In terms of the logistics of IVF, think in terms of the objective. The objective is to produce very good quality eggs and be able to fertilise them with the husband’s sperms and produce very good quality embryos, set the uterine environment that is the soil for implantation. These are the objectives. Now, how is this to be done?
Well, my first recommendation is that the couple needs to be assessed in terms, number one of his sperm quality and if his sperm is not good, what is causing the problem and treat the problem first so that at the outset, your perimeter of the sperm must be of good quality to start with. You cannot use very poor quality sperm where the chromosomes in the sperm head is poor and hope to achieve pregnancy. I think you doom your cycle. Doom not only in terms of success rates, but in terms of expenses, failure of the cycle, all the frustrations that follow after that. So the guy needs to be looked into first. And, in my experience today, I find that many guys have problem with the sperm quality, so that is one big area that needs to be looked into first before you even start IVF.
Secondly, with the woman herself, you got to assess her and answer the question, is her reproductive system malfunctioning? What is malfunctioning? Improve on the condition first. For example, if she has active endometriosis, and you went ahead to do IVF. You can end up with poor egg response and poor quality eggs. So the preliminary part of it must be to assess the husband and wife, to improve on their condition in terms of the state of fertility and then when you embark on IVF, you give yourself a far greater chance of success. Now then, the first then is to stimulate the ovaries to produce eggs by hormone injections, and it takes roughly about two weeks to reach that stage where the eggs are fully grown and mature. They are then extracted using an ultrasound machine under sedation. The patient is asleep so she doesn’t feel the pain. And at the same time, the husband produces a sperm, then the laboratory then takes over to fertilise the egg with the sperm by injecting single sperm into each egg.
After fertilisation, the embryos are cultured in the laboratory and then it comes to implant. Usually, the implant takes place between 3 to 5 days after collection. And after the implant is done, then hormonal support is necessary over a 9 day period because by the 9th day, you can test the butt for the presence of pregnancy and if pregnancy does occur, further hormonal support and close supervision is essential. Otherwise, if you feel to do that, find yourself getting a transient pregnancy and no baby at the end of it, so called take home baby.
Answered by Dr. Christopher Chen