Ovarian Stimulation

• The ovaries will be stimulated to produce eggs.
• Firstly, a gonadotropin-releasing hormone (GnRH) analogue is given for about 8-10 days. 
• Secondly, daily injections of human menopausal gonadotrophin (hMG) are given to stimulate the ovaries to produce an increased number of follicles containing the eggs.
• After about 8 days, the number and size of the follicles will be measured using ultrasound. 
• When 1-2 of the follicles reach 18mm in diameter, an injection of human chorionic gonadotrophin is given, and the oocyte retrieval scheduled for 36hrs later.

Oocyte Retrieval

• The oocytes will be retrieved via transvaginal ultrasound.
• Ultrasound allows the physician to visualize the follicles and can then push a needle into each of them and aspirate the fluid inside the follicle containing the oocyte. 
• The follicular fluid is examined by laboratory personnel for the presence of the egg and if found, is placed in an incubator.
• This is done for all the follicles.

Semen Processing and Insemination

• At the time of oocyte retrieval or immediately thereafter, the male partner's sperm will be processed to isolate the highest quality sperm.
• The best quality sperm will then be used for inseminating the oocytes.
• Approximately 5-6hrs after the oocyte retrieval, the oocytes and sperm are put together in a petri dish and placed in an incubator.

Fertilization Check (Day 1)

• After 18hours of coincubation, the eggs are examined for the presence of two pronuclei, one male and one female, which will indicate that fertilization has taken place.
• The fertilized oocytes are then transferred to special culture media to allow them to develope further.

Cell Division (Day 2)

• At this stage, the fertilized oocytes would have started cell division and would show 2 to 4 cells stages.
• These embryos are then again placed in special media to help them develop further.

Embryo Biopsy (Day 3)

• On Day 3, these embryos will be at the 6-8 cell stage.
• At this point, it would be considered safe to remove one of the cells (blastomeres) for Preimplantation Genetic Diagnosis (PGD).
• A hole is made in the outer covering of the embryo (zona pellucida) using an acid solution.
• Thereafter, one of the blastomeres is aspirated through the hole into a biopsy pipette.
• The blastomere is placed on a slide and is ready for PGD.
• The embryos are placed back into the special culture media to allow them to developm futher.

Cell Division (Day 4)

• On Day 4, the embryos will start to compact and enter the morula stage.

Embryo Transfer (Day 5)

• On Day 5, the embryos will be at the blastocyst stage, the last stage before they start to hatch and subeseqnetly impnat into the uterus.
• Upon review of the Preimplantation Genetic Diagnosis (PGD) results, only the normal embryos will be transferred into the uterus.
• Embryo transfer involves aspirating the embryos (blastocysts) into a catheter, and passing the catheter through the cervix into the uterine cavity and depositing the embryos in the uterus.
• The embryos should then be able to implant into the wall of the uterus.
• Hormonal treatments are given for the following 3 weeks.
• Any excess embryos not transferred  may be cryopreserved for later use

Pregnancy Test

• A pregnancy test is scheduled for 14 days after the embryo transfer.