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In all cases, for a certain number of oocytes ICSI technique is used (fecundation is done by inserting the spermatozoon directly inside the oocyte) in order to avoid the situation in which the oocytes are not fertilized after 24 hours. There is no additional fee for this procedure.

In Vitro Fertilization(IVF) / ISCI implicates some distinct activities like investigations, making up a file, discussions with the couple and scheduling the treatment and also a number of stages in its implementation.

It is good for you to know the amount of time that you will allocate prior to the beginning of the treatment, in order to make all the necessary arrangements at home and at work and to be able to correctly schedule the treatment in the period of time in which you will be available for all stages.

Although the treatment is ambulatory, your presence in the clinic might be frequently required for monitoring or different procedures. That is why we offer you a guide plan. Depending on the individual response to the treatment or other considerations, this plan can be adapted and it is even possible to interrupt the treatment in any of its stages.

 

1. I. The previous cycle of the scheduled treatment

Call at 0232 216 260 or 0728 450 098 for an appointment to one of our infertility counselor. 

 

II. First discussion

The presence of both partners is required

On your first meeting, you will be consulted and you will get all the necessary information regarding the investigations and analysis needed to be undertaken prior to the beginning of the procedure.

Also, you will fill an acceptance document of the treatment and financial obligations.

III. Ovarian stimulation

After studying the results of all investigations and analysis and taking into the consideration the most important factors the doctor will establish the treatment protocol and stimulation doses. On the established, date you will start a recommended injection treatment, in one of the following versions:

1. a. Short protocol with GnRH antagonist (the most modern protocol)



Ovarian stimulation begins in the first days of the menses; it is necessary to dose the most important hormones and perform an ultrasound in the first day of the stimulation.After 5-6 days of daily stimulation, another ultrasound is performed and it is added a prepared substance for premature ovulation inhibition (antagonist). At the most appropriate moment hCG is administered in order to trigger the ovulation.



2. b. Long protocol with agonists

1. A single injection dose of a GnRH analogue substance is administered, usually in the 21st day of the cycle previous to IVF procedure. Blood analysis and/or ultrasound performed after 14 days indicate if stage 2 can begin.

2.Daily injection administration of a prepared substance for ovarian stimulation, for 9/15 days, depending on the response to the treatment.

3.Checking through ultrasound the response to the treatment during this period; 2-3 ultrasound examinations might be necessary, first one being performed, usually, after 7-9 days of treatment.

4.. Triggering ovulation in day established by the medic, with an hCG substance.

1. c. Short protocol with Agonist

1.. Daily injection administration of a GnRH analogue substance, beginning in the first day of menstruation after the consultation. An initial ultrasound might be necessary at the beginning of the cycle.

2. Adding an ovarian stimulation substance, daily injection administered, for about 7-14 days, depending on the response to the treatment.

Points 3. and 4. of the long protocol must be applied here too.

1. d.Ultramodern protocol with Elonva and Antagonists

Ovarian stimulation begins in the first days of the menses, hormonal dosage and ultrasound are necessary to be performed.

For stimulation a single Elonva injection is administered, subsequently followed by 3-4 doses of Antagonist. 

               
IV. Monitoring the ovarian stimulation

It is mainly performed using vaginal ultrasound; hormonal dosage might be necessary.

Vaginal ultrasound is a non-radiative procedure to visualize the internal genital organs. It is performed while the patient sits in the gynecological position, by inserting a transducer in the vagina. The discomfort is the same as in a usual genital examination. On the screen there are evaluated the size and development of the uterine mucosa, the number and size of ovarian follicles obtained through stimulation.

Follicles are fluid-filled sacs, more or less spherical, which contain oocytes. Usually, each follicle contains one oocyte, but there are exceptions. Oocytes can not be visualized through ultrasound.

V. Harvesting oocytes

After about 35-36 hours from the administration of hCG, oocytes and sperm are harvested.

The harvesting of oocytes is performed through ultrasound guided vaginal puncture, using general anesthesia, in conditions of maximum comfort. After the puncture you will remain under the surveillance and monitoring of the medical personnel until the effect of the anesthetic is gone.

Dupa punctie, veti ramane sub supravegherea si monitorizarea  personalului medical pana la epuizarea efectului anestezicului.

It is the procedure through which the follicular fluid, that contains oocytes, is aspirated from the ovarian follicles. No toxic anesthetics are used for the future product of conception.

After the disinfection of the vagina, the follicles are located and visualized, similar to an usual ultrasound examination. Aside from the ultrasound transducer there is also inserted, in sterile conditions, a thin non traumatic needle attached to the absorption device. Puncture of the ovaries is performed and the follicles are aspirated in sterile test tubes, preheated at human body temperature. In the same conditions, the test tubes are immediately transferred to the embryologist.

After the puncture you will remain under the surveillance and monitoring of the medical personnel until the effect of the anesthetic is gone.

During the day you might feel a little tired or dormant, with a pelvic discomfort sensation. Little vaginal bleedings from the puncture location should not cause any concerns.

You are not allowed to drive immediately after the procedure.

VI. Sperm harvesting is performed in the clinic, in special recipients, in the same morning after the harvesting of oocytes.

VII. Laboratory procedure

The lab procedures stage through which embryos are formed lasts, usually, 2-3 days. First results are recorded after 24 hours.

Immediately after the puncture of ovaries, the follicular fluid is sent to the embryologist who seeks, counts and evaluates the quality of oocytes under the microscope. Sperm is prepared and put in contact with the oocytes in the incubator. After 24 hours a checking is made to determine if the fecundation took place. The number and quality of the formed embryos can be evaluated after another day, when the cells begin to divide. You will be informed by telephone on this evolution in order to schedule the day for embryo transfer.

In all cases, for a certain number of oocytes, ICSI technique is used (fecundation is done by inserting the spermatozoon directly inside the oocyte) in order to avoid the situation in which the oocytes are not fertilized after 24 hours. There is no additional fee for this procedure.