In Vitro Fertilization (IVF) is a process that was developed in the 1970s to overcome infertility. Since that time, IVF has helped countless people create the families they so desire. The term ‘In Vitro’ actually means “outside of the body” which is where fertilization happens during this process. A simple explanation for IVF is that eggs (oocytes) are retrieved from a woman’s ovaries and fertilized with sperm within an IVF laboratory. Once fertilization happens, an embryo is created. The embryo is then transferred back to the woman’s uterus for implantation to occur naturally.
A common misconception is that IVF is just the procedure itself. One round of IVF is actually called a ‘cycle’ because it works in tandem with your menstrual cycle. Typically, there is a month of preparation before the much anticipated IVF procedure month. Deciding to move forward with IVF is a big commitment – emotionally, physically, and financially. The good news? At The Fertility Center (TFC), your team of dedicated physicians and nurses are here to help you throughout each step of your journey.
Whether you’re an established patient who is ready to move on to IVF or you’re interested in becoming a patient here at TFC for the purpose of pursuing IVF, the first step is to speak to one of our physicians to determine if this is the best treatment option for you. Once your doctor has had the opportunity to review this with you, you can then move forward with paying your IVF deposit and scheduling your ART consult with one of our experienced IVF nurse coordinators.
We realize that this process can be overwhelming with all that it requires. That is why we have you meet with one of our nurses for this one-on-one appointment that details what you can expect, from start to finish. This consultation allows you to address any questions or concerns you may have about the process. You are encouraged to ask any and all questions so that you fully understand each step of the process and are comfortable with all aspects of your treatment plan. No question is too small – we are proud to be your greatest source of support.
Our IVF program consists of four steps:
Developing and Monitoring Follicles
Follicles are fluid filled sacs located within a woman’s ovaries. Immature eggs (oocytes) are attached to the inner wall of the follicles. As the eggs mature, the follicles increase in size.
To assist in follicle growth, you will be started on medications that may include Gonal-F, Follistim, and/or Menopur. These injections are used alone or in combination to stimulate egg development. In addition, you may also use leuprolide acetate (Lupron), Cetrotide or Ganirelix. These injections suppress pituitary stimulation of the ovaries. By suppressing hormones released by the pituitary, egg development is stimulated by the medication alone and not by a woman’s own body.
After starting these medications, you will be monitored for follicle growth with both transvaginal ultrasounds and a blood test for estradiol (E2) and progesterone (P4). The size of the follicles and E2 and P4 levels give us information regarding egg maturity. Ovarian stimulation may require 8-14 days of injections, with several ultrasounds and blood tests along the way. When the follicles are mature, you will receive an injection of human chorionic gonadotropin (hCG, Novarel or Pregnyl) and/or Lupron to begin the final maturation of the eggs. The oocytes are collected approximately 36 hours after hCG is given.
Collection of Eggs
Collection of the mature eggs (oocytes) will be completed by transvaginal ultrasound guided needle aspiration. This technique is performed in our office with intravenous (IV) sedation or anesthesia. 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 pain medications for the egg retrieval procedure. Most patients do very well with minimal discomfort. You have the option to have MAC anesthesia administered by an anesthesiologist or IV conscious sedation. Please talk to your doctor to get more information about these options. MAC anesthesia will need to be set up prior to your IVF cycle.
Fertilization of the Egg and Growth of the Embryo
Once the eggs are retrieved by one of our physicians, our embryologist will use a microscope to isolate the eggs. She will then place the eggs in a special culture medium (fluid) to optimize their development. Frozen sperm or 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 sperm collection. This promotes optimal sperm quality. After the sperm are prepared, a small number of active sperm are either placed in the media with each egg or Intracytoplasmic Sperm Injection (ICSI) will be performed.
The eggs will be examined approximately 18 hours after the time of potential fertilization to determine if fertilization has occurred. 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 the number of embryos to transfer back. The risk of a multiple pregnancy (e.g. twins) must be considered carefully in this decision. The following choices may be available to you if you have an excess of eggs and/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
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 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.
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 and into the uterus, and the embryo(s) are placed within the uterine cavity under ultrasound guidance. 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.
The medications you will be taking to stimulate egg growth have been proven safe for use; however, there are potential side effects and risks.
These side effects and risks may include:
- Ovarian Hyperstimulation Syndrome (OHSS)
OHSS is when the ovaries are over stimulated and become very large with cysts. In severe cases, fluid collects in the abdomen and lungs, blood clotting problems may occur, fluid and electrolyte imbalances can ensue and rarely, life-threatening complications may arise. OHSS may require hospitalization. Severe hyperstimulation occurs in less than 1% of cases. Deaths have occurred with severe OHSS. Due to these risks, your procedure may be canceled if the risk for hyperstimulation is high.
- Ovarian Torsion
The ovary twists around its blood supply causing a decrease in blood flow. This is rare (less than 1% of all assisted reproduction procedures), but if it occurs, it may require surgical removal of the affected ovary.
- Multiple Gestation
Multiple gestations (twins, triplets, etc.) are a risk with this procedure, occurring about 25% of the time for younger women. Most of these multiple gestations are twins. As with any multiple gestation, there is an increased chance of preterm birth. Some of the major problems associated with preterm birth may include respiratory distress, brain hemorrhage, and nervous system problems such as blindness and cerebral palsy. It is your decision in consultation with your physician as to how many embryos will be returned to the uterus. If a high risk multiple pregnancy does occur, selective fetal reduction with an outside provider may be an option.
- Egg Retrieval Risks
If you have a transvaginal egg retrieval or embryo transfer, the chance of a complication is very low (approximately 3 in 1,000 cases). Complications may include, but are not limited to, injury to the intestines, blood vessels, bladder, infection and/or bleeding. In the unlikely event of physical injury resulting from your participation in this procedure, it is important to understand that the costs of such treatment will be at your own expense and that financial compensation from your insurance carrier may not be available.
- Ectopic Pregnancy
The risk of an ectopic (tubal) pregnancy is slightly higher than in natural conception, approximately 2-5%.
- Ovarian Cancer
Some studies have suggested the possibility of a slightly increased risk of ovarian cancer.
Our embryology lab is equipped to handle a multitude of ART techniques including but not limited to:
Intracytoplasmic Sperm Injection (ICSI)
Time Lapse Photography
Embryo biopsy for Preimplantation Genetic Testing (PGT)
Embryo Cryopreservation (embryo freezing)
Oocyte Cryopreservation (egg freezing)
IVF Pre-Procedure Month
Egg Retrieval Process
Embryo Transfer Procedure
How Many Eggs to Choose for an IVF Procedure
IVF Success Rates
An Introduction to In Vitro Fertilization (IVF)
We conceived our daughter when we were newly married, no problems at all, actually were not even trying. When she turned about 20 months old, we started to try and conceive again. After months of trying with no luck, we sought our general...