Once the follicles are ready for retrieval, injection HCG is given so as to make the eggs ready for retrieval.

The retrieval is usually scheduled 34-36 hours following HCG injection. The patient is generally called empty stomach so that short sedation could be given for the procedure. A needle is inserted through the vagina into the ovaries under ultrasound guidance but the patient does not feel the pain due to sedation. The follicles are punctured one by one and the fluid containing the eggs is collected in test tubes and quickly given to the embryologists in the IVF laboratory. The procedure takes about 15-20 minutes to complete. Simultaneously husband is asked to give his semen sample. An abstinence of 2-5 days is recommended before the scheduled day of retrieval. After the procedure is over, the patient is allowed to rest for some time and then sent home. The patient might have some pelvic pain or soreness and heaviness with some amount of spotting on that day. She is advised rest and abstinence on the day.

Once the eggs are retrieved, they are placed in special culture media inside special carbon dioxide incubators for a few hours during which time the semen sample is prepared. The best quality sperms are then placed in the same dish as the eggs so as to allow them to fertilize the eggs. Alternatively, fertilization can also be achieved by injecting the sperms directly into the eggs by performing ICSI (Intracytoplasmatic sperm Injection).
Normally an embryo starts to cleave first into two then into 4 cells after 36-48 hours. The best quality embryos are then transferred back into the uterus on D3 to D5 depending on several factors.

This procedure is scheduled either on D3 or D5 of the retrieval depending on the number and the quality of embryos. The number of embryos to be transferred would depend on the age, previous IVF history, quality, number of embryos available etc. The embryologist loads the embryos into a thin catheter and the specialist passes the tip of catheter through the cervix into the uterus and transfers the embryos under ultrasound guidance. This procedure is totally painless and does not require sedation. The additional good quality embryos, if available, are frozen and kept for future use.
On the day of transfer there is no need of fasting and the patient is asked to come with a partially full bladder will allows transfer to happen easily and gives a better picture ultrasonographically. Thereafter the patient is advised rest for a couple of hours and should be completely relaxed. It is pertinent to mention here that nothing the patient does such as walking, going to washroom etc would dislodge the embryos from the uterine wall. The main factors that determine whether implantation would take place or not are the receptivity of uterine living and the viability of embryos.

Following Embryo transfer, progesterone support is started to enhance the chances of a successful IVF pregnancy. Progesterone is the natural hormone which the body produces to support the endometrium and maintain an early pregnancy.

The pregnancy test is usually scheduled two weeks after the embryo transfer. This might be the most difficult time for the patient but she needs to be relaxed. She might experience a feeling of heaviness or cramping in the lower abdomen. Sometimes there might be some spotting as well but the medication should not be discontinued.
On the day of the test, if it is positive, a repeat test is done after 2-3 days to ascertain the growing levels of BHCG. If unfortunately the test is negative, the patient is instructed to stop the medicines and then counselled for her next step. Another cycle of treatment can be started as soon as one month after the failed cycle.

1. Avoid heavy work and vigorous exercise.
2. Use the steps sparingly and with caution.
3. Avoid vaginal creams or lubricants other than those prescribed by your specialist.
4. Avoid intercourse until advised. Avoid hot baths, Jacuzzis.
5. Travel slowly and avoid jerks.
6. Avoid stress.