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Over one million children have been conceived through in vitro fertilization (IVF), a term that means fertilization “in glass.” IVF may be recommended for couples who have not been or cannot be helped with other fertility treatments. First, the female partner’s menstrual cycle is regulated and the ovaries are stimulated with the aid of hormone medications. Then one or more eggs are harvested from the ovaries and fertilized in the laboratory with the male partner’s or a donor’s sperm. The embryos are allowed to develop in the lab for a few days, at which time up to three of the healthiest specimens are placed in the uterus in the hope that one will result in a full-term pregnancy.
IVF is a complex process with many steps that must be successful in order to maximize the chance of conceiving. The steps are as follows:
- Pre-treatment
- Ovulation Induction
- Egg Retrieval
- Insemination & Fertilization
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- Embryo Development
- Embryo Transfer
- Luteal Phase
- Pregnancy
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Pre-Treatment
Before any treatment is begun, you will meet with Dr. Ramirez and complete a thorough screening. The initial consultation will include a full medical history and
recommendations. You will then be referred for a Financial counseling appointment with our Financial Administrator. She will describe the costs as they pertain to you and give a more precise amount. Next you will be scheduled to see the Clinical Coordinator,
who will give prescriptions for a variety of tests, which may consist of blood tests, ultrasound, uterine imaging (hysterosalpingogram or HSG, hysteroscopy, hysterosonogram), or other exams.
These tests are done to detect anything that might interfere with the success of an IVF cycle or eliminate you as a candidate for standard IVF. Findings include fibroids, endometriosis, tumors, infectious disease, hormone levels and other potential problems. The male partner will also be asked to undergo semen analysis to assess sperm count and health.
Your doctor will also tell you about ways to increase your chance of conceiving during the initial IVF stages. This includes instructions about diet, nutritional supplements, exercise and weight loss, and sexual behavior as well as a recommendation to avoid tobacco, alcohol, caffeine, and certain medications.
You may be referred to a counselor who is specially trained to help you through the emotional upheaval that often accompanies a diagnosis of infertility as well as treatment.
When these tests have been completed and the results examined, you and your partner will meet with the physician and nurse. At this time, the details of the treatment plan will be explained and scheduled, and any questions and concerns you have will be addressed. You will be asked to sign all necessary consent forms.
A woman’s body normally produces one egg per ovulation cycle. However, if more eggs can be collected and fertilized in one cycle, there will be more viable embryos to select from, and thus a greater chance of conception. For this reason, prior to egg retrieval the ovaries are carefully stimulated to produce more eggs than usual. This process is known as superovulation.
Superovulation is achieved through a series of injections of special medications that regulate the menstrual cycle by adjusting the levels of certain chemicals in the body. These include:
- GnRH agonists, or gonadotropin-releasing hormone agonists – Stimulate high-quality egg production and help prevent mid-cycle increases in estrogen levels. (Lupron)
- GnRH antagonists – Prevent premature ovulation. (Antagon, Cetrotide)
- FSH, or follicle stimulating hormones, and LH, or luteinizing hormones – Stimulate egg-producing follicles in the ovaries. (Follistim, Bravelle, Gonal-F; Repronex)
- hCG, or human chorionic gonadotropins – Prepare eggs for harvesting. (Pregnyl, Profasi, Novarel)
There are some risks associated with these treatments, including side effects from the injection itself (bruising, swelling, tenderness or infection), allergic reaction, and excessive or insufficient response from the ovaries. Increased estrogen levels may cause fluid retention, weight gain, nausea, diarrhea, breast tenderness, moodiness, headache or fatigue. A rare but possible complication is ovarian hyperstimulation syndrome (OHSS), in which estrogen levels rise sharply and the ovaries produce too many eggs, potentially causing excessive fluid retention, thrombosis and enlarged ovaries. OHSS is a serious condition that requires hospitalization. Severe reactions to the medications may result in the cancellation of the treatment cycle and referral to the reproductive endocrinologist.
The best candidates from among the eggs harvested may then be fertilized or transferred with a sperm sample to the fallopian tubes, or each of the eggs may be fertilized in the laboratory and allowed to develop for 1-5 days before selecting the healthiest embryos. The sperm is collected from the male partner on the day of retrieval or from a donor. Any untransferred embryos or eggs may be frozen and stored for later use or donation.
The next step in IVF is the retrieval of the eggs (oocytes) from the ovaries. Retrieval takes about 30 minutes under IV sedation. An ultrasound-guided needle is inserted into the ovary, where one or more eggs and fluid are removed. The sample is brought to the laboratory. Some soreness, cramping or spotting is normal after the procedure but recovery is quick – usually only about two hours. After retrieval the woman may be asked to take progesterone supplements to compensate for hormone-producing cells removed during the procedure.
Pregnancy
About two weeks after retrieval and transfer, a blood sample is taken to measure levels of the “pregnancy hormone” hCG and determine whether the pregnancy has been successful so far. A second blood test two days later is required to confirm a positive result. At this time the pregnancy is called a chemical pregnancy. Ultrasound images taken two weeks and four weeks later indicate whether a gestational sac has formed in the uterus around the developing embryo. This is known as a clinical pregnancy.
Pregnant patients will continue to take progesterone supplements and follow an individualized treatment plan. If the test is negative, progesterone is stopped and the patient should have a regular period within 5 days. Follow-up visits will be scheduled with the physician and a counselor so couples can discuss their feelings and options.
After 10 weeks patients are referred to an OB/GYN for the remainder of the pregnancy.
Every patient is different. Accordingly, IVF treatment plans are tailored to each individual. With this in mind, below is an outline of what to expect during a typical IVF cycle. The average time from the start of pre-cycle testing to the embryo transfer is 6 to 10 weeks.
1st Consultation |
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2nd Consultation |
7 - 10 days after initial consult |
Pre-treatment Exams |
Weeks 1 - 2 |
Birth Control Pills |
Weeks 3 - 4 |
Start of Treatment Cycle |
Week 5 |
Ultrasound |
Weeks 5 - 8 |
Stimulation (FSH) & Monitoring |
Weeks 6 - 7 |
hCG Trigger Shot |
Week 8 |
Egg Harvesting |
Approx. 36 hours after injection |
Embryo Transfer |
3 - 5 days after harvesting |
Pregnancy Test |
10 - 14 days after harvesting |
2nd Pregnancy Test |
2 days after first pregnancy test |
Ultrasound |
6 ½ - 7 wks of Pregnancy |
Ultrasound |
7 ½ - 8 ½ wks of Pregnancy |
Referral to Obstetrician |
8-10 wks of Pregnancy |
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