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 An ovulation-inducing agent is used to stimulate the ovaries into producing numerous mature ovarian follicles (eggs). The type of ovulation-inducing agent used is determined on a case-by-case basis. The optimal time for hCG administration and egg retrieval is determined according to the number and size of ovarian follicles produced. Testing may be performed to check your hormone levels along with transvaginal ultrasound to confirm the optimal timing for administering hCG. Egg retrieval is carried out approximately 36-37 hours following hCG administration. Egg Retrieval Eggs are contained within follicular fluid. Egg retrieval is accomplished with the use of transvaginal ultrasound. Transvaginal ultrasound is used to determine the position of the ovarian follicle and to help guide a collection needle to the site of each follicle. Each egg and the surrounding follicular fluid are then withdrawn. No pain should be experienced during this procedure since it takes place while under anesthesia. The effects of the anesthesia are strong but short lasting. Patients who have undergone general anesthesia can leave the hospital within 2 hours after collecting the oocytes. If only a few eggs (such as 1 or 2) are to be retrieved or if the eggs are located in an area where you should not experience much pain, a suppository painkiller may be all that is required for pain treatment during egg retrieval. Sperm Collection In order to ensure that your semen is in pristine condition, we ask you to provide a fresh sample of semen at our hospital in the room provided. The semen is then washed with a culture medium and centrifuged so that we may select the most healthy and active sperm from it. After the eggs are retrieved they are cultivated for approximately 4-5 hours, to make either matarity completed then they are then placed together with the selected sperm in a laboratory dish for insemination. (Even if the original plan was to perform IVF, at this stage it might be determined that the plan should be changed to ICSI (Intra Cytoplasmic Sperm Injection) due to the recognition of a problem such as a low sperm mobility rate.) The fertilized eggs are then placed into a culture medium to be nourished while they are incubated. Approximately 18 hours after insemination, a microscope will be used to confirmed if and which eggs had been successfully fertilized. After confirmation the successfully fertilized eggs will be returned to the incubator. After 2 days each fertilized egg (embryo) will divide into 4 cells, and after 3 into 8 cells. At the stage when the embryo contains 4-6 cells (2days after egg retrieval), it is then replaced back inside the uterus. In order to increase the chances of successful implantation, the patient is given injections of a hormone called progestin (a synthetic form of the female hormone progesterone). There are two basic methods of returning fertilized eggs to the uterus for implantation. One method is embryo transfer in which the eggs are returned shortly after they have been fertilized and divided 2-3 days after oocyte collection. The second method is where the egg is first fertilized then the resulting embryo is cryopreserved for a period of time at the stage of 4-8 cells before being implanted in the uterus. One case where cryopreservation of embryos might be required is when the ovulation-inducing agent has caused the endometrial layer (lining of the uterus) to become too thin (a side effect of fertility drugs). In this case the embryos would be kept frozen until time that the woman's uterus naturally develops an endometrial layer that is sufficiently thick enough to support the growth of an implanted embryo. Another common method of embryo transfer is called Blastocyst Transfer. Blastocyst Transfer entails culturing the embryo longer, after fertilization, until the embryo develops for 5 days to the point just before implantation. Generally the more the embryos develop, the higher the implantation rate rises. However this long culture is not always beneficial for all embryos. Note some embryos' quality decrease during this culture. It's crucial to determine the timing of embryo transfer, seeing the embryo quality and endometrial condition. Generally 16 days after Egg Retrieval, and normally 14 days after the transfer, we will conduct your first pregnancy test. If pregnancy is confirmed, the remainder of the process is the same for a natural pregnancy. 
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