How long does ovarian stimulation take

OHSS can be classified as mild, moderate, or severe. These symptoms may include mild abdominal bloating, nausea, and weight gain due to fluid. Women with moderate OHSS typically have more of these same symptoms. Women with severe OHSS usually have vomiting and cannot keep down liquids. They experience significant discomfort from swelling of the abdomen. They can develop shortness of breath, and blood clots can form in the legs.

In all cases of OHSS, the ovaries are enlarged. The size of the ovary is a marker of the degree of OHSS. If symptoms are present, a transvaginal or abdominal ultrasound can be done to measure ovary size and the amount of fluid collected.

OHSS can be serious, so careful monitoring and managing the symptoms are important whenever it occurs. For the conventional method, sperm is placed in the culture medium in a small petri dish containing an egg; the sperm and eggs are incubated together in the dish in the lab, allowing the sperm to enter the egg on its own.

For ICSI, one sperm is injected into the cytoplasm of the egg using a needle and a sophisticated operative microscope. No matter which process is used, fertilization is checked the next morning.

Following fertilization, the IVF team and the couple determine exactly when embryo transfer will take place — anywhere between 1 and 6 days but usually days after egg retrieval. However, if the decision is made to do genetic testing, first a biopsy is taken from the embryo, almost always on culture day 5 or 6.

Usually 3 to 8 cells are sent for testing performed at an outside lab, while the embryos are frozen and remain in the IVF laboratory. After receiving the genetic test results, the selected embryo is chosen, thawed and transferred into the uterus, usually within 1 to 2 months after the egg retrieval. The number of embryos produced depends on several factors including the age of the couple. In the past, multiple embryos were transferred in the hope of maximizing success but this often resulted in twins or rarely triplets, both of which are associated with pre-term birth and other serious complications to both babies and mother.

The safest approach is to limit transfer to a single embryo. To maximize the chance for success, the healthiest embryo is selected by the embryologist based on a grading system used to evaluate each embryo. We have found that this method is more precise and reliable as compared to the traditional method — which is usually manual measurements in two dimensions. The computer in the machine traces the follicle borders in three dimensions.

It then calculates a volume for each one. From the volume it calculates an average diameter for each follicle as if it was a sphere. Close-up view of the transverse plane from the same image above Computer generated tracings of follicles are different colors Rendered 3D ultrasound picture of follicles in stimulated ovary.

See a sample Lupron IVF calendar that shows timing of office visits and procedures. Usually, it is not difficult to get enough follicles to develop. However, sometimes the response of the ovaries is poor — and a low number of growing follicles are seen.

The ability of the ovaries to stimulate well and give us numerous eggs can be predicted fairly well by an ultrasound test — the antral follicle count.

The minimum number of follicles needed to proceed with in vitro fertilization treatment depends on several factors, including their sizes, age of the woman, results of previous stimulations and the willingness of the couple and the doctor to proceed with egg retrieval when there will be a low number of eggs obtained.

In our experience, IVF success rates are very low with less than 3 mature follicles. Some doctors will say that you should have at least 5 that measure 14mm or greater while others might do the egg retrieval with only one follicle. Women that are more likely to be low responders to ovarian stimulation would be those that have low antral counts, those women who are older than about 37, women with elevated FSH levels , and women with other signs of reduced ovarian reserve.

Patient Resource Center. This can be very effective, but if the hormonal balance or the condition of the lining of the womb uterus is in question, the clinic may elect to delay transfer until a later cycle, where they will do their best to ensure appropriate development and receptivity of the lining of the uterus. A frozen embryo transfer is also preferred in patients with a higher risk of over stimulation, or the complication called Ovarian hyperstimulation syndrome OHSS.

It is a fact that symptoms of OHSS may worsen if the patient becomes pregnant during a treatment cycle. Patients at risk of OHSS will often be scheduled for a frozen Embryo Transfer FET to allow the ovaries and the lining of the uterus to recover from stimulation and return to normal.

In a frozen embryo transfer the clinic will wait until a future menstrual cycle before attempting to implant the embryo back in the womb. This would usually be a month later but could be several months later depending on your situation.

We are seeing an increasing number of frozen embryo transfers recently, as it can help the clinic to create an optimal uterine environment before implanting, particularly in those who are considered high responders to egg stimulation.

All patients having IVF will be given some form of progesterone to support the recently transferred embryo. This is to help the embryo remain implanted and to support it in the early stages. Progesterone will be in the form of a vaginal pessary, tablet, or an injection. Patients having a frozen embryo transfer usually have even more progesterone support following transfer.

This may continue for many weeks depending on whether the embryo has successfully implanted, and a pregnancy is ongoing. At this point the clinic will have done all they can to give you the best opportunity at getting pregnant. After 2 weeks you will take a blood pregnancy test to find out if you have achieved pregnancy — a quantitative blood test that shows how much human chorionic gonadotropin hCG is in your blood.

If you are pregnant, your clinic will want to regularly check on the development of the embryo and may ask you to continue with the progesterone and sometimes other medication to help maintain a healthy pregnancy. Despite advances in technology and understanding, many IVF cycles end in failure. According to the 2. Within these results is the inevitable variation in success rates which do vary from clinic to clinic.

If you have a failed IVF cycle it does not mean you are doomed; many people experience success on subsequent cycles. As a result of the pandemic, hospitals are currently being pushed to their limits and therefore it has become more difficult to get IVF treatment when needed.

There are still many steps prior to treatment you can take, with a lot of consultations and screenings now taking place virtually. If your body does not respond as expected to the medication, then the amount of good quality eggs produced can be low or none. On the other hand, some women can be overstimulated by fertility medication and experience OHSS ovarian hyperstimulation syndrome.

If you encounter either of these issues you may have to abandon the current cycle and possibly start your cycle over again. Embryos can be analysed through genetic testing prior to implantation.