Procedure Period

A. Scheduling of the menstrual cycle

During this period, an oral contraceptive is prescribed to some women to adequate the menstrual period date to the date of the procedure.

A day before the suspension of this prescription, a subcutaneous drug is indicated to supress the normal stimulus from the hypophysis to the ovaries, which shall be use daily until otherwise indicated. In average, four days after suspending the contraceptive patient will present her menstrual cycle. The first day of menstruation is the first day of the cycle, which must be informed inmediately that same day to the physician.

At the start of this period you will be verbally informed and in writing about the scheduled date for the procedure and the protocol of medication that will be applied.

B. Ovarian Hyperstimulation or endometrial stimulation

In case of being an IVF, GIFT or ICSI, medication is indicated to estimulate the ovaries to develop multiple ovarian follicles, within which the eggs mature. This stimulation can last nine days or more, as the follicle growth requires it.

In case of being a procedure with egg donation or a frozen embryo transfer, drugs for the growth of the endometrium are indicated (endometrial growth inducer). The endometrium is is the most inner layer of the uterus. In any case, follow-up of the response to medication wil be conducted via a transvaginal ultrasound and estradiol in blood levels (two to four appointments in average).

The patient will start the treatment while at home, but her presence in Mexicali will be required the previous week to the procedure for follow-up (about the sixth or eighth day of the cycle).

The average staying in Mexicali is about ten to twelve days. This will depend on things like how far re you from home. If your husband can not accompny you on this stage of the procedure, you should not worry about, since your presence will only be required until the day of the aspiration, day in which the sperm sample is taken.

In general, a full follicle development or an adequate endometrial growth takes place around day twelve of the cycle, followed by the follicle aspiration on day thirteen or fourteen. Ocasionally, the quality and quantity of the stimulated follicle are not the adequate, which in such case, cancellation of the procedure takes place. The full cost of the treament does not need to be covered.

On the other hand, in case of an excesive response in the number of follicles, full cost of the procedure must ne covered one day prior to aspiration. In this case, usage of albumina and hospitalization may be required.

C. Follicle aspiration

After 34-36 hours of application of the hCG, the patient is hospitalized without having taken any food. Under sedation, the aspiration of the follicle fluid that contains the egg takes place guided by ultrasound. The patient then goes to Recovery, getting out of the hospital aproximtely 2-3 hours later.

The day of the aspiration a sperm sample is requested, which is prepared to put it in contact with the eggs, either by IVF or ICSI. In this last one method some cases requires aspiration of te epididymis or testicular biopsy, as well as micromanipulation of the male and female gamete in order to insert a single sperm into an individual egg.

Ocasionally, when analyzing the sperm sample it is possible that the parameters has changed from previous studies not being adequate for an IVF. In this case, the physician will proceed with an ICSI. In case of a GIFT, once the eggs as been obtained, the sperm and the egg is transfered to one of the fallopian tubes through a laparoscopy. The patient goes home that same day.

D. Embryo Transfer

The following day after the aspiration around 11 am the results will be delivered, in other words if fertilization has occured. In general, 70-80% of eggs get fertilized. 48 hours later, a revision is required to look for cellular division, providing a tentative date in which the embryos will be transfered. Usually, transfer gets done between second and fifth day after the aspiration, depending on the number and characteristics of the embryos.

The patient will enter the hospital for the transfer around noon, with breakfast taken if desired, and not requiring any medication or anesthesia (in special cases). Procedure consist in transfering the embryos all the way into the uterus, in a very similar way to a conventional intrauterine insemination. The patient will go the recovery and will leave the hospital around two hours later.

A report will be delivered to the patient with the corresponding recommendations.

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