In the run-up to fertility treatment, a number of preliminary examinations are necessary which are carried out by your gynaecologist, urologist or us, and serve to determine the cause of your unfulfilled desire to have a child. Only then can a treatment planned with care and optimal time management begin, which runs through several phases and steps. So approach the treatment with a broad timeframe and do not put yourself under pressure.
Usually, fertility treatment begins in the second half of the menstrual cycle preceding the actual treatment cycle. Certain drugs, so-called GnRH analogues, severely restrict or "down regulate" the body's own production of hormones necessary for ovarian maturation. In this way it is possible to influence the following treatment cycle, which makes it possible to determine the optimal time for ovulation. An alternative to down regulation is treatment with GnRH antagonists during the stimulation phase, usually from 5-6 days of stimulation. This prevents premature ovulation.
Stimulation of the ovaries with special hormones (FSH) usually begins on the second or third day of the cycle. The aim of stimulation is to allow as many follicles as possible to grow in the ovaries. This results in several mature eggs, which increases the chances of success of the treatment. The stimulation phase usually lasts 10 -14 days. During this time, a certain amount of hormone is injected under your skin every day. You should let us do this for you. Later, you or your partner can inject yourself, which saves you the daily trip to the doctor. In order to follow the maturation of the follicles and thus the oocytes, several blood samples are taken during the stimulation phase and ultrasound examinations of the ovaries are carried out. On the basis of the findings obtained in this way, the optimum state of maturity of the oocytes can be determined.
If the blood and ultrasound values during the stimulation phase show that the time of optimal egg cell maturity has been reached, treatment with stimulation hormones is discontinued and ovulation is triggered by the administration of human chorionic gonadotropin (hCG). The hCG must usually be injected under the skin in the evening and can therefore be administered easily by yourself or your partner.
Insemination is performed approximately 36 hours after the hCG injection that triggers ovulation or, in the case of IVF/ICSI treatment, the oocytes are removed from the mature follicles of the ovaries. This is done by means of a special puncture needle which is guided through the vagina under ultrasound control. To facilitate the procedure, you will be slightly anaesthetised. Therefore, you should appear sober for puncture. After egg collection, we will keep you with us for about two hours for observation. Then you can go home.
At about the same time as the follicle puncture, we will ask the partner to obtain a semen sample by masturbation. If this causes you problems, talk to us openly about it in advance of the treatment. We will also find a viable way for you. Semen samples for inseminations can also be collected at home.
After preparation of the semen sample, it can now be used for insemination or extracorporeal fertilisation of the collected eggs. Conventional IVF or ICSI is used to unite egg and sperm cells. On the following day, the oocytes are examined for pronuclei, which indicate that fertilisation has taken place. A maximum of three of these fertilised eggs are now selected and kept in the incubator until the next day. Surplus fertilised eggs can be frozen and used for later transfers. If you do not wish this, we must destroy them. After a further day, embryos have developed from the fertilised oocytes, which usually consist of 2 - 4 cells and can now be returned to the uterine cavity (embryo transfer).
The embryos created during IVF/ICSI treatment are transferred into the uterus on the second or third day after egg collection (embryo transfer). A thin, flexible plastic catheter is used, which is inserted through the vagina into the uterine cavity, where the embryos are then rinsed out. Embryo transfer is usually painless. After the transfer you stay 10 - 15 minutes and can then go home.
The luteal or corpus luteum phase is the most unpleasant phase of the fertility treatment for you, because only after two weeks can it be assessed whether the treatment was successful, i.e. whether a pregnancy has occurred or not. During these long two weeks of waiting you will normally receive supportive hormones such as progesterone and, if necessary, hCG. A control ultrasound examination of the ovaries is also carried out routinely. If the pregnancy test is positive, an ultrasound examination will be performed in the next two weeks if the menstrual period is still missing. If the pregnancy is intact, report again to your gynaecologist for further care.