Mini-IVF™ stimulates your ovaries with minimal medications (an oral stimulant, such as Clomid, and an injectable combination of FSH and LH hormones) to produce only the best quality eggs your body can mature in one cycle (approximately one to three eggs). The mild nasal spray Synarel is used for ovulation induction, which has a short half-life in the body and does not have the side effect profile common to hCG. The major benefits of the Mini-IVF™ protocol are listed below.
Step 1: Ovarian Stimulation and Cycle Monitoring
On or near day three of your menstrual cycle, you will begin a daily course of an oral stimulant, such as Clomid, as needed, until your follicles have developed sufficiently for ovulation. Some injectable medication may also be necessary depending on your hormonal requirements. Routine sonograms and blood tests will monitor follicular growth progression and ovulation timing.
Figure 3.1 Follicular Growth Progression: Once follicles have
reached the desired size, ovulation will be triggered.
Step 2: Egg Retrieval
Prior to ovulation, once your follicles have reached the desired size and your hormone levels have risen, a trigger will be used to prompt final maturation, approximately 36 hours before egg retrieval. On the day of retrieval, a thin, flexible ultrasound-guided needle will be directed to the ovaries through the vaginal canal for egg collection. Since this protocol uses a small, flexible needle and produces only a few eggs, retrievals are relatively quick and simple. Note: You have the option of local anesthesia or IV sedation. However, most patients choose local anesthesia with an antianxielytic such as valium.
After retrieval you may experience spotting and abdominal tenderness. This is normal and should subside shortly after the procedure. Though the entire retrieval process will last approximately three to ten minutes, please allow a few hours for recovery. Note, on a case-by-case basis, if any of your eggs are not fully matured at the time of retrieval, they may be developed via in-vitro maturation (IVM).
Figure 3.2 Egg Retrieval: An ultrasound-guided needed
will be directed to the ovaries through the vaginal canal.
Step 3: Sperm Collection
Immediately following egg retrieval, sperm is collected from your male partner through ejaculation in preparation for fertilization. If your partner is unavailable the day of your retrieval, he may produce sperm at an earlier time and it will be frozen until needed. Sperm previously obtained from a TESE may be used at this time. Also, if you wish to use a sperm donor, your personal care team can guide you in the process of obtaining donor sperm prior to egg retrieval.
Step 4: Fertilization and Assisted Hatching
In most cases, the sperm is added to your mature egg(s) and fertilized via intracytoplasmic (ICSI) sperm injection. Once fertilized, cell division occurs in the zygote and may be transferred on the second day after fertilization. If the plan is to transfer an embryo into the uterus five days after fertilization, it must "hatch," or escape from the zona pellucida, before it can implant for pregnancy. Thus, all zygotes in our laboratory undergo laser-assisted hatching on the third day after fertilization to enhance implantation as an embryo.
Figure 3.3 Fertilization: Sperm and egg are fertilized.
Step 5: Culturing and Selection
Based on a patient's clinical history, embryos are cultured for up to five days prior to transfer. The culturing process aids in selecting the best quality embryos for transfer, ensuring the viability of the embryo to undergo implantation, gestation and live birth.
Step 6: Embryo Transfer
Embryo transfer only takes a few minutes and requires no incision or medication. In preparation, it is important that you maintain a regular schedule and avoid stress and strenuous exercise.
The embryos are placed in a small amount of fluid and injected gently into the uterus through the cervix with a long, thin catheter. The transfer feels similar to a pap smear and requires no anesthesia, though you may experience minor cramping following the transfer. Post-transfer, embryo implantation generally requires two to five days.
Since New Hope promotes a single-zygote/embryo transfer policy, you can choose to freeze surplus embryos using our vitrification freezing method to be placed in your personal embryo bank.
Figure 3.4 Embryo Transfer: Embryos are injected into the uterus.
Step 7: Confirmation
A pregnancy test performed seven to twelve days following transfer will confirm whether the embryo has successfully implanted. An ultrasound, typically performed three weeks after a positive pregnancy blood test, will confirm pregnancy.