Infertility Clinic Trilogy
Dr. XU, CHAO-QIN
Due to advances in reproductive technology, most infertile couples nowadays know that with more advanced reproductive technologies such as IVF, more than 90% of couples are expected to successfully conceive. However, rumors are going around such as “you have to receive IVF once you visit the infertility clinics”, “IVF babies are different from naturally conceived babies”, and “receiving IVF treatment costs a lot”.
Here we introduce three major steps along the path to conceiving with IVF in infertility clinics:
（1）Consultation and guidance on conception
In this initial stage, a series of fertility tests are involved, e.g., semen analysis, ovulation and fallopian tube tests. The physicians will explain basic mechanisms conception and may prescribe low dose ovulation induction drugs and uterus conditioning medicines. The doctor may calculate the ovulation date and recommend better timing for conception. About 30 to 50% of infertile couples successfully conceive within one year.。
（2）Intrauterine insemination (IUI)
IUI is pursued only after instructed conception for 6 months to one year has failed, poor sperm quality, or cervical factor infertility, etc. The doctor will prescribe ovulation inducing drugs or injections to increase the number of mature follicles. Ovulation is induced by HCG injection, and after wash, the selected sperms are placed into the uterus to achieve pregnancy. The average prices for IUI, including the medicines,are between TWD 10,000 and 15,000. The pregnancy rate via IUI is elevated because the doctors screen for better sperms and deliver them to the location in uterus where is more close to the oocyte. The average conception rate is 15% per IUI, about 50% couples successfully conceive after four cumulative IUIs. If the initial IUI fails, next round of IUI can be carried out immediately in the next cycle or after two to three months of adjustment.
（3）In vitro fertilization (IVF)
IVF is the best option for fallopian tube obstruction, severe endometriosis, extremely rare spermatozoa, and multiple failures in IUI. The average prices for IVF, including the medicines, are between TWD 80,000 and 100,000. The average pregnancy rate via IVF is approximately 35%, after 3 to 4 cycles of IVF, the pregnancy rate can reach 80% to 90%. Usually, if an IVF cycle fails, it is better to take a two to three months rest before entering the next cycle.
The physician will discuss in detail with the infertile couple the preparations required for IVF treatment.
- Birth control pills will be given one to two months prior to the IVF cycle, the main reasons is to inhibit ovulation, help the ovaries better response to the stimulation ovulation after one to two months of rest.
- After taking the contraceptive pill for two weeks, or on the 20th to 22nd day of the cycle, the patient needs to return to the clinic for ultrasound scan of uterine and ovary condition before receiving supremon spray or Lupron injection until menstruation.
- Return to the clinic on the 2nd or 3rd day of menstrual cycle to monitor the cycle by both ultrasound scan of the number and size of immature follicles expected to grow in both ovaries, and for blood test of hormone status.
- The next step is triggering the oocytes to go through the last stage of maturation via daily injection of Gonal-F, Puregon, FSH, or HMG until the maturation of follicles. The final shot of HCG was given at 10,000 IU, and egg retrieval will take place 34 to 36 hours later.
- An intravenous medication will be given for light sedation before ultrasound-guided transvaginal oocyte retrieval. The retrieval takes 10 to 15 minutes and the patient will wake up in a short period of time.
- After insemination, the fertilized eggs are cultured in the lab for two to five days before embryo transfer at 4- to 8-cell or blastocyst stage.
- A pregnancy check-up can be performed two weeks after egg retrieval.
The formal treatment plan is subject to your attending physician