Treatment

In Vitro Fertilization (IVF)

In a nutshell, IVF is a process in which the eggs collected from the ovaries are fertilized by the sperm in the laboratory. The resulting embryos are then cultured in an incubator for several days before one or two of the healthiest ones are placed into the uterus with the hope that a successful, full-term pregnancy will ensue.

Since the birth of the first IVF baby in 1978, over one million children have been conceived worldwide through in vitro fertilization. Under expert hands, IVF can be conducted safely and successfully to help couples who cannot conceive through other fertility treatments.

We design IVF treatment plans tailored to the specific needs of each patient. The IVF process spans approximately 6-7 weeks and consists of the Pre-Treatment and Treatment cycle. Below is an outline of what to expect during a typical IVF cycle.

Pre-Treatment Cycle

The Pre-Treatment cycle is used for IVF preparation and consists of the following:

  • Baseline sonogram- usually performed on day 2-4 of the cycle to assess the reserve of the ovaries. The young follicles are counted in order to predict the responsiveness of the ovaries to stimulation. When used in conjunction with the AMH level, antral follicle count can help the physician to choose the stimulation protocol and medication dosages appropriate for the egg reserve.
  • Birth Control Pill- is started on day 2-5. The pill allows the ovaries to rest during this cycle and lowers the risk of an ovarian cyst prior to ovarian stimulation. The pill also facilitates the planning and timing of the start of the stimulation cycle.
  • Trial Transfer- is conducted 1-2 weeks into the pretreatment cycle. During this visit the uterus and cervix are evaluated to ensure easy passage of the embryo(s) in the future. A flexible catheter is used to measure the depth of the uterus and to determine the best location for embryo placement. If the uterine cavity has not been evaluated by a HSG within the prior 12 months, a sonoHSG or a hysteroscopy can be performed on this day.
  • Injection Teaching and IVF Cycle Review- are usually conducted immediately after the trial transfer. By the time you leave the clinic you should have a firmer idea about your treatment plan.
  • Lupron- is an injectable medication used at least 10 days before the start of ovarian stimulation. Under normal conditions, only one egg is allowed to develop and mature in a cycle. When there are multiple follicles growing at the same time, the pituitary will release the LH signal to trigger the largest follicle to ovulate and stop the lesser follicles from developing further. Lupron binds to the pituitary to cause pituitary discharge of its LH and FSH so that after 1 week of Lupron, the pituitary will be exhausted of signals that can interfere with future recruitment of multiple follicles. The combination of Lupron and birth control pill is quite effective in preventing pituitary interference to allow recruitment and growth of multiple follicles during the second phase.
  • Stopping the Birth Control Pill- The pill will eventually be stopped while Lupron is continued throughout ovarian stimulation. A pelvic sonogram is performed to rule out any large cyst and an Estradiol is checked to confirm that the pituitary has been suppressed. Ovarian stimulation can now begin.

    Treatment Cycle

    1. Ovarian Stimulation- is initiated once there is sufficient suppression of the pituitary, as evident by a low estradiol level and quiet ovaries on the sonogram. The injectable medications used to stimulate the ovaries are actually LH and FSH, the same hormones normally produced by the pituitary. Close monitoring of the ovaries with blood tests and sonograms is essential during this period to ensure optimal egg development and to minimize complications.
    2. Human Chorionic Gonadoropins (HCG) injection is given when several follicles have reached mature sizes. HCG induces the eggs within the follicles to undergo the final maturation. It also causes the eggs to be detached from the wall of the follicles to facilitate their removal
    3. Egg Retrieval- is performed about 34-36 hours after the HCG injection. The procedure takes 20 minutes and is conducted under IV sedation. A long needle is introduced into the pelvis through the vagina under ultrasound guidance to retrieve the eggs. Although some women may experience soreness, cramping or spotting after the procedure, complete recovery is typically achieved within two hours.
    4. Fertilization and Culture- After their aspiration, the eggs are inseminated or injected with the sperm on the same day. On the following day, the eggs are examined for sign of fertilization. Typically, about 70% of the mature eggs are fertilized. The resulting embryos are cultured for 5 days, the same number of days an embryo takes to travel from the tube into the uterus.
    5. Embryo Transfer- usually takes place on the fifth day of culture. One or two of the best embryos are transferred into the uterus using a soft catheter. The procedure is similar to an IUI and does not require sedation. Any remaining embryos can be frozen for future use if they meet criteria.
    6. Endometrial Support with progesterone and estrogen supplements is important to prepare the uterine lining for implantation. Progesterone is started on the day after the retrieval. Progesterone transforms the endometrium into a rich environment to prepare for embryo implantation. Progesterone is usually administered in oil form by deep muscular injection into the buttocks. Our patients use progesterone vaginally instead of by injections. Our decision to use vaginal progesterone is based on numerous scientific researches that show the superiority of the vaginal route over the intramuscular or oral route in endometrial maturation. Estrogen is added back to maintain hormonal balance within the endometrium. The estrogen level usually drops after egg retrieval since many estrogen producing cells are also removed along with the eggs. Estrogen can be used as a patch or taken as tablets.
    7. Pregnancy Test- can be performed 12 days after embryo transfer. Once the test is positive, progesterone and estrogen are continued until the 11th week. A vaginal sonogram is performed at the 7th week to confirm the pregnancy before the patient is referred to an OB/GYN for the remainder of the pregnancy.

    • back to top