1. Ovarian Stimulation and Control
After the first medical appointment, the woman begins to be treated with ovulation-stimulating drugs, administered by subcutaneous injections. These drugs (similar to hormones that are naturally produced in women) will stimulate the ovaries to produce more oocytes than usual.
The development of oocytes is then controlled by periodic ultrasound examinations and blood tests (to assess levels of specific hormones).
When the doctor considers that the follicles are sufficiently developed, they prescribe the injection of another hormone (human chorionic gonadotropin - hCG), whose role is to trigger the release of the oocytes from the ovarian follicles.
At this stage timing has a key role: the oocyte pick-up (retrieving oocytes from the ovaries) should be made 35 to 36 hours after the hCG administration. It is very important that couples adhere strictly to the timings indicated by the gynaecologist for the administration of the injections as a mistake at this stage could jeopardise the whole treatment process.
At Ferticentro we take special care with this phase of the process - our clinical team is in constant touch with patients for 24 hours to ensure that all medicines are administered correctly and patients are reassured throughout the process.
2. Oocyte pickup
The oocyte pick-up is carried out under ultrasound monitoring and involves the introduction into the vagina of a very fine needle that will allow the collection of oocytes from each of the ovaries. This operation is performed under sedation and takes about 15 minutes. From the day of the egg retrieval, the woman starts taking 2 tablets of progesterone every 8 hours, in order to prepare the endometrium for a successful embryo implantation.
On the same day as the oocyte retrieval, the man will be asked to collect sperm in the clinic, so that it can be used in the treatment (although the use of frozen sperm is also possible). Once obtained, the sperm is centrifuged at high speed and subjected to a series of treatment processes in order to select the strongest and more viable spermatozoa.
In situations where it is not possible to produce sperm by masturbation, it may be necessary to perform a testicular biopsy to collect sperm directly from the testicles.
After the oocyte pick-up, the oocytes are treated and transferred to special culture media in the laboratory. Later, each viable and mature oocyte will be microinjected with a single spermatozoon. After this process, the microinjected oocytes are transferred once again into another culture medium to encourage the formation of embryos.
The following day, our embryologists will call you to inform you of the results of fertilisation and also to talk about scheduling the embryo transfer.
3. Embryo Transfer
On the Embryo transfer day (two to five days after fertilization) the embryos (usually two) are transferred into the womb of the woman for implantation and potential pregnancy.
In cases where there are several good quality embryos to transfer or when further embryo analysis is required the transfer may be made on the fifth day. At Ferticentro this extended embryo culture has no additional costs for the couple as it is a technical decision based on the individual case. It is recommended to avoid intense physical activity for 5 days after embryo transfer. Women can travel by car or plane after embryo transfer but we recommend they avoid physical activity such as heavy lifting. This type of precaution is advised in the interest of best practice rather than based on any scientific evidence – we encourage all our patients to take some time out to encourage nature to do its work.
4. Embryo Cryopreservation
Any viable surplus embryos that are not used during the fresh treatment can be frozen and used later in a subsequent frozen transfer cycle (either because the couple wants to have a second child, or if the first attempt fails); can be donated for scientific research; can be donated to another couple or may be destroyed, depending on the couple's decision and the conditions laid down by law.
The pregnancy test should be done 2 weeks after embryo transfer. We advise all women to have a blood pregnancy test as a preferred alternative to using urinary markers. A blood test will be more accurate and provide relevant information regarding the treatment.