Qingdao Women and Children's Hospital IVF Process and Precautions Detailed Explanation

Opening: Real consultation scenario

"Doctor, we've been married for three years. We've had two failed IUIs at other hospitals. We want to ask, how exactly is IVF done at your hospital? How long does it take? How much does it roughly cost?" — This is one of the most frequently asked questions in the reproductive clinic. Below, I will break down the process, examinations, costs, and easily overlooked details to explain it clearly.

How is IVF Actually Done?

The Reproductive Medicine Center of Qingdao Women and Children's Hospital performs In Vitro Fertilization-Embryo Transfer (IVF-ET) and Intracytoplasmic Sperm Injection (ICSI). Simply put, the woman's eggs and the man's sperm are taken out, fertilization is completed in the laboratory, and after the embryo develops, it is placed back into the uterus. The entire process is divided into four core stages: Ovulation Induction → Egg Retrieval → Embryo Culture → Transfer. A complete cycle takes approximately 2 to 3 months, with the period from starting the cycle to transfer usually taking 4 to 6 weeks.

Suitable conditions include: blocked or severely粘连 fallopian tubes, moderate to severe endometriosis, male oligoasthenospermia, ovulation disorders unresponsive to repeated induction, and unexplained infertility after other treatments have failed. Unsuitable conditions include: untreated severe uterine structural abnormalities (e.g., large fibroids, severe intrauterine adhesions), uncontrolled acute pelvic infection, or severe medical or surgical conditions that make pregnancy intolerable.

Actual Process: From Initial Consultation to Transfer

Phase 1: Pre-operative Examinations and Filing

Both partners need to complete a full set of fertility assessments and pre-operative screenings, including:

• Female: Day 2-4 menstrual cycle hormone panel (FSH, LH, E2, etc.), AMH, antral follicle count, thyroid function, infectious disease screening (Hepatitis B, Hepatitis C, Syphilis, HIV), coagulation function, liver and kidney function, electrocardiogram, chest X-ray. Hysteroscopy or chromosomal karyotype analysis may be added if necessary.
• Male: Semen analysis + morphology assessment, sperm DNA fragmentation index (DFI), infectious disease screening, blood type, chromosomal karyotype (if there is recurrent miscarriage or severe oligoasthenospermia).

Once all test results are complete, both partners bring their original ID cards and marriage certificates to the hospital's reproductive center to file and sign the informed consent form. This step usually takes 2 to 4 weeks (depending on examination scheduling).

Phase 2: Ovulation Induction

Starting from day 2-3 of the menstrual cycle, gonadotropin injections (Gonal-f, Pergoveris, Lishenbao, etc.) are administered, lasting an average of 9 to 14 days. During this period, you need to return to the hospital for monitoring follicle development (ultrasound + blood hormone levels), typically every 2 to 3 days. When the leading follicles reach 18-22 mm in diameter and blood E2 levels match the follicle count, a trigger shot (hCG or GnRH agonist) is administered, and egg retrieval takes place 36 hours later.

Phase 3: Egg Retrieval and In Vitro Fertilization

The egg retrieval procedure is performed under intravenous anesthesia, using transvaginal ultrasound-guided follicle aspiration. The entire process takes about 10 to 20 minutes. After a 1-2 hour observation period with no complications, you can leave. Meanwhile, the male provides a semen sample. The laboratory selects conventional IVF or ICSI fertilization based on sperm quality. The fertilized embryos are cultured in an incubator for 3 to 6 days, forming cleavage-stage embryos or blastocysts.

Phase 4: Transfer and Luteal Support

Embryo transfer is performed on day 3 or day 5-6 after egg retrieval. The transfer procedure does not require anesthesia, is similar to a gynecological exam, and is completed in a few minutes. After the transfer, luteal support medication (dydrogesterone, progesterone gel, or injections) is started and continued until the pregnancy test 12 to 14 days after transfer. Remaining good-quality embryos can be cryopreserved.

Key Examination Indicators Explained: What These Numbers Mean

Many patients' primary concern after receiving test reports is, "Is my AMH level normal?" or "Can I still do IVF with such a high FSH?" Below is a clear explanation of the meaning of several core indicators.

Doctor's Perspective: Decision-Making Logic and Individualized Plans

In the reproductive center, doctors follow a patient-centered, evidence-based medical pathway for decision-making. Here are several questions doctors evaluate daily in the consultation room:

• Is this patient suitable for first-generation or second-generation IVF? First-generation (IVF) primarily addresses female factors like tubal issues; second-generation (ICSI) primarily addresses male factors like severe oligoasthenospermia. If both partners have issues, or if previous IVF fertilization failed, ICSI is also recommended.
• Which ovulation induction protocol to use? Age, AMH, AFC, weight, presence of PCOS or endometriosis all influence protocol selection. For example: young women with normal ovarian reserve often use an antagonist protocol; PCOS patients might use mild stimulation or a follicular phase long protocol; those with diminished ovarian reserve might use a PPOS protocol or mild stimulation.
• How many embryos to transfer? According to National Health Commission regulations, for first-time transfers in women under 35, a maximum of 2 embryos can be transferred; for women over 35 or those with previous transfer failures, 2-3 embryos can be transferred. However, single blastocyst transfer is becoming the trend to reduce the risk of multiple pregnancies.

What doctors least want to see are patients coming with unrealistic expectations or repeatedly requesting unnecessary tests due to anxiety. Trusting the doctor's professional judgment while proactively communicating your concerns is the most efficient way for doctor-patient cooperation.

Easily Overlooked Details: More Than Just Injections and Transfer

Based on daily clinical experience, here are several details many patients initially overlook but later find very important:

• Validity of pre-operative tests: Infectious disease screenings (Hepatitis B, Hepatitis C, Syphilis, HIV) are typically valid for 6 months; chromosomal karyotype is valid for life. If test results expire, they need to be redone, which can delay starting the cycle.
• Don't leave the male examination until the end: Many patients think IVF mainly concerns the female, and the male just needs a quick check. In reality, semen quality can fluctuate significantly. If the initial test is abnormal, a repeat test is needed after 2-4 weeks. Severe oligoasthenospermia may even require pre-treatment or sperm freezing. It is recommended that the male completes a semen analysis simultaneously when the female starts her examinations.
• Uterine cavity evaluation: For patients with recurrent implantation failure or ultrasound suggesting uneven endometrial echo, a hysteroscopy is recommended before transfer. Mild intrauterine adhesions, polyps, or endometritis may not be visible on ultrasound but can affect embryo implantation.
• Luteal support medication should not be stopped arbitrarily: Luteal support medication after transfer must be taken on schedule. Do not reduce the dose or stop on your own because you dislike injections or feel "nothing." Luteal phase deficiency can cause the implantation window to close, preventing embryo implantation.
• Emotions and sleep: Chronic anxiety and staying up late can affect the hypothalamic-pituitary-ovarian axis function, thereby impacting follicle development and endometrial receptivity. Try to maintain a regular sleep schedule during ovulation induction; this is as important as the injections and medication.

Frequently Asked Questions: Top 5 Things Patients Ask

Observations from a Practitioner: Some Honest Words

In my years working at the reproductive center, a few situations strike me as particularly regrettable: First, patients who still have a chance but, due to excessive anxiety, repeatedly switch hospitals and doctors, starting from scratch with examinations each time, wasting time. Second, having an excessive fixation on the "success rate," believing it should work the first time, and completely negating all previous efforts if it fails. Third, couples blaming each other, placing the entire burden of fertility on one person.

Assisted reproduction is a field of "probability medicine." No one can guarantee success on the first try. However, standardized diagnostic and treatment procedures, good doctor-patient communication, and stable psychological state can indeed make the journey smoother. The doctors at the Reproductive Medicine Center of Qingdao Women and Children's Hospital have accumulated extensive experience in handling complex situations like advanced age, poor ovarian response, and recurrent implantation failure. If you fall into these categories, it is advisable to bring all your previous medical records and test reports to allow the doctor to quickly understand your full picture.

Additionally, a positive change I have observed is that more and more people are proactively learning about the specific procedures and risks of IVF, rather than blindly "giving it a try." This rational attitude is commendable.