The IVF cycle complete guide in Azoury IVF Clinic

Your IVF guide in AZOURY IVF CLINIC.
All the practical information you need to know to make your experience better.
Please note that you can ask for a FREE consultation with our IVF consultants Dr. Jessica Azoury or Mrs Krystel Kaldawi at any time of the process.

1. Previous exams

   • Undergoing an IVF process means that you were not able or you have failed to conceive naturally.

   • In some cases, Dr. Azoury might ask for some medical tests after performing the ultrasound during your first visit. However, in the majority of cases, you will not need additional tests since the ultrasound and the previous tests performed elsewhere are enough for Dr. Azoury to come up with a diagnosis.

   • Serology tests (less than 1 year old) are mandatory for all to ensure laboratory safety.

2. Ovarian stimulation

   • The goal of this step is to have a high number of eggs (more eggs = more embryos = more chances of having a baby).

   • How? By taking daily injections of hormones for a period of time that generally varies from 8 to 12 days.

   • When? You should start at day 2 of your period (Come at day 1 – or day 3 if you cannot make it on day 2 or if day 2 is a Sunday).

   • After coming to the clinic on day 2, an ultrasound is necessary to start the treatment. Although Dr. Azoury may have told you to come without making an appointment, it is always better to call us on day 1 and make an appointment for the next day. Kindly note that Dr. Azoury might not be present in the clinic and that our working hours vary from one day to another. If, for any reason, you were not able to make an appointment, come at day 2 between 8:30 and 9:30 AM.

   • If your treatment seems complicated please do not hesitate to ask for the assistance of one of our midwives; it is better to spend two hours to understand the treatment than making any mistake and ruining the whole process!

   • After you start your treatment you will have to come for monitoring once or twice. At each of these visits, an ultrasound will be performed and Dr. Azoury will determine the evolution of your treatment.

   • These ultrasounds show the number and size of the follicles you have. When a satisfying number of follicles at the good size is reached Dr. Azoury will stop your stimulation and determine the time of your egg retrieval by prescribing an ovulatory injection.

   • The ovulatory injection is the most important injection in your treatment and it should be done at the exact precise time that the Dr. gave you. An error in the administration of this injection can lead to a complete failure and arrest of the cycle.

   • Some types of ovulatory injections cause Ovarian hyper-stimulation Syndrome (OHSS) which is the only danger you encounter during IVF. Please note that the stimulation protocol that we use has a 0.01% risk of OHSS and if you are at high risk, we will freeze all your embryos and will not perform fresh embryo transfer. Frozen embryos will be transferred to your womb on the next cycle after endometrial preparation (an easy process that does not require injections).

   • Please note that follicles are not the eggs but rather the “bags” that contain the eggs. Eggs cannot be seen by ultrasound. So the ultrasound gives us an idea about your response to the treatment but does not reflect it completely. You can have 10 follicles at the good size and 10 eggs retrieved. However, you can also have 10 follicles at the good size and zero eggs retrieved. Sometimes these “bags” are empty. On average, 60% of the follicles contain an egg.

3. Egg retrieval

   • This procedure is performed under sedation so it is not painful. However, you will need to have someone with you to take you back home.

   • You should not eat or drink anything before it.

   • You should take a shower in the morning before you come but please do not wear perfume or any cream with a strong smell, to avoid its spreading in the laboratory.

   • Egg retrieval takes between 2 and 10 minutes depending on the number of follicles you have.

   • The time of egg retrieval +/- one hour has to be respected so please be there on time.

   • You might see some bleeding after it and it is normal.

   • The pain after the egg retrieval procedure is comparable to the period’s pain and could last 2 to 3 days.

   • When you recover from sedation we can inform you about the number of eggs retrieved but we cannot give you details about their quality as egg quality assessment is not performed directly after retrieval.

   • Before you go, a midwife or a nurse will explain the treatment you need to start after retrieval and will give you an appointment for embryo transfer. DO NOT LEAVE before she does so.

   • You can resume normal life directly after this procedure. No need for food, drink or sexual life restrictions.

   • If you are undergoing egg freezing, your cycle ends here. Only mature, good quality eggs will be frozen. You will receive a call from the clinic on the same day or maximum 2 to 3 days later to inform you about the number of frozen eggs. No need to come to the clinic. However PLEASE remember to SIGN the egg freezing contract.

4. Fertilization and Embryo culture

   • Fresh sperm from the husband is collected on the day of egg retrieval, unless we have frozen sperm.

   • All mature, good quality eggs will be fertilized mainly using Intra-Cytoplasmic Sperm Injection (ICSI), we very rarely perform conventional IVF.

   • The whole semen sample will be prepared for ICSI and discarded after it. No “remaining” sperm will be kept in the laboratory or frozen unless the contrary is precized.

   • Bad quality eggs will not be fertilized as they will give bad quality embryos.

   • Embryos are cultured in an incubator that tries to ensure conditions as similar as possible to a woman’s womb.

   • Some of the fertilized eggs will give an embryo (on average 70%) while others will not.

   • Some of the embryos will divide correctly (75%) while others will not.

   • Regular assessment of embryo development will take place and will be noted.

   • We prefer not to give daily information of what is happening in the laboratory as this might sometimes lead to false hope or false alarms. We will give you all the information about all your embryos on the day of the transfer or the freezing.

   • The Embryoscope ensures un-interrupted embryo culture as it films the embryos while they are in the incubator. It will also allow the dis-selection of badly dividing embryos. You are encouraged to use the Embryoscope if you have previous unexplained IVF failure or in case you have a high number of expected eggs.

   • PGT

     The sex of the baby and its genetic status cannot be determined using morphology or the Embryoscope, they can only be determined using Pre-implantation genetic testing (PGT).
     If you are doing PGT whether for a medical cause or for sex selection please note the following:

     • Embryos are biopsied or prepared for biopsy on day 3 so PGT cannot be decided at the last minute.

     • PGT is very expensive and costs more than the procedure itself, so if you don’t have a real motivation to do it we will not encourage you to do so.

     • Only good dividing embryos will be sent for PGT there is no point in sending an embryo that did not divide well as even if it turns to be genetically normal, it will not implant.

     • We cannot predict the result before it is sent from the genetic lab, all embryos can be abnormal or normal and they can all be girls or boys. So for example, having a normal boy is not guaranteed.

     • Embryos that underwent PGT have more chances to give a pregnancy as they are genetically normal but it is not guaranteed that they will.

5. Embryo Transfer/Freeze decision

   • An IVF consultant will give you all the details about the procedure you went through and the results obtained.

   • Dr. Azoury will take the embryo transfer decision by taking into account your opinion and preferences as much as possible.

   • The number of transferred embryos depends on the mother’s age, embryo quality and endometrial quality.

   • If you are less than 35 years old, maximum two embryos will be transferred and the remaining embryos will be frozen.

   • We will freeze all the embryos in case of high risk of OHSS or if we have unsatisfying endometrial conditions. We will not transfer nor freeze any embryo in case of absence of good quality embryos

     • Please note that if the transfer is only performed if the Doctor thinks that your endometrium is suitable. If there is any problem in it, embryos will be frozen and not transferred.

     • If you have embryo freezing, do not forget to sign your contract !

     • If you don’t have embryos that can give you a real chance of pregnancy you will not have a transfer. It is hard to accept this fact, but it is still better than transferring embryos with no hope, paying embryo transfer fees, and spending 15 days waiting for a result that will turn out to be negative!

   • Embryo transfer Procedure

     • Please take a shower before you come and do not wear perfume or any cream with a strong smell, to avoid its spreading in the laboratory.

     • You can have breakfast before embryo transfer, unless you exceptionally have anesthesia.

     • You will be asked to drink water, this makes the transfer procedure easier but no need to explode your bladder!

     • Embryo transfer takes two minutes and it is a pain free procedure that does not require sedation.

     • You can use the bathroom directly after transfer (even in the same minute) with no risk of losing the transferred embryos.

     • A midwife will pass by you after transfer to make sure you are taking your medication properly and will give you a paper with the date and type of the pregnancy test you need to perform. Please do not leave before she passes by you!

     • The timing of embryo transfer (in hours) does not influence the result. You might have a long waiting time this day, as egg retrieval procedures for other patients are scheduled at the last minute and have to be done on time.

     • If you have Freeze-all of your embryos, you should come at day 2 of your next cycle for ultrasound and preparation of your endometrium. You will receive a call from the clinic on the day of embryo freezing to inform you about the number and quality of embryos frozen. No need to come to the clinic. However PLEASE remember to SIGN the embryo freezing contract anytime during your next visits.

6. Post-transfer Period

   • Activity

     • This period is the most stressful. You don’t want to make it harder by living in prison for 15 days!

     • You can directly resume your normal life.

     • You can sleep as usual.

     • You can travel, climb the stairs and take the car the same day.

     • The embryo needs to implant to receive nutrients from his mother’s blood. If it does not implant during the first 48 hours, it will die! So in case you decide to rest, you do not have to do it for more than 48 hours, as after this period what is done is done and resting cannot change anything.

   • Food

     • Caffeine intake should be moderate and, if possible, 3 hours away from vitamin intake.

     • Dr. Azoury prefers zero alcohol intake.

     • Smoking should be limited to a maximum of 5 cigarettes per day.

     • Fruits and vegetables should be disinfected before consumption using a specific product.

     • Avoid eating raw meat.

   • Symptoms

     • There are no symptoms whatsoever to tell you if the pregnancy has succeeded or not. Back pain, abdominal pain, bloating, nausea, sensitivity to some odors, and even blood spotting are normal and can be due to the hormones that you are taking.

     • Urine test will show negative at this period even if pregnancy has occurred so no need to spend money and stress on unnecessary urine pregnancy tests.

7. IVF outcome

   • Perform your pregnancy blood test on the date specified on your transfer day.
     The result, whatever it is, has to be sent to the clinic by whatsapp on the following number 00961 76 910891

   • If your first BHCG test is negative, please send us the result and stop your treatment, our midwives will contact you as soon as possible after discussing your file with Dr. Joseph Azoury to inform you about the next steps and possible solutions.

   • If your first BHCG test is positive, you continue your medication and repeat it 48 hours later.

   • If your second Bhcg test is decreasing, this is a very bad prognosis, you are experiencing a biochemical pregnancy, our midwives will contact you as soon as possible after discussing your file with Dr. Joseph Azoury to inform you about the next steps and possible solutions.

   • If your second Bhcg test is increasing slowly, this is not a very good prognosis but you will be advised to continue your treatment and repeat the test in one week.

   • If your second Bhcg test is doubling, this is a very good sign. You should continue your medication and you will have an appointment to confirm pregnancy by ultrasound 2 weeks later.

   Remember that we wish you the best and our goal is to help you and assist you to build your family in God’s Will.