Steps for IVF with premature ovarian failure

Generally speaking, patients with premature ovarian failure will not be able to get pregnant successfully, which will affect their fertility. Only after the condition improves will there be a chance of successful conception. This will lead many patients to do in vitro fertilization to increase their chances of successful childbirth. However, before doing in vitro fertilization, they should first have a physical examination to ensure that their body is able to successfully conceive.

Monitoring follicles:

In order to evaluate the effect of ovarian stimulation and determine the time for egg retrieval, vaginal B-ultrasound is required to monitor the size of follicles, and blood tests are conducted to check the E2 value (estrogen) and adjust the dosage. When two to three or more follicles are larger than 1.8 cm in diameter, and the number of follicles larger than 1.4 cm is equivalent to the E2 value, human chorionic gonadotropin (hCG) can be injected to promote the maturation of the follicles. Egg retrieval is done 34 to 36 hours after hCG injection.

Egg Retrieval:

The most commonly used method of egg retrieval is to insert the egg retrieval needle through the vaginal vault and directly reach the ovary to absorb the eggs under local anesthesia and then immediately transfer the eggs to a culture dish containing embryo culture medium under a microscope and culture them in a 37°C incubator.

Sperm collection:

Sperm retrieval is done on the same day as egg retrieval. Wash your hands before collecting semen and use masturbation to collect semen. The small cup given is sterile. Do not touch the rim or inside of the cup when taking the liquid. The semen was extracted and processed by swim-up method or Percoll density gradient centrifugation.

In vitro fertilization:

4 to 5 hours after egg retrieval, place the processed sperm and eggs in the same culture dish. After culturing them together for 18 hours, the fertilization can be observed under a microscope. If the sperm quality is too poor to allow natural fertilization, forced fertilization must be achieved by microinjection (see intracytoplasmic sperm insemination).

Embryo transfer:

The fertilized egg can develop into an 8- to 16-cell embryo after 48 to 72 hours of in vitro culture. At this time, the number of embryos to be transplanted is determined based on the patient's age, whether she has been pregnant before, and the quality of the embryos. Excess embryos can be frozen and stored. Embryo transfer generally does not require anesthesia. Currently, embryos are usually transplanted 2 to 3 days after fertilization. I use embryo transplantation 3 to 5 days after fertilization. The later the embryo transfer is delayed, the higher the requirements for in vitro culture conditions will be. However, delaying the transfer is more in line with the physiology of pregnancy. At the same time, it can also eliminate inferior embryos through natural selection, thereby increasing the pregnancy rate and reducing the multiple birth rate.

Hormone supplementation after embryo transfer:

Currently, we mostly use injections to give progesterone to support the corpus luteum. If pregnancy is confirmed, hCG supplementation is continued until the 10th week of pregnancy.

14 days after embryo transfer, pregnancy can be confirmed by urine test or blood draw.