Understanding IMSI Treatment
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There is a growing tendency in IVF to default every patient to a freeze-all strategy — freeze all embryos, transfer in a later cycle. It is not wrong. In specific clinical situations — high responders, elevated progesterone, PGT-A planned — it is clearly the better choice. But it is not the universal answer, and applying it universally does not serve every patient.
Fresh IVF Cycle — The Right Choice for the Right Patient
Not every patient needs to freeze all embryos and wait an extra 6–8 weeks. For the optimal fresh candidate, this path is faster, equally effective, and more cost-efficient.
An IVF cycle in which the embryo is transferred back to the uterus in the same stimulation cycle it was created — no freezing required.
Approximately 3–4 weeks from Day 1 of stimulation to embryo transfer. Pregnancy test 14 days after transfer.
Women under 38 with normal ovarian reserve, normal progesterone on trigger day, 2–5 embryos only, no OHSS risk, no PGT-A planned.
Day 3 (cleavage) or Day 5 (blastocyst) — Dr. Shah’s default is Day 5 blastocyst where embryo number permits.
Best For: Most patients — first-line choice for normal and high responders. PCOS patients.
Stimulation Duration: Day 2–12.
Trigger Type: hCG trigger or GnRH agonist trigger.
Best For: Endometriosis, adenomyosis, fibroids.
Stimulation Duration: Down-regulation 14–21 days.
Trigger Type: hCG trigger.
Best For: Poor ovarian reserve, low AMH.
Stimulation Duration: 9–12 days total.
Trigger Type: hCG trigger.
Best For: Very low AMH, poor responders.
Stimulation Duration: 5–8 days only.
Trigger Type: hCG trigger or natural LH surge monitoring.




The word “surgery” understandably causes anxiety. Understanding exactly what happens – in plain language – transforms this from something frightening to something logical and manageable. Here is every step of a diagnostic and operative laparoscopy at Wellspring IVF:
| Factor | Fresh Transfer | Frozen (FET) |
|---|---|---|
| Total cycle time | 3–4 weeks stimulation to result | 6–10 weeks |
| Endometrium quality | May be suboptimal | Fully prepared in a dedicated cycle |
| OHSS risk | Present in high responders | Zero |
| Cost | Lower overall cost | Higher due to vitrification and FET |
| PGT-A compatible | No | Yes |
The Evidence on Fresh vs Frozen Success Rates
Multiple large RCTs show: in normal responders with normal progesterone, fresh transfer success rates are equivalent to FET. In high responders, freeze-all strategies show significantly higher live birth rates due to the OHSS-free, fully prepared endometrium.
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Culturing to blastocyst (Day 5) allows natural selection — embryos with poor developmental potential arrest before reaching blastocyst, eliminating them from the transfer pool without invasive testing.
Fewer than 3 fertilised embryos, previous blastocyst arrest, or patient age with very few eggs.
For fertility patients, the choice between laparoscopic and open surgery is not simply a preference – it has direct consequences for recovery speed, adhesion formation, and how quickly you can attempt conception or IVF. Here is the complete comparison:
| Medication | Type | When | Purpose |
|---|---|---|---|
| Gonal-F / Puregon / Menopur | Recombinant FSH or FSH+LH | Days 2–12 | Stimulates ovarian follicles |
| Cetrotide / Orgalutran | GnRH Antagonist | Days 5–6 until trigger | Prevents premature LH surge |
| Ovitrelle | Trigger injection | 34–36h before OPU | Final maturation of eggs |
| Crinone gel / Utrogestan | Progesterone | From day after OPU | Supports uterine lining |
This decision is made in real-time during your cycle — not at your first appointment. At the trigger day monitoring (approximately Day 12), Dr. Shah checks: (1) your serum progesterone — if >1.5 ng/mL, fresh transfer is cancelled and all embryos are frozen. (2) Your endometrial thickness and pattern. (3) Your ovarian response — if OHSS risk is high. If all three are favourable, fresh transfer proceeds. If any one raises a red flag, freeze-all protects your embryos and your outcome.
For a standard antagonist protocol, approximately 10–15 injections in total: FSH/HMG daily for 8–12 days, GnRH antagonist for 5–6 days, a single trigger injection, then progesterone pessaries (not injections) for luteal support. The FSH injections are subcutaneous — most patients self-administer confidently within 2 days of the nursing training session. The needles are very small. For a long protocol: add 14–21 days of agonist nasal spray or injections before stimulation.
The injections: minimal discomfort — subcutaneous needles in the abdomen are well tolerated by most patients. Some mild bruising at injection sites is common. The egg retrieval: performed under IV sedation — you are asleep and feel nothing. Post-retrieval: mild cramping for 1–2 days, similar to period pain. Paracetamol is adequate. The embryo transfer: no sedation, no pain — a soft catheter through the cervix. Most patients compare it to a smear test. The procedure takes 5–10 minutes.
All surplus good-quality embryos — those that are not transferred in the fresh cycle — are vitrified (frozen) and stored at Wellspring IVF. These embryos remain yours and are available for future Frozen Embryo Transfer (FET) cycles. If the fresh transfer succeeds and you want a second child later, you may have frozen embryos available — eliminating the need for another full stimulation cycle. Frozen embryos can be stored for years. Full FET guide: Frozen Embryo Transfer at Wellspring IVF
For women under 35 with good ovarian reserve, the fresh transfer success rate at Wellspring IVF is approximately 60–75% per cycle. This depends on: your age, your embryo quality, your endometrial response, and whether Dr. Shah’s fresh vs frozen decision framework supports fresh transfer at your trigger day. The overall Wellspring IVF success rate (across all protocols and patient groups) is 70%+. Dr. Shah gives you a personalised probability at your first consultation — not a generic clinic average.
Yes — most patients continue working throughout stimulation. You will need to attend the clinic on approximately 3–4 weekday mornings for monitoring scans (each takes 30 minutes). Egg retrieval day requires a full day off — sedation means you cannot drive. Embryo transfer day: many patients take a half-day and return to light work the same evening. The 2-week wait: normal activity is fine. Physical exertion and hot environments should be avoided from trigger day onwards.
For a Day 5 blastocyst transfer (Dr. Shah’s default): 5 days after egg retrieval. Egg retrieval on Day 14 of the cycle → blastocyst transfer on Day 19–20. For a Day 3 cleavage embryo transfer (when indicated): 3 days after retrieval. From the first stimulation injection to the embryo transfer: approximately 3 weeks.
Continue: all prescribed progesterone and oestrogen medications exactly as directed. Light walking. Normal diet (high protein, avoid raw or unpasteurised foods). Normal sleep routine. Paracetamol for any pain (not ibuprofen). Avoid: hot baths, saunas, vigorous exercise, alcohol, smoking, heavy lifting. Do not stop progesterone even if you have spotting — spotting is common in early pregnancy and does not indicate failure. Wait for the blood beta-hCG on Day 14 post-transfer — do not rely on home urine pregnancy tests, which can mislead in both directions.