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IVF Thailand |
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Introduction |
Treatment options range from the
most simple to the most high-tech , according to the causes of
infertility and the decision making will be made together by the
patients and the doctor. The successful of treatment needs a
shared concern , co-operation and understanding of both
partners.
Assistance may first be given to couples trying to achieve a
pregnancy by monitoring cycles and timing natural intercourse.
If ovulation is not regular then drugs may be used in the early
part of the cycle to help ovulation more reliable. The chance of
conception are higher if more eggs are produced , therefore an
ovarian stimulation protocol may be used. Each patient's
prescription is carefully designed and the dosage varies
depending on age and the cause of infertility.
In Vitro Fertilization (IVF)
In Vitro Fertilization technically mean "fertilization outside
of the body." While considered an experimental procedure for
years, IVF has been a proven way for many couples to build their
family.
The IVF program is made up of four steps:
1) Use of fertility medications to develop oocytes or "eggs."
2) Collection of the oocytes (eggs).
3) In Vitro Fertilization of the egg and growth of the embryo.
4) Replacement of the embryo back into the uterus.
Developing and Monitoring Follicles
To assist in follicle growth, you will be started on a program
of medication. These medications shut off pituitary stimulation
to the ovaries. By shutting down the pituitary, the ovaries are
isolated so that oocyte (egg) development is stimulated by
medication alone. These medications are used together to help
stimulate multiple follicles so that, at the time of egg
retrieval, several eggs can be collected. This increases the
number of eggs that have an opportunity to fertilize and develop
into embryos.
After starting these medications, you will be monitored for
follicle growth with both transvaginal ultrasounds and a blood
test for estradiol (E2.) The size of the follicles and amount of
E2 present tells if the follicles have reached optimal maturity.
This may require 8-12 days of treatment, with several
ultrasounds and blood tests. When the follicles are mature, you
will receive an injection of human chorionic gonatotropin (hCG)
to begin the final maturation of the eggs. Eggs are collected 36
hours after the medication is given.
Collection of the Eggs
Mature eggs will be collected by ultrasound-directed needle
aspiration. Follicles are located by ultrasound and then a
needle is guided through the top of the vagina into the ovary to
aspirate the eggs from the follicles.
Fertilization of the Egg and Growth of the Embryo
Once the eggs are retrieved, they are transported to the
in-house Assisted Reproduction Technology (ART) laboratory where
they are placed in a special culture medium (fluid) and allowed
to remain there for approximately 2-3 hours. A semen specimen
collected by masturbation is given to the lab within one hour of
collection on the morning of your procedure. You must abstain
from intercourse for 2 days prior to the IVF procedure. This
ensures optimal sperm quality. The sperm are prepared and a
small number of active sperm are placed in the medium with each
egg. If Intracytoplasmic Sperm Injection (ICSI) is to be done,
it will be performed approximately 4 hours after the oocyte
retrieval.
The eggs will be examined for the first time approximately 18
hours after the time of insemination to determine if they have
fertilized. You will be informed about the outcome of
fertilization the day after your retrieval. If fertilized, the
eggs will be kept in the incubator for an additional day or
possibly two for further development before they are transferred
to your uterus.
Embryo Transfer
All of the eggs you produce will be collected. In consultation
with your physician, you will decide the number of embryos to be
transferred back to you. The risk of multiple pregnancy must be
considered carefully in this decision. You will need to decide
before the IVF procedure what will be done with the remainder of
the embryos. Your choices include the following:
1) discarding the extra eggs before fertilization
2) freezing extra embryos for future pregnancy attempts for
yourself
3) donating the unfertilized eggs to another infertile couple.
Information regarding these choices is included in the packet of
information you will receive from the IVF team. It is critical
that you make your decision known regarding the disposition of
any extra eggs and/or embryos before the cycle begins.
The embryo replacement procedure is very simple and requires no
anesthesia. The embryos are picked up into a very fine catheter,
which is inserted into the uterus through the cervix, and the
embryo(s) are placed into the uterine cavity.
You will need to stay in a reclining head down position for
approximately 2 hours after the embryo(s) have been placed in
your uterus. Activities after embryo replacement should be
minimal for the first 72 hours. After that, you may resume your
normal activities, albeit no sports activities and no
intercourse until your pregnancy test results are known. You
will receive progesterone injections until pregnancy test
results are known. Progesterone is given to assist successful
embryo implantation. If you are pregnant, further instructions
related to activity level and progesterone supplementation will
be given.
Risks
You will be taking strong medications to stimulate egg
production. While these medications have been proven safe to
use, there are some possible side effects of which you need to
know.
These side effects may include:
* Ovarian Hyperstimulation - the ovaries become too
stimulated and can become very large with cysts. In severe
cases, fluid collects in the abdomen and lungs, blood clotting
problems may occur, fluid and electrolyte imbalances can occur
and rarely, life-threatening complications may ensue. Deaths
have occurred with severe hyperstimulation syndrome (OHSS.) Your
procedure may be canceled if the risk for hyperstimulation is
high. Ovarian hyperstimulation may require hospitalization.
Severe hyperstimulation occurs in less than 1% of cases.
* Ovarian Torsion - the ovary twists around its blood
supply causing blood flow to be shut off; this is rare (less
than 1% of all assisted reproduction procedures), but if it
occurs, it may require removal of the affected ovary.
* Multiple Gestation - multiple gestations (twins,
triplets, quadruplets) are more common with this procedure,
occurring about 25% of the time. Most of these multiple
gestations are twins. As with any multiple gestation, there is
an increased chance of preterm birth. Some of the major problems
associated with preterm birth may include respiratory distress,
brain hemorrhage, and nervous system problems such as blindness
and cerebral palsy. It is your decision in consult with your
physician as to how many embryos are returned to the uterus. If
a multiple pregnancy does happen, the option of selective fetal
reduction (aborting some of the fetuses while still carrying
some) is available.
* Egg Retrieval/Laparoscopy Risks - if you have a
transvaginal egg retrieval, laparoscopic egg retrieval or embryo
transfer, the risks are very low (about 3 in 1,000) and may
include: injury to the intestines, blood vessels, and bladder
(if this does occur, it would be repaired during surgery, but
would require a larger incision), infection and bleeding. In the
unlikely event of physical injury resulting from your
participation in this procedure, it is important to understand
that the costs of such treatment will be at your own expense and
that financial compensation from your insurance carrier may not
be available.
* Ectopic Pregnancy - the risk of ectopic (tubal)
pregnancy is slightly higher than in natural pregnancy,
approximately 5% (5 out of 100.)
* Ultrasound - ultrasound has been used in obstetrics and
gynecology for many years with no cases of fetal abnormalities
or maternal complications directly related to its use.
Alternatives
Alternative treatments, including other assisted reproductive
procedures (Gamate Intrafallopian Transfer - GIFT; Zygote
Intrafallopian Transfer - ZIFT), ovulation stimulation with
intrauterine insemination (IUI), no treatment, and adoption are
available.
Recovery Time
The expected recovery time for IVF is 72 hours of minimal or no
activity.
Signing of Consent Form
The consent form set forth must be executed before you begin
your first IVF treatment. Your joint consent will be binding in
the future, even though your personal circumstances may change.
Costs
IVF will cost between US$ 5,500 - 6500. There is no way of
accurately estimating in advance the cost of the fertility
treatment since it depends upon your medical history and the
amount of medication required. The maximum you will pay is US
$6500.
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