Home plan

Follicular growth is monitored to the time of ovulation (regular visits to the clinic) and the patients are advised on the optimal time for sexual intercourse. If the women's cycles are regular the same plan can be repeated for a period of time, without having to visit the clinic.

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Ovulation induction

Ovulation induction or super ovulation is the stimulation of the ovaries with the use of fertility drugs. Depending on the treatment response required the ovaries are stimulated to either mimic a normal ovulatory cycle (1-2 oocytes) or to produce a large cohort of oocytes (4-10 oocytes). During the induction process the response is closely monitored and at the correct time ovulation is induced.

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Artificial insemination (Ai)

Requirements:

• An adequate semen sample 
• Normal female reproductive pathway 

1. Hormone treatment (ovulation induction) to ensure the development of more than 1, but less than 3 oocytes. 
2. Monitoring of follicular growth. 
3. Induction of ovulation.
4. The sperm sample is prepared, on the day of ovulation. 
5. Intrauterine insemination of the wife with the husband's sperm. 
6. Pregnancy test (Day 12, after insemination).   
   

Number of visits to clinic: 4 to 7 per cycle
Pregnancy chance: 12-20% per cycle

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Gamaete intrafallopian transfer (GIFT)

Requirements:

• At least 1 million sperm cells per millilitre after preparation. 
• At least 1 normal Fallopian tube. 
• The production of 3 or more oocytes. 

1. Hormone treatment (super ovulation) to ensure the development of several oocytes. 
2. Monitoring of follicular growth. 
3. Induction of ovulation. 
4. The sperm sample is prepared approximately 2 hours before the aspiration of the oocytes. 
5. Laparoscopic (general anaesthetic) aspiration of oocytes. 
6. Transfer of 3 (mature) oocytes plus a sample of sperm into the upper part of the fallopian tube. 
7. Pregnancy test (Day 12, after transfer). 

Number of visits to clinic: 7 to 10 per cycle
Pregnancy chance

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In vitro fertilization (Ivf)

IVF is the original 'test tube baby' technique. The most common indication for this procedure is blocked or damaged Fallopian tubes.
Requirements:

• An adequate semen sample. 
• The production of 4 or more oocytes. 

1. Hormone treatment (super ovulation) to ensure the development of several oocytes. 
2. Monitoring of follicular growth. 
3. Induction of ovulation. 
4. Transvaginal aspiration of oocytes, under conscious sedation (intra-venous introduction of drugs for sedation).
5. The sperm sample is prepared approximately 2 hours before the aspiration of the oocytes. 
6. Oocytes are inseminated with the husband's sperm sample.
7. Embryo development (2-3 days).
8. Transvaginal transfer (no anaesthetic) of up to 4 embryos.
9. Pregnancy test (Day 10, after transfer).

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Intracytoplasmic sperm injection (icsi)

Requirements:

• The production of more than 4 oocytes. 

1. Hormone treatment (super ovulation) to ensure the development of several oocytes.
2. Monitoring of follicular growth.
3. Induction of ovulation.
4. Transvaginal (conscious sedation) aspiration of oocytes.
5. The sperm sample is prepared approximately 2 hours after the aspiration of the oocytes. The sample can be an ejaculated sample or a sample from a testicular biopsy.
6. A single sperm is injected into each oocyte (ICSI).
7. Embryo development (2-3 days)
8. Transvaginal (no anaesthetic; up to 4 embryos; into the uterus) or a laparoscopic (general anaesthetic; up to 3 embryos; into the Fallopian tube) transfer of embryos.
9. Pregnancy test (Day 10, after transfer) 

Number of visits to clinic: 7 to 10 per cycle
Pregnancy chance

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Embryo cryopreservation

Excess embryos, of good viability (8-cell stage on day 4 after aspiration), not transferred during the assisted reproduction procedure can be cryopreserved (frozen). These embryos can be transferred in a subsequent unstimulated cycle if no pregnancy was obtained from the original procedure.

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Oocyte donation

Oocyte donation presents many medical, ethical and legal issues. Counseling of both the donor and the recipient is therefore very important to resolve all possible problems (present and future). Indications for oocyte donation:

• Premature ovarian failure
• Absence of ovaries
• Female age associated with ovulatory dysfunction, repeated in vitro fertilization failure 
  and repeated pregnancy loss.
• Carriers of undesirable genetic traits.

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Risks of assisted conception

• Cancelled cycles
• Disappointment, as the overall chance of conception using an assisted reproduction procedure is only 20%.
• Multiple pregnancies (15% of conceptions).

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Benchmark results that can be expected in Assisted Reproduction