In Vitro Fertilization (IVF)

1. Preparation for the Cycle

Patients receive birth control medication for a few weeks, generally less than a month, to synchronize the growth of follicles.

2. Ovarian Stimulation

Ovarian stimulation involves taking hormone medications for approximately 8-14 days to stimulate multiple follicle development to increase the number of eggs retrieved. Patients are closely monitored by ultrasound and blood workups. Once follicle sizes and hormones reach appropriate levels, a “trigger shot” (HCG or Lupron) is administered to initiate the final egg maturation.

3. Egg Retrieval

The egg retrieval is scheduled approximately 35 hours after the trigger shot. This minor surgical procedure is performed under ultrasound guidance and uses a guide to insert a thin needle through the wall of the vagina into the ovary to collect eggs from each follicle. This procedure may last 15 to 30 minutes and is usually done on an outpatient basis under sedation.

4. Sperm Processing

This is usually done on the day of the egg retrieval. Fresh or frozen sperm may be used and will be “washed” (or processed) using advanced laboratory techniques to separate the sperm from the seminal fluid, increasing the number of motile sperm and improving the likelihood of fertilization. In instances when sperm collection on the day of egg retrieval looks stressful, semen sample can be collected ahead of time and cryopreserved in the andrology lab as a backup option. Some men with severe male factor infertility may require a testicular biopsy for extraction of sperm for IVF.

5. Egg Fertilization

Eggs are then fertilized either conventionally (by placing the egg and sperm in a dish to allow fertilization) or by injecting a single sperm directly into the egg (intracytoplasmic sperm injection or ICSI). ICSI is a micromanipulation procedure that allows fertilization even with a very low sperm count.

A fertilization check is done approximately 18-19 hours after conventional insemination or ICSI. Fertilization is the union of male and female reproductive cells (sperm and egg) to produce a fertilized egg (zygote).

6. Embryo Development & Selection

The embryos are then cultured in the laboratory for 5-7 days.  On the day of embryo transfer (done either on day 3 or day 5 for fresh embryo transfer), the embryo or blastocyst with the highest morphological grade is selected for transfer. Preimplantation genetic testing (PGT) is performed at this time for patients who choose this testing. Remaining embryos can be cryopreserved for future transfer attempts.

7. Embryo Transfer

Embryo transfer requires the use of a small catheter to draw up the selected embryo(s) and to transfer them into the woman’s uterine cavity. This procedure is generally painless and usually does not require anesthesia. For best results we use ultrasound guidance for accurate catheter localization and transfer of the embryo into the uterine cavity.  We follow the American Society for Reproductive Medicine (ASRM) guidelines and typically transfer one or two embryos at a time, reducing the likelihood of multiple births. Upon completion of the transfer, the embryo(s) should hatch from their outer shell and implant into the uterine wall.

8. Next Steps

A blood test is performed typically 9 to 11 days after transfer to determine if a woman is pregnant. If embryo implantation has occurred, the HCG hormone will be detected in the bloodstream and the woman will be considered pregnant. Patients who achieve pregnancy will schedule a follow-up visit for blood work and an ultrasound. For those patients who were not able to achieve pregnancy, we will schedule a consultation to review your cycle in detail and discuss further options to continue or alter the treatment.