І. Preliminary tests and exams
Tests and exams that intend to show that we are eligible for engagement into the ART program. The tests can include:
1. Blood work for some hormones level (LH, FSH, Estradiol, Prolactin, Progesteron, Inhibin B, etc.);
2. Tests for infectious diseases (Chlamydia trachomatis, HIV-I and -II, НBV, HCV, Neisseria gonorrhea);
3. Blood cell’ analysis and coagulation status.
4. PAP smear for microbiology;
5. Ultrasonography (HSG)
6. Cervical canal’ preliminary test.
7. Free passage of the uterine tubes, if necessary.
8. Medico-genetic consultation;
9. Semen analyses, microbiology of the semen sample.
10. SDI test (sperm DNA integrity) showing the DNA fragmentation of the sperm genome.
11. Additional tests, if necessary.
ІІ. Hormonal medication for ovary stimulation
Hormonal stimulation of the ovaries gives the opportunity to have as many as possible matured eggs for a fixed period of time and under precise control. The following medication can be used: Triptorelines (example: Decapeptyl®, Dipheriline®), recombinant human FSH (example. Gonal F®, Puregon®) Fostimon, Merional), human chorion gonadotropin-HCG (Pregnyl®).
ІІІ. Using medications prior to ART procedures
Using of antibiotic or corticosteroid therapy, if necessarily, to obviate inflammatory or infectious disease.
IV. Stimulation monitoring.
Includes trans-vaginal ultrasound monitoring combined with blood work to follow up the follicles growth dynamics and maturation and the expected ovulation as well.
V. Egg retrieval (follicular puncture).
This is procedure to collect eggs from the ovaries through aspiration of the follicular fluid. The procedure is performed trans-vaginally under ultrasound control and intravenous anesthesia.
VI. Medication after the ART procedures.
To prevent any infections, an antibiotic treatment is applied for the next few days.
VІІ. Production of the semen sample
The semen sample is obtained by masturbation/ejaculation followed by specific laboratory treatment of the sample
VІІІ. Specific ART procedures.
Conventional in vitro fertilization is performed when the sperm cells are placed together with the eggs in a special dish with specific culture media that will help the natural fertilization process. If the fertilization is successful, the embryos are growth in laboratory conditions until the embryologist and the gynecologist decide that they are ready to be transferred into the woman’s uterus.
If there is a male factor involved as well as previous in vitro failures, the ART team may offer the technique known as ICSI. This is micromanipulation where one sperm cell is selected and injected into the egg’ cytoplasm.
The embryo(s) are transferred in to the uterus with a plastic catheter through the cervical canal and the embryos are flushed inside the uterus cavity. The procedure is performed under the ultrasound control.
Х. Post-ART Monitoring.
Taking blood work to follow some analyses as well as pregnancy blood test on 14th day after the embryo transfer. If the test is positive there will be regular ultrasound follow-ups during the next 6-8 weeks to monitor the pregnancy.
ХІ. Medications after the ART procedure.
Progesterone (like Utrogestan) and choriongonadothropin hCG (like. Pregnyl) for the cycle’ luteal phase support as well as for early pregnancy maintenance.