designed to ensure that all your information is accurate and that all the relevant tests and screening are performed prior to your main treatment.
The following is the sequence of events you should expect on your first visit:
1- Meeting with your patient coordinator: Every couple is assigned a patient coordinator for the duration of their visit. Your meeting with your patient coordinator will involve filling out some forms, an information session about the course of your treatment and signing the consent form for the treatment which you have agreed to receive.
2- Testing and Screening with your IVF Nurse: Once your session has ended, your patient coordinator will take you to your IVF nurse. Your nurse will provide some basic measurements such as height, weight, pulse rate, respiratory rate, blood pressure and blood glucose levels. These are called your “vitals” and are measured as a standard procedure.
3- Seeing Your Doctor: Once your vitals have been taken, the next stop is the doctor’s office. Here, you will speak to your doctor, and your doctor will provide a final ultrasound scan for monitoring.
– If you are using your own eggs during your IVF treatment, the scan will aim to measure the number and the size of follicles (eggs) in your ovaries. Based on this information, your doctor will decide on a suitable time for your “Oocyte Pick-up” also known as “egg retrieval”. After the ultrasound scan, you will be given a time to administer your “trigger injection” which will prepare your eggs for the egg retrieval procedure. Egg retrieval is a procedure performed under sedation and light anesthesia so that the matured eggs can be collected from your ovaries and are prepared for fertilization. On the day of egg retrieval, your partner will provide his sperm sample so that fertilization can take place via the ICSI method where we take each healthy sperm cell and inject it directly into the egg’s zona pellucida to manually fertilize it.
– If you are using donor eggs during your IVF treatment, the scan will aim to measure the thickness of your endometrium lining. Given that you are using an egg donor, your egg donor will undergo the “Egg retrieval” procedure for you so that her eggs can be collected and prepared for fertilization. We will let you know about the day of your donor’s egg retrieval so that your partner can provide his sperm sample so that fertilization can take place via the ICSI method where we take each healthy sperm cell and inject it directly into the egg’s zona pellucida to manually fertilize it.
After your appointment with the doctor, depending on your scan results and depending on your doctor’s assessment, you will be given a second appointment date.
If you are using your own eggs, then you will be required to undergo an egg retrieval procedure where the mature follicles (eggs) can be collected from your ovaries while you are sedated. The egg retrieval procedure will be scheduled once your doctor observes that your follicles have reached a certain level of growth and maturity, which is why you have been using the IVF medication in the first place.
You will be asked to come to your egg retrieval procedure at a certain time (which is about 35.5 hours after the trigger injection which will be administered at a time specified by the doctor). You will need to be on an empty stomach, therefore, it is a good idea to start fasting at midnight before your egg retrieval procedure. Fasting is for food and drinks, therefore, no liquids are allowed during the fasting period.
The egg retrieval procedure itself takes about 15 to 20 minutes, depending on the number of follicles you have. Once the procedure is final, you will be taken into a recovery room and have a bed rest for about 2 hours. After the two hour period, you will be able to go back to your normal daily routine.
Immediately following your egg retrieval, your partner will be asked to provide his sperm sample. We ask for a 3 to 5 days of abstinence before providing a sperm sample as too long or too short of abstinence periods can cause problems with regards to sperm maturity or motility. Sperm sample is provided through manual stimulation (masturbation) in a private sperm collection room.
If you are using donor eggs, then your donor will undergo an egg retrieval procedure where the mature follicles (eggs) can be collected from your donor’s ovaries. The egg retrieval procedure will be scheduled once your doctor observes that your donor’s follicles have reached a certain level of growth and maturity. When your egg donor is ready for her egg retrieval, you will be notified so that you can also come in for an appointment.
Immediately following your donor’s egg retrieval, your partner will be asked to provide his sperm sample. We ask for a 3 to 5 days of abstinence before providing a sperm sample as too long or too short of abstinence periods can cause problems with regards to sperm maturity or motility. Sperm sample is provided through manual stimulation (masturbation) in a private sperm collection room.
Regardless of whether you are using your own eggs or donor eggs, you will need to start using progesterone supplements on the day that eggs have been retrieved. This is approximately on day 15 of your menstrual period. This is also mentioned in your treatment calendar.
Progesterone is a hormone which normally prepares the uterus in order to facilitate embryo implantation once ovulation takes place. However, given that we are manipulating the cycle artificially; your body will not be producing progesterone. Therefore, we will be supplementing you with external progesterone supplementation so that we can help prepare your uterus for a successful implantation.
We use crinone gel 8% as a progesterone supplement. It is a progesterone gel which is applied vaginally with an applicator tip. Your IVF nurse will explain how this gel will be used. However, you can also find more information on this in your welcome pack, which will be handed to you by the clinic’s driver when you are picked up from the airport.
The rest of your medication usage will be in accordance with your treatment calendar unless otherwise specified.
Approximately 2 hours after the egg retrieval procedure, all the follicles that have been collected will be processed in a special enzyme so that the eggs can be removed and stripped away from the rest of the cumulus cells, which will allow the embryologist to grade the quality. Eggs are classified into three quality grades:
MII: This is the mature egg, which is likely to fertilize
MI: Is the immature egg, which rarely fertilizes
Some others can be graded as a germinal vesicle or a degenerate and are discarded. The ultimate goal is to get as many MII quality eggs as possible, of course without hyperstimulating the ovaries. When ovaries are hyperstimulated, the quality of the eggs can decline, therefore, the aim should be to obtain an average number of eggs with high quality rather than many eggs with low quality. You can call your patient coordinator to find out about the number of eggs and their quality gradings.
Approximately 24 hours after the egg retrieval procedure, we will perform our first check on your embryos to observe how many of the eggs have fertilized. You will be able to call your patient coordinator around noon (one day post egg retrieval) to find out about the number of fertilized embryos. You can also stop by the clinic and see your patient coordinator and get this information.
After your or your donor’s egg retrieval procedure, you will be given a date and time for your expected embryo transfer. This is your next official appointment at the clinic. However, you are always welcome to make an appointment with us to come in and ask any questions you may have outside the official appointments.
Should things change and we decide that it will be in your best interest to change the date of your embryo transfer, we will notify you accordingly and let you know why it would be a good idea to change the date of your embryo transfer. This is usually based on embryo growth progress or your endometrial thickness.
Before you come in for the embryo transfer procedure, you can have a very light breakfast, but we prefer that you are not on a full stomach. You will, however, need to have a full bladder, therefore, prior to the embryo transfer procedure, you will see the doctor for a final assessment and will be asked to drink fluids for a certain period of time until your bladder is ready for the embryo transfer.
Embryo transfer does not require sedation. You will rest for a little while and then go back to your normal routine. You will be given a separate document on things to do and things to avoid following your embryo transfer in order to maximize your chances of success.
Please Contact us for more information!