Important concepts for the in vitro fertilization treatment (IVF)

Many consulters visiting our hospital considered that the in vitro fertilization (IVF) treatment always make them feel complicated and troublesome because a series of injections, medications, blood test, and ultrasound scan should be taken. The distance or work related factors make some of them have poor cooperation. How much time and vigor cost actually for in vitro fertilization treatment?

（1）Multiple stimulations
The medications used to stimulate follicular development to increase the mature of eggs. The common approach is oral medications like Clomid or injectable HMG or FSH depending on situations of the patents after detailed examination. The main purpose is to obtain eggs with good quality to improve the pregnancy probability, but is should be noted that the ovarian hyperstimulation syndrome (OHSS) occurs.

（2）Why takes the blood tests?
Drawing blood and running around the hospital is painful and troublesome, but it is an important part of the entire course of the treatment. Estrogen (E2) level is an indicator of follicle maturity. The doctor can adjust the medication prescription or dosage according to the E2 levels and the number and size of follicles under the ultrasound.

（3）Determination of follicle maturity and number using ultrasound
Combination with E2 value offers more information to determine the follicle maturity. Additionally, it also observes the thickness of the endometrium. The endometrium is a breeding ground for embryo implantation. If the endometrium is too thin, it may not be suitable for embryo implantation.

（4）HCG is used to trigger final follicular maturation
A rise of luteinizing hormone (LH) is usually released from the pituitary gland once a developing egg follicle reaches a certain size that is known as LH surge. LH surge triggers the final stage of follicular maturation, and it is time to oocyte retrieval. Injection of human chorionic gonadotropin (HCG) is usually used as a surrogate LH surge. Timing of HCG injection depends on E2 levels and the size of egg by ultrasound scan.

（5）GnRHa（Gonadotropin Re1easing Ho rmone Anan1ogue）
Gonadotropin releasing hormone analogs (GnRHa) inhibits pituitary function to prevent early ovulation. GnRHa is a synthetic gonadotropic hormone, which adds into HMG or FSH responsible for controlling follicle development in in vitro fertilization treatment.

（6）The timing of egg retrieval
An egg pick-up procedure is scheduled after 34 to 36 hours of HCG injection. HCG injection accelerates follicular maturation and this is the best time for egg pick-up.

（7）Progesterone supplement
The Egg retrieval may reduce the potential progesterone production so that progesterone supplementation will be given until fourteen days after an embryo implanting. Keep progesterone supplementation going until twelve weeks if conceive.

（8）Multiple pregnancies and embryo cryopreservation
Dose the transfer of many embryos result in multiple pregnancies? The fact is that implantation rate is low. The pregnancy rate is greater with the transfer of two embryos, than one embryo, but there is no difference in outcomes of twin pregnancies. The multiple pregnancy rate increases with the transfer of more than four embryos, therefore, it should be avoided the multiple embryos implanting. Multiple gestation pregnancies raise the risk although it is accepted that fetal reduction with high risks that should be done by a qualified gynecologist. Excess embryos additionally can be cryopreserved to replant into the uterus following in thawing in the future, which remit the painful injection of ovulation of in vitro fertilization.

Not only many mature eggs but also good quality sperms develop to optimal fertilized eggs that transfer into uterus during in vitro fertilization. Therefore, infertile couples should take evaluation and treatment together to figure out the real causes. No matter what causes of infertility are diagnosed with fallopian tube factors or endometriosis, male infertility, or unexplained infertility, and other factors caused by infertility, and couples have to face and receive treatment together in order to have their own baby.