IVF – Four Steps

The In Vitro Fertilization (IVF) program is made up of four steps:

Developing and Monitoring Follicles

Follicles are fluid filled sacs located on the ovaries. The immature egg (oocyte) is attached to the inner wall of the follicle. As the egg becomes more mature, the follicle becomes larger. Information regarding maturity of the oocyte can be obtained by measuring the size of the follicle.

To assist in follicle growth, you will be started on medications that may include Gonal-F, Follistim, Bravelle, and/or Menopur. These injections are used alone or in combination to stimulate egg development. In addition, you will also use leuprolide acetate (Lupron), Cetrotide or Ganirelix. These injections suppress pituitary stimulation to the ovaries. By suppressing the pituitary, the ovaries are isolated so that egg development is stimulated by medication alone and not by the woman’s body.

After starting these medications, you will be monitored for follicle growth with both transvaginal ultrasounds and a blood test for estradiol (E2). The size of the follicles and amount of E2 present give us information regarding maturity. This may require 8-14 days of treatment, with several ultrasounds and blood tests. When the follicles are mature, you will receive an injection of human chorionic gonadotropin (hCG, Novarel, or Pregnyl) to begin the final maturation of the eggs. The oocytes are collected approximately 36 hours after hCG is given.

Collection of the mature eggs will be completed by transvaginal ultrasound guided needle aspiration. This technique is performed in the office with IV sedation. Follicles are located by ultrasound and then a needle is guided through the vaginal wall into the ovary to aspirate the eggs from the follicles.

You will be given IV medications (conscious sedation) for the actual egg retrieval day. Most patients do very well, with minimal discomfort. However, you do have the option to have MAC anesthesia (more sedation) if desired. Please talk to your doctor to get more information about this option. This will need to be set up prior to the IVF cycle.

Fertilization of the Egg and Growth of the Embryo

Once the eggs are retrieved, the embryologist will use a microscope to isolate the eggs, place them in a special culture medium (fluid) and allow them to remain there for approximately 2-3 hours. A semen specimen provided on the day of the egg retrieval will be used in the fertilization process. We recommend abstaining for at least 2 days prior to the IVF procedure. This promotes optimal sperm quality. The sperm are prepared and a small number of active sperm are either placed in the media with each egg or the Intracytoplasmic Sperm Injection (ICSI) procedure will be performed.

The eggs will be examined approximately 18 hours after the time of potential fertilization to determine if fertilization has occured. You will be informed about the outcome of fertilization the day after your retrieval. The fertilized eggs (embryos) will be kept in the incubator for further development before they are transferred to your uterus.

In consultation with your physician, you will decide how many eggs to attempt to fertilize and number of embryos to transfer back. The risk of multiple pregnancy must be considered carefully in this decision. There may be choices available to you if you have extra eggs or embryos:

–Discarding the extra eggs before fertilization,

–Freezing extra eggs or embryos for future pregnancy attempts,

–Donating the unfertilized eggs to another infertile couple,

–Donating the embryos to another infertile couple or research.

Information regarding these choices is included in the packet of information you will receive from the IVF team. It is critical that you make your decision known regarding the disposition of any extra eggs and/or embryos to your physician before the cycle begins. The Fertility Center will not discard any embryos. If you decide to discard embryos, you will need to sign the appropriate paperwork and personally discard them.

Embryo Transfer

The embryo transfer procedure is very simple and requires no anesthesia. The embryo(s) are picked up into a very fine catheter, which is inserted through the cervix, into the uterus, and the embryo(s) are placed within the uterine cavity. Activities after the embryo transfer should be minimal for the first few days. After that, you may resume your normal activities, albeit no sports activities and no intercourse until your pregnancy test results are known. If you are pregnant, you will be scheduled for an ultrasound approximately four weeks after transfer.