Step 1: Control Ovarian Hyperstimulation (COH)

COH is achieved with different protocols. The most popular protocol is the GnRH antagonist which prevents premature ovulation by suppressing the secretion of gonadotropin hormones. After optimum suppression is reached, the next step is to recruitment of multiple follicles with regular gonadotropin injections. The follicular growth is monitored using ultrasound imaging and hormone tests. When the lead follicles are of the correct length, HCG administration completes the final maturation of the eggs. Egg recovery 34-36 hours after HCG injection is scheduled. You can opt ivf in hyderabad for a better quality success.

Step 2: Egg Retrieval

Egg recovery is conducted in an intravenous sedation procedure. Ovarian follicles are drawn in with a trans-vaginal ultrasound-guided needle. The embryologist scans follicular fluids to locate all available eggs. The eggs are placed in special media and cultivated before insemination in an incubator.

Step 3: Fertilization and Embryo Culture

When sperm parameters are natural, about 50,000-100,000 motile sperm is transferred to the egg dish. It is referred to as normal insemination. 

The ICSI process is used for fertilizing mature eggs with abnormal sperm parameters. This is done under a high-powered microscope. The embryologist extracts a single sperm with a thin glass micro needle and directly injects it into the cytoplasm of the egg. If the sample has low sperm count and/or motility, poor morphology or poor development, ICSI increases the probability of fertilization. Unless the ejaculate does not contain sperm, sperm can be retrieved by surgery. ICSI is often used when the sperm is surgically removed to achieve fertilization.

Fertilization after insemination or ICSI is measured 16-18 hours. The fertilized eggs are called zygotes and cultivated in a culture medium which supports their development. They will be tested after recovery on the second and third day. If adequate embryos are well developed and developing, they can grow in a culture medium specifically designed for the blastocyst stage. There are also benefits to the history of blastocyst. Embryos have a higher propensity for implantation at this time so that less embryos can be transferred to reduce the chance on day 5 for multiple embryos. Low embryo numbers and low embryo production reduce chances to produce successful blastocysts. For small number and/or poor quality cycles, a day 3 embryo transfer is recommended.

Step 4: Embryo Quality

Several criteria are used to determine the embryo output. This is especially important when deciding which embryos to be used for the transfer of embryos. The embryo will be examined and photographed by the embryologist early in the morning on the day of the move. Depending on the rate of development and appearance of the embryos, the embryologist and your doctor will determine which and how many embryos are required to be transferred. 


Embryos are usually moved at a stage of cleavage (day 3 following oocyte recovery) or at a stage of blastocyst (day 5). A rating system is used in the laboratory to determine the consistency of the embryos.

Day 3 Transfers

Day 3 embryos are called cleavage phase embryos of 4 to 8 cells. We examine not only the number of cells, but also cell structure and fragmentation when analyzing such embryos. The cells divide unevenly and fragmentation contributes to cell-like structures that congest the embryo. There is no preferred heterogeneity, but some are appropriate. In our laboratory, we divide embryos into grades 1 to 4. Grade 1 represents the best embryos of production.

Day 5 Transfers

Day 5 embryos are called embryos of blastocyst. At this stage, the embryos are larger and more mature. They  look like a ball of fluid cells inside. One thing we are looking at this point is how these embryos are expanded.   The further developed, the better the embryo’s output. These embryos are also graded by a scale of 1 to 6. Grade 6 is the highest blastocyst rating.

Step 5: Embryo Transfer

When embryos enter the cleavage stage (6 to 8 cells), or when the blastocyst stage is reached, the embryos are transferred on day 3.Transfer of embryos is a straightforward procedure without anesthesia. Embryos are wrapped in a soft catheter and placed under ultrasound guidance in the uterine cavity via the cervix. You can opt for a fertility center in hyderabad for a good success.