Normally women after attaining menarche, will produce one egg per month around 14 th day after menstrual period. For our In Vitro Culture program, one egg may not suffice and the whole procedure and success of the program depend on the number and quality of the eggs obtained. So, we hyper stimulate the ovaries in a safe manner using a method called controlled ovarian hyperstimulation by Down Regulation under "long protocol" and "Antagonist protocol". After downregulating the system we give Hormone injections of International Quality e.g. Recombinant FSH, LH, HcG,Pure FSH, HMG , etc which helps the woman to produce more number of better quality eggs. The dose and number depends on the age, weight, Basal hormonal status of the women and the Ovarian Volume & reserve. We teach the spouse to give injections to his wife since most of the medicine comes in self injectable syringes. Once the follicles harbouring the eggs reach sufficient size "egg pick up" is planned and the whole procedure is explained to the couple. The nature of anesthesia could be the couple's choice, provided it doesn't alter the egg quality. Usually we give IV analgesia for shorter time.
Usually planned in the day working hours, under IV sedation which will not harm the eggs. An Ultrasound machine is used to pick up the eggs through vaginal vault using a specific instrument called TRANSVAGINAL PROBE with Its guide through which the egg pick up needle is introduced and the follicle is punctured. The needle system is a complex one having two ports, one for aspirating the follicular fluid and the other one for flushing the empty follicle with specific medias. This needle system is connected to a low power suction motor which aspirate the fluid very gently without harming the eggs. The aspirated fluid which contains the eggs are collected in a Polystyrene test tube and sent to the adjoining IVF lab. The aspirate is examined by an embryologist under stereozoom microscope to identify the eggs and keep them separately in an ideal nutritious culture media in incubator till they are inseminated.
This identification, separation and, handling needs an ideal gas mixture (N2 CO2, O2) and warm (37°c) environment under a sterile zone called Integrated Laminar Flow Work station. The whole procedure takes maximum 30 minutes and the amount of bleeding or pain will be very minimum.
Sperm collection and processing is to be done with great care to avoid infection. Before this IVF program is designed, the husband must have a trial preparation of sperms to see the integrity and biological nature of the sperms and it's survival hours. Now after egg pick up the husband is asked to give the semen sample within 2 hours. If he thinks it might be stressful to ejaculate in these occsions with tension, he can provide a sample before the cycle preparartion, which could be cryopreserved. Same applies to the husbands working abroad, Army or undergoing surgery / radio, chemotherapy. The husband could be given non toxic condom if he is unable to produce the sample by masturbation. Vibrator could also be used for need.