Article -> Article Details

There are many different protocols and we try to individualise the protocol to the patient and so there are many different ways that we can do IVF. So in terms of diet, we usually recommend the Mediterranean diet. So, lots of fruits and vegetables, healthy fats like avocado, olive oil, poultry, fish, these types of things. In terms of exercise, so we don't want you exercising during the actual stimulation process, but in preparation for IVF, exercise can be important. So, we recommend four to five days of good cardio for 30 minutes, intermittent weight, just overall trying to be healthy. In addition, we want you to avoid processed foods, try and avoid alcohol and smoking and minimising caffeine. In terms of supplements, so we usually recommend prenatal vitamins, vitamin D, calcium, these types of things. And if we're concerned about ovarian reserve, then we would also recommend CoQ10 and DHEA. So, these are some of the things that you can do in preparation for the process. The overall idea of IVF involves a woman undergoing stimulation.

For aspiring fertility specialists seeking comprehensive and hands-on education in assisted reproductive technology, Medline Academics has emerged as a trusted destination for reproductive medicine training. Through its hybrid programs, Medline Academics provides in-depth exposure to IVF protocols, ovarian stimulation strategies, embryo culture, ICSI, and latest advancements in reproductive medicine. Professionals searching for Dr. Kamini Rao IVF Fellowship in India, often recognize Medline Academics for delivering structured, evidence-based leaning aligned with international standards in infertility management. This institute is often regarded as the best training institute in reproductive medicine for healthcare professionals aiming to build successful careers in reproductive medicine.

Now there is a series of steps involved, and we're going to go through each step in detail.

·       Number one, synchronisation. So what this means is birth control. So how this will work is the patient will call with the first day of their period, and then we'll put them on birth control around cycle day three, and they will remain on birth control for a period of two to three weeks. The point of this is to what we call synchronise the follicles.

We want them to all grow together so that they grow at the same pace, and they all get large at the same time. This will help us maximise the number of mature eggs that we get from this process. While the patient is on birth control, the patient will also come into the clinic and do a couple visits with us.

So one visit will be meeting with the physician, and with the physician we'll go over the process again, answer any questions, and sign consents. In addition, we'll do a couple of procedures with the patient. So one is what's called a trial transfer.

So what this is, is basically a practise run at putting the catheter in. We just don't want to run into any surprise on the real day that we're putting the embryo back in, so that's why we do this practise run to make sure it's a nice and smooth process. The second procedure is what's called a saline ultrasound or hysterosonogram.

The last thing we'll do with the patient is a clearance ultrasound. So we will do an ultrasound particularly looking at the ovaries and making sure there are no cysts there and all the follicles are small, ideally less than 10 millimetres in size. So that is all of the things that you'll do with a physician at that visit.

The other visit that you'll do is with the nurses, and with the nurses you'll do a medication review. They do a very thorough medication review going through all the medicines and going through how to use them. Then you'll also create a calendar with the nurses, and so they will do a nice job of laying out the timeline, so that is also very clear.

So that is pretty much what you will do in that step one, the synchronisation phase. Step two is stimulation. Stimulation refers to the process of stimulating the ovaries to grow multiple eggs.

So I first like to go over what happens in a normal cycle versus what happens in IVF, so you can get a good understanding of both and how they're different. So what happens in a normal cycle is a certain number of follicles are released and become visible on ultrasound. So one of those follicles will grow to be the dominant follicle to eventually release the egg in a process called ovulation, and the rest of the eggs will die off.

The next cycle, another set of follicles become visible. So in a cycle, you're not losing just one egg, but you're losing a whole set of eggs. Now in IVF, the hope with that is that we give medication so that instead of those eggs dying off, we want them all to grow, so hopefully we get multiple mature eggs from that cycle.

So that is how the two are different. Sometimes patients will ask me if IVF affects future fertility. It does not.

The only difference between a normal cycle and IVF is that instead of those eggs dying off, we're trying to grow them so that hopefully we get many eggs from the IVF process. Now stimulation can be broken down into two components. So, one is the stimulation medicines to stimulate the eggs to grow, so that is FSH and LH.

·       The second component of stimulation is a medication to suppress ovulation, because if the patients were taking the stimulation medicines alone, then they could ovulate and we could lose the eggs, and so that is not what we want. So the suppression medicines that we use are called an antagonist. So let's go through the process in a little bit more detail.

So the patients will start on the stimulation medicines, and then once the follicles reach about 14 millimetres in size, or the oestrogen level is above 400, we will start the antagonist. So the patients will initially take two injections a day until we start the antagonist, and then they'll take three injections a day. The overall process of injections lasts anywhere from 8 to 12 days.

It just depends on the woman and her response, and we will monitor you with blood work and ultrasound every two to three days during this process for a total of usually four to five visits. We try and make them in and out in the morning so we don't interfere with work, and then we'll call you in the afternoon with the results and the next steps from there. So let's go over the medicines so you can be more familiar with the terminology.

So FSH and LH again are our stimulation medications. So FSH comes in gonalf or folistim. LH can be done in a couple different ways.

We sometimes will do microdose abadril, which substitutes for that LH component, or a medication called menopur, which has both FSH and LH in it. So an example of a protocol could be gonalf and menopur, so you're getting both that FSH and LH component for the stimulation, or folistim and microdose abadril, where you're getting again that FSH and LH component. So there are a few different ways to do it.And then the antagonist medications are called ganrelix and cetratide. So that is the stimulation process.

·       Step three is the trigger.

When the follicles reach the right size, we will trigger ovulation, and the point of this is for the last steps of egg maturation. The timing of the medication is very important. We will time the egg retrieval 35 to 36 hours after the trigger.

Examples of triggers are Novarel. Another trigger we use is called a Lupron trigger. We often use that in patients where we're worried about overstimulating, and sometimes we'll use a combination of both.

·       Number four is the egg retrieval. The egg retrieval is a minor surgical procedure that we do to remove the eggs. It's done under ultrasound guidance and with anaesthesia.

So how the procedure works is once you're under anaesthesia, we will put a speculum in, and we will perform a lavage, basically a cleansing of the vagina. Then we will put the ultrasound probe in, and there is a needle guide above it. We will feed a needle through that needle guide, and it will go basically through the vaginal wall and into the ovary.

When it's in the ovary, we will step on a pedal. This will activate a suction mechanism. So we're actually suctioning the fluid out.

Each follicle, in theory, has a microscopic egg that we can't see. So as we're removing the fluid, the egg should be coming with it. It'll travel through the tubing into a test tube, and then we hand the test tube off to the embryologist.

They'll look through the fluid under a microscope and identify the eggs. The procedure length varies depending on how many eggs are there, but generally speaking, it's about 15 to 20 minutes, and patients will go home the same day.

·       Step five is fertilisation. We will obtain a sperm specimen the same day of the egg retrieval, and the egg and sperm will meet that same day. There are two ways to do fertilisation. One is with conventional IVF, and the other is with ICSI, which stands for intracytoplasmic sperm injection.

With conventional IVF, we put a certain number of egg and sperm on a petri dish and let them meet on their own. With ICSI, the embryologist will identify the best-looking sperm and will directly inject the sperm into the egg. Some reasons why we do ICSI is if the patient had a previously low fertilisation rate in a previous IVF cycle, if the eggs were previously frozen, if the man has a male factor, or if we're planning PGT. So we usually plan in advance which type of fertilisation method we are using, but sometimes on the day of the egg retrieval, if we see lower number of sperm than we anticipated, sometimes we'll decide to do ICSI that day instead of conventional IVF.

·       Step six is embryo development. We will let the embryos grow in the lab for a period of about five to six days usually.

The embryologist will be calling the patient and giving them periodic updates on how the embryos are growing. Once the embryo gets to the blastocyst stage, which usually happens after five to six days of growth in the lab, we have two options. We can either put the embryo back in, which is called a fresh embryo transfer, or we can freeze the embryo for the plan of putting the embryo back in in a later cycle, and that is called a frozen embryo transfer cycle. Doing the frozen embryo transfer allows us the option of doing PGT, which stands for pre-implantation genetic testing.

·       This leads us to step seven, which is PGT or pre-implantation genetic testing. What this is, is screening the embryos to determine which embryos are genetically normal.

How it works is when the embryo reaches the blastocyst stage, the cells have differentiated into the inner cell mass, which becomes a future baby, and the cells on the outside of the embryo, which is called the trophectoderm, and those cells become the future placenta. So PGT means we are taking a sampling of a few of those cells that would become the future placenta, get the genetic makeup of those cells, and extrapolate the genetic makeup of the embryo that way. So we get the chromosome number, and there's 46 chromosomes, so it's a very thorough test, and we get the sex, and you can choose to know or not know the sex depending on your preference.

It's overall about a 96% accurate technology, so it is very accurate, but there is a small error rate there. The benefits of doing this is that it helps us to increase our success rate and decrease the miscarriage rates. If we do PGT, it takes about two weeks to get the results.

·       Number eight, meeting with the physician. About three weeks after the egg retrieval, we'll meet with the patients, we'll go over the outcome of that cycle, and we'll review family goals, and we'll see if their goals were met with that IVF cycle, and then we'll discuss next steps from there. That is IVF in a nutshell.

Why Choose Dr. Kamini Rao Hospitals?

Established to carry forward the remarkable legacy of Dr. Kamini A Rao, Dr. Kamini Rao Hospitals stands as a trusted IVF Treatment Clinics in Bangalore, renowned for its excellence in assisted reproductive technology and patient-centred care. Backed by experience fertility specialists, state-of-the-art embryology lab and overcome infertility challenges and achieve successful pregnancy outcomes. With a focus on innovation, clinical excellence and compassionate care, the hospital continues to be a preferred destination for people seeking world class fertility treatment.