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The IVF Process

IVF Process And Procedures

Over five 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. We realize that this complex process may be overwhelming but Dr. Ramirez and his staff are there every step of the way to help you towards the ultimate goal: Getting Pregnant!

Please watch this recent TED-Ed video on “How In Vitro Fertilization Works” on the Doctor’s Blog or on the TED-Ed IVF video on YouTube.

The steps are as follows (please scroll to the very bottom of the page for the “Treatment Timeline”):

  • Pre-treatment
  • Ovulation Induction
  • Egg Retrieval
  • Insemination & Fertilization
  • Embryo Development
  • Embryo Transfer
  • Luteal Phase
  • Pregnancy

 

Pre-Treatment

At Monterey Bay IVF, 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, Melissa Magno. 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, Elvira Garcia, 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.

Dr. Ramirez 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.

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.

Ovulation Induction

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. You will meet with our IVF coordinator, Karen Warfield, for medication and injection training. She is always available during cycle to help you with your needs and concerns regarding the medications you will be taking.            

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.

Egg Retrieval

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 placed into a test tube and passed through a sterile, hermetically vacuum compartment directly into the embryology laboratory. The patient is taken back to the surgery center recovery room to awaken. Some soreness, cramping or spotting is normal after the procedure but recovery is quick – usually only about two hours.  

Fertilization And Transfer

The most mature follicles from among the eggs harvested are then 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.Whether the patient has a Day 3 or Day 5 blastocyst embryo transfer cannot be predicted. The ideal day of embryo transfer varies from woman to woman and from cycle to cycle. Any untransferred embryos or eggs may be frozen and stored for later use or donation.

Pregnancy Testing

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 our patients are referred to an OB/GYN for the remainder of the pregnancy. They will be sent away with all our good wishes and hopes for a safe and successful pregnancy. We encourage all our patients not only to send us pictures of their newborns but to return and visit us! We like to keep track of our patients as well in order to accurately report our live birth statistics.

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.

Treatment Timeline:    

1st Consultation
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