In vitro fertilization (IVF)

What is in vitro fertilization (IVF)?

IVF is one of the most commonly used treatments for infertility, because it maximizes the chances of conception.

When conception happens naturally, an egg which has been released from an ovary is fertilized by a sperm in a female’s fallopian tube. Through IVF, the process of fertilization occurs in a lab, where embryologists combine the eggs and sperm. Successfully fertilized eggs are then transferred into the woman’s uterus for further development.

Who is likely to benefit from IVF treatments?

IVF may be right for patients who have:

• Unexplained infertility
• Male factor infertility
• Endometriosis
• Failed to conceive via IUI
• Blocked fallopian tubes or other ovulation problems
• Women of advancing maternal age

Understanding the six phases of IVF treatments

Phase 1: Pituitary suppression phase (or “Ground Zero”)

In a natural menstrual cycle, circulating hormones will stimulate the development of follicles (fluid filled spaces) in the ovaries. It is normal for several follicles to start at once, with one follicle eventually becoming dominant. This dominant follicle grows a mature egg or “oocyte”, which is then released at ovulation. In a natural cycle, ovulation is caused by a surge or sudden rise in the level of luteinizing hormone (LH).

For IVF, we aim to have several eggs develop at the same time and to prevent them from being released until they reach maturity. In order to accomplish this, we use certain medications (e.g. lupron or cetrotide) to prevent the LH surge, at various times in a patient’s cycle. This allows us to block ovulation. The medications to be used will be chosen by the patient’s fertility doctor, based on her fertility and menstrual history, as well as her physical exam and test results.

Phase 2: Ovarian stimulation phase

Over the course of the 10-12 days that a patient takes the medication, her response to the drugs will be monitored via vaginal ultrasound and blood work during the clinic’s cycle monitoring hours. The first monitoring session will be three or four days after the patient has started the injections, and will continue at least every other day until she is ready for egg retrieval.

It is important to acknowledge that up to 10% of patients do not respond to the medications as planned. These patients have no ovarian response or respond with too few follicles. When this happens the doctor will let the patient know whether the treatment cycle will be cancelled completely or converted to an inter-uterine insemination cycle.

Phase 3: Egg Retrieval Phase

When a patient’s ultrasound and blood work show that she has a number of follicles inside her ovaries that have reached a diameter of about 2 cm, the stimulation phase will end. At this point, the egg retrieval procedure will be scheduled and the patient will be instructed to take an injection of HCG (Human Chorionic Gonadotropin) to induce the final maturation of her eggs, 34-36 hours prior to her appointment time.

On the day of the egg retrieval the patient will be asked to change into a clean hospital gown, before she is given an intravenous (IV) line with a saline infusion. Next the doctor will give her medication to control pain.

Once the patient is comfortable, a speculum is used to clean her vagina and cervix with a sterile solution. The speculum is then removed, and a sterile-draped ultrasound probe is inserted. The probe allows the doctor to guide a fine needle through the patient’s vaginal wall into her ovary, and then directly into a follicle. Using the needle, the fluid inside the follicle is drained and placed into a sterile test tube. This procedure is repeated from one follicle to the next until all of the eggs are retrieved.

When the egg retrieval is complete, the test tubes are sent to the embryology lab, where the embryologists examine the fluid in the test tubes to identify and remove all eggs.

After the procedure, the patient will be asked to rest in the recovery area for 1-2 hours to allow the effects of the medication to wear off. This rest period also allows the doctor to make sure that the patient is able to eat, walk and void normally before leaving the facility.

It is normal for patients to have some discomfort that may still linger the day after egg retrieval. Many patients find that taking Tylenol, resting, and using a heating pad or hot water bottle are effective ways to ease their discomfort. Patients who experience pain more than two days after the procedure should contact their doctor.

Phase 4: Fertilization

For patients using a fresh sperm sample, the male partner will be asked to produce his sample on the day of the egg retrieval. In contrast, when patients are using frozen or donor sperm , their sperm sample will begin the thawing process as they arrive for the retrieval procedure. Once the sperm sample is ready, it is washed and concentrated, and then added to the eggs a few hours after retrieval. The next day the embryologist examines the eggs for signs of fertilization.

Generally, a normal sperm sample results in approximately 70-80% of the eggs being fertilized. However, it is important to note that not all of the eggs that are collected will be fertilized or result in a high quality embryo.

Phase 5: Embryo Transfer Phase

The fertilized eggs will be transferred to the patient’s uterus three to five days after the egg retrieval, using a transfer catheter. The embryo transfer process is usually pain free and only takes a few minutes. Most patients are able to leave the clinic within minutes of completing the procedure.The doctor will choose the healthiest embryos for the transfer. The number of embryos implanted during the procedure will be based on the patient’s age and the quality of her embryos. The patient will then be given the option of having any remaining healthy embryos frozen for future embryo transfers.

Phase 6: Luteal Phase and Pregnancy Test

The patient will be advised to take it easy during the 24 hours following the embryo transfer. Generally, patients can engage in light activity and return to work after a few days if their jobs are not physically demanding.

The patient will return to the clinic two weeks after the transfer to have blood work done, to determine if she is pregnant. If the test comes back positive, an ultrasound will be scheduled. Once a healthy pregnancy has been confirmed via ultrasound, the doctor will discuss prenatal care options with the patient.