In Vitro Fertilization - IVF
In vitro fertilization is a method of assisted reproduction in which the man’s sperm and the woman’s eggs are combined outside the body in a laboratory dish. If fertilization occurs, the resulting embryo or embryos are transferred back to the woman’s uterus, where they may implant in the uterine lining and mature. IVF may be used to treat various types of infertility, including endometriosis, tubal factor, male factor, immunologic factors, and unexplained infertility. The following description outlines a typical IVF cycle. Your own cycle plan may differ in some ways.
Pre-cycle Preparation
If you haven’t undertaken these steps in the last year, you and/or your partner will need the following:
- Semen analysis performed by the REI staff
- Baseline hormonal testing for women
- Prenatal lab tests (hepatitis B, rubella, etc.)
- Multivitamin/prenatal vital supplementation (men and women)
- Physical exam (with Pap smear for women)
- Anatomical assessment of the uterus (e.g., sonohysterogram, hysterosalpingogram)
- Uterine depth measurement (a “sounding,” which may be performed just before stimulation)
Modest weight loss may be beneficial in some cases. In addition, we encourage both partners to quit smoking to improve IVF success rates.
Preparation Month
You will take oral contraceptive pills (OCP) during the month before stimulation. Light bleeding while on OCP may occur; it will not affect pregnancy chances.
Stimulations Cycle
You will have a vaginal ultrasound exam to look for ovarian cysts and take a blood test to check for adequate ovarian suppression. If ovarian suppression is not achieved, you may be scheduled for repeat tests one week later while continuing the injections.
Once the baseline ultrasound is completed, you may be instructed to stop the OCP and begin stimulations (taking injections mornings and evenings).
You will be monitored periodically over the next several days with ultrasounds and blood tests, and your medication will be adjusted as necessary. Depending on your protocol, you may begin injections to shut down hormonal signals from the brain to the ovaries. These injections continue through the last day of stimulation. Once ovarian follicle size and estradiol reach mature levels, final egg maturation is triggered with a timed hormonal injection of hCG.
Egg Retrieval
Approximately 34 hours after that hormonal trigger, you will undergo egg retrieval in our specially modified operating room. After you are sedated, the IVF physician will insert an ultrasound probe with an attached needle guide into your vagina and extract the eggs from the ovarian follicles; the eggs and surrounding fluid are passed to the waiting embryologists. The procedure takes approximately one hour; after an hour in the recovery room, you may go home.
That same day, your partner will provide a semen specimen. Specimen collection takes place at our office in private rooms. After processing, microdrops of sperm are placed with the eggs in the laboratory that afternoon for overnight incubation.
Intracytoplasmic Sperm Injection (ICSI)
If the reason that you are undergoing an ART cycle is because of male factor infertility (e.g., your husband has a low sperm count, his sperm have little motility, or the sperm that are produced are poorly developed), then you will be asked to have your gametes (sperm and eggs) undergo intracytoplasmic sperm injection (ICSI). The ICSI procedure involves injecting a sperm into an egg and then culturing the resulting embryo once fertilization occurs. The ICSI procedure is also used if your partner does not produce sperm from an ejaculate and needs to have his sperm surgically removed from his testes.
After Egg Retrieval
You will be contacted by phone the following morning with a fertilization report. Based on the number of fertilized eggs, you and the reporting physician will discuss the optimal number of embryos to be transferred or frozen.
Progesterone supplementation via injection begins on the morning after egg retrieval. Also, you will begin twice daily doses of a steroid.
Embryo Transfer
Three days after egg retrieval, embryos are ready for transfer. You will take an antibiotic beforehand and arrive for the procedure with a moderately full bladder. Having a full bladder helps to straighten the uterus, aiding embryo transfer.
Embryo transfer is performed in the same specialized operating room and involves an exam with a speculum, much like your annual gynecologic exam. That exam is followed by passage of a catheter through the cervix into the uterine cavity. The doctor may use ultrasound as a guide to place the embryos in your uterus. After transfer, the catheter is removed and inspected by the embryologists to ensure that it does not contain any residual embryos. During the transfer and for one hour afterward, you will lie with your hips tilted slightly upward. After discharge from the recovery room, you will remain on modified bed rest at home until the following morning. In addition to the progesterone injections, you will begin placing a progesterone suppository in your vagina on the night of transfer and will be instructed on when to begin wearing estrogen patches.
Approximately one week after egg retrieval, you will come to the office to check for any sign of ovarian hyperstimulation. A pregnancy test is scheduled 12 days after embryo transfer; meanwhile, you will remain on medications until otherwise instructed. Depending on the results of the pregnancy test, you may be asked to return in several days for repeat lab testing to determine the progression of the pregnancy. Otherwise, you will be scheduled for an endovaginal ultrasound exam several weeks later to further evaluate the pregnancy and check on the health and number of implanted fetuses.
For more information about Reproductive Endocrinology & Infertility services, please call 864-455-1600.
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