In vitro fertilization (IVF) is a procedure in which a physician will remove one or more eggs from the ovaries that are then fertilized by sperm inside the embryology laboratory. IVF is the most successful treatment you can do using your own eggs and sperm (or donor sperm). IVF has become mainstream and widely accepted, and continues to grow due to significant technological advances.
Common Indications for IVF Treatment
Once diagnostic testing is complete, your physician will review your treatment options. Many patients are surprised to learn that IVF is not their only treatment option. However, IVF would be the first line of treatment for patients with the following conditions:
- Tubal disease or tubal ligation: If a patient has a tubal ligation, IVF treatment would be the best treatment option since it bypasses the Fallopian tubes to achieve pregnancy.
- Severe male factor infertility: If the semen analysis shows there are not enough healthy sperm to be successful with more basic treatment, such as intrauterine insemination (IUI), then IVF treatment can help patients overcome male factor infertility. With IVF treatment, an advanced method of fertilization known as intracytoplasmic sperm injection (ICSI) (pronounced “ick-see”) can be performed in the lab. With ICSI, only one healthy sperm is needed for each egg.
- Endometriosis: For women who have this condition, their endometrial tissue (the tissue lining the inside of the uterus) grows outside of the uterus. The endometrial tissue can attach to other organs in the abdominal cavity, such as the ovaries and the Fallopian tubes. The uterus will respond to this tissue the same way it responds to menstrual cycle hormones – it will swell and thicken and ultimately, shed.
- Recurrent miscarriage: Recurrent miscarriage, also called recurrent pregnancy loss, is defined as two or more consecutive clinical pregnancy losses before 20 weeks gestation. It is important to consider clinical pregnancies rather than biochemical pregnancies, as biochemical pregnancies are usually not included in a diagnosis of recurrent pregnancy loss.
Patients with other diagnoses may start with basic, ‘low-tech’ treatments like hormone therapies or IUI and then transition to IVF, if needed. However, with most of the more basic treatment options, data shows that after three to four treatment cycles, success rates begin to decline sharply. By moving to IVF treatment, a couple increases their chances of success dramatically. Some additional diagnoses for which IVF treatment can improve the chances of success include: advanced age, ovulatory disorder, genetic abnormalities, and unexplained infertility.
Medical Contribution: Naveed Khan, M.D.
What to Expect
The IVF Timeline
In a normal ovulation cycle, one egg matures per month. The goal of an in vitro fertilization (IVF) cycle is to have many mature eggs available, as this will increase your chances of success with treatment. In order for there to be more than one egg available, stimulation of the ovaries needs to occur. It's important to note that the eggs being stimulated would have grown or died that month, so stimulating the ovaries does not deplete eggs for the future. This is a common question that patients ask, so rest assured.
Part I: Stimulation of the Ovaries
In the stimulation phase of an IVF cycle, you will use injectable medications for approximately 8 to 14 days to stimulate the ovaries to produce eggs. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH), both produced naturally within the body, comprise the medications. During this phase, you will come into the office approximately 7 to 8 times for morning monitoring, which allows the physician to track the progress of your cycle and adjust medication dosages as needed.
The trigger shot is the final step in the stimulation phase of treatment. Depending on your individual protocol, you will either have a human chorionic gonadotropin (hCG) or Lupron trigger shot. This shot helps the developing eggs complete the maturation process and sets ovulation in motion. Timing is very important here, as the physician must perform the egg retrieval prior to the expected time of ovulation.
Part II: Egg Retrieval
A physician will perform your egg retrieval procedure at one of Shady Grove Fertility's ambulatory surgery centers (ASC) in Atlanta, GA; Rockville, MD; Towson, MD; or Chesterbrook, PA. On the morning of your egg retrieval, a physician will meet with you before the procedure to review your protocol. You will also meet with an anesthetist, who will review your medical history and will administer the intravenous fluid you will receive prior to the start of the procedure to induce sleep.
Obtaining the sperm: If you are using a fresh sperm sample, a lab technician will come to accept the sample. If you are using a frozen sperm sample or donor sperm collected previously, the technician will verify those details with you. Our andrology laboratory will wash and prepare the sperm, so that the healthiest sperm are brought together with the eggs for fertilization (after the physician performs the egg retrieval).
Obtaining the eggs: The egg retrieval itself takes about 20 to 30 minutes. During the procedure, the physician will guide a needle into each ovary to remove the egg-containing fluid in each follicle. The physician utilizes an ultrasound during the procedure to see where to guide the needle.
Recovery will take about 30 minutes and you will be able to walk out on your own. It's important that a responsible adult drive you home after the procedure, as it is unsafe to drive after receiving anesthesia. The person who is driving you will need to stay at our center during your procedure—he or she should anticipate being at our center for approximately 3 hours in total.
Part III: Fertilization
After the egg retrieval, the embryologist will sort and prepare the eggs and sperm. There are two ways that fertilization can take place: conventional insemination or intracytoplasmic sperm injection (ICSI). The physician will discuss with you which method to use based on sperm quality; this is traditionally planned in advance. In some cases, the embryologist may see that semen parameters for conventional insemination are not being met, so she or he will recommend the switch to ICSI to produce the greatest chance of success. Your clinical team will let you know if they recommend an unanticipated ICSI procedure.
- Conventional insemination: For conventional insemination, the embryologist takes the prepared sperm sample and isolates the healthiest sperm. He or she will then incubate this sperm with the eggs in a Petri dish. This gives the egg and sperm the opportunity to find one another and fertilize.
- ICSI: During ICSI, an embryologist injects a single, healthy sperm into the cytoplasm, or center, of each egg. Since fertilization only requires one healthy sperm, ICSI has become one of the most incredible advances in fertility treatment because it allows for fertilization even in cases of severe male factor infertility. Typically, ICSI is planned in advance, but sometimes it is unanticipated. The embryologist may see that semen parameters for conventional insemination are not being met, in which case, the embryologist will make the decision to switch to ICSI so that the cycle can still produce embryos and increase the chances of success for the patient. Your clinical team will let you know if an unanticipated ICSI procedure is recommended.
Part IV: Embryo Development
Embryo development begins after fertilization. An embryologist examines each developing embryo over the course of the following 5 to 6 days. The goal is to see progressive development, with a two- to four-cell embryo on day 2 and an six- to eight-cell embryo on day 3. After the eight-cell stage, rapid cell division continues and the embryo enters into what is called the blastocyst stage at day 5 or 6. It is your physician's goal to transfer the highest-quality embryo(s) to give you the greatest chance of reproductive success.
Part V: Embryo Transfer
The embryo transfer is a simple procedure that only takes about 5 minutes to complete. There is no anesthesia or recovery time needed. When your nurse schedules your transfer, she will notify you and provide instructions on when to arrive and how to prepare. You need to have a full bladder for the procedure as a full bladder ensures good visualization of the lining of the uterus and proper placement of the embryos. It's important to drink the specific amount of liquid recommended 30 to 40 minutes ahead of time.
You will review your cycle with the physician and the number of embryos recommended for transfer. The embryologist will load the transfer catheter in the embryology lab with the embryo(s); upon entering your procedure room, the embryologist will again confirm your last name and the number of embryos in the catheter. The physician will insert the catheter into the uterus and push the embryo through with a small amount of fluid. An external abdominal ultrasound provides visual guidance via a monitor to the physician throughout the procedure.
Once the physician transfers the embryo, he or she will slowly remove the catheter. Since the embryo is invisible to the naked eye, the embryologist will then examine the catheter under a microscope in the lab to ensure that the catheter did indeed release the embryo. The nurse will give you instructions for the following 2 weeks until it's time for the beta pregnancy test.
Part VI: The Beta Pregnancy Test
Two weeks after the embryo transfer, a nurse or clinical assistant will perform a blood pregnancy test. This test is frequently called a "beta" because it measures the beta chain portion of the hCG hormone produced by the developing embryo.
To learn more or to schedule an appointment, please speak with one of our New Patient Liaisons at 1-877-971-7755 or fill out this brief form.
Autologous In Vitro Fertilization (IVF) Success Rates, Rockville, MD
Jan 1, 2015 - Dec 31, 2015
View SGF's most recent SART data for Rockville, MD
|Pregnancy rate per Cycle||38%||31%||22%||13%||7%||27%|
|Pregnancy rate per Retrieval||41%||34%||25%||16%||9%||30%|
|Pregnancy rate per Transfer||51%||47%||39%||25%||15%||43%|
|Average number of Embryos Transferred||1.4||1.5||1.8||2.2||2.4||1.8|
Autologous In Vitro Fertilization (IVF) Success Rates, Towson, MD
Jan 1, 2015 - Dec 31, 2015
View SGF's most recent SART data for Towson, MD
|Pregnancy rate per Cycle||38%||38%||25%||16%||12%||33%|
|Pregnancy rate per Retrieval||39%||42%||28%||21%||15%||36%|
|Pregnancy rate per Transfer||49%||53%||46%||33%||25%||48%|
|Average number of Embryos Transferred||1.2||1.4||1.9||2.2||2.7||1.7 |
Autologous In Vitro Fertilization (IVF) Success Rates, Chesterbrook, PA
Jan 1, 2015 - Dec 31, 2015
View SGF's most recent SART data for Chesterbrook, PA
|Pregnancy rate per Cycle||18%||8%||0%||0%||10%||12%|
|Pregnancy rate per Retrieval||20%||9%||0%||0%||13%||13%|
|Pregnancy rate per Transfer||53%||29%||0/5||0/1 ||1/1||43%|
|Average number of Embryos Transferred||1.3||1.5||1.8||2.0||1||1.6|
At Shady Grove Fertility, we understand the financial considerations that go into the decision to begin—or continue—fertility treatment. As part of our efforts to make treatment more affordable, we participate with more than 30 insurance providers. While you may have some form of insurance coverage for treatment, or live in a location that has coverage provided by mandate, we recognize that there are many without sufficient coverage or insurance benefits. With that in mind, we developed exclusive financial programs to help ease the cost of treatment, including our Shared Risk 100% Refund Program for IVF and donor egg treatment.
Our Shared Risk 100% Refund Program financially insures you against the risk of not being successful. You are insured because we only earn our fee when you take home a baby. In this program, you will pay a flat fee that covers the medical cost of up to six cycles of IVF treatment. This fee also includes the cost of vitrification (flash-freeze technology) and unlimited frozen embryo transfers (FETs) from those six cycles. If you do not take home a baby as a result of those six cycles (and the transfer of any frozen embryos), or you choose to withdraw from the program before the end of six cycles, we will refund 100 percent of the fee*, preserving your resources for other family building options.
*Some exclusions apply.
Will IVF treatment work for me?
In vitro fertilization (IVF) is the most widely discussed form of fertility treatment. For many, IVF treatment can offer the highest chances of success, with a nearly 50 percent live birth rate for women under the age of 35.
What is involved in the basic infertility work-up?
The first step on the path to parenthood is identifying all the factors that might be contributing to a couple’s infertility. This is done through a basic infertility work-up that includes testing of both the male and female partner. The work-up includes:
- Initial consultation: Your physician will take a detailed medical history that includes medical and lifestyle factors that may affect conception.
- Day 3 testing: This consists of simple bloodwork to determine a women’s hormone levels and a pelvic ultrasound to count the potential eggs in each ovary. These tests will help your doctor select the proper dosing and types of medication for your treatment.
- Anti-Müllerian hormone (AMH) testing: AMH is the most accurate predictor of a woman’s egg supply. Determined through a blood test, a higher AMH level would indicate a large amount of antral follicles and a strong ovarian reserve where as a lower value would lead your physician to believe there has been a decrease in the ovarian reserve.
- Hysterosalpingogram (HSG): An x-ray dye test used to assess the uterine cavity and the Fallopian tubes. This allows the doctor to check for abnormalities in the cavity of the uterus and to verify your Fallopian tubes are open.
- Semen analysis: Because male factor counts for 40 to 50 percent of all infertility cases, it’s critical to have a semen analysis as part of the basic infertility work-up. In this non-invasive test, we will analyze a sample of semen from the male partner under a microscope to evaluate the number and quality of the sperm. The test measures volume, concentration, motility (movement), and morphology (shape).
What’s the difference between conventional insemination and ICSI?
With convention insemination, the embryologist takes the prepared sperm sample and isolates the healthiest sperm. That sperm is incubated with the mature eggs in a Petri dish and fertilization is visualized the next day. (Fertilization is not ‘automatic.’)
During ICSI, an embryologist injects a single, healthy sperm into the cytoplasm, or center, of each egg. Since fertilization only requires one healthy sperm, ICSI has become one of the most incredible advances in fertility treatment because it allows for fertilization even in cases of severe male factor infertility.
Typically, ICSI is planned in advance, but sometimes it is unanticipated. The embryologist may see that semen parameters for conventional insemination are not being met, in which case, the embryologist will make the decision to switch to ICSI so that the cycle can still produce embryos and increase the chances of success for the patient. Your clinical team will let you know if an unanticipated ICSI procedure is recommended.
Does IVF take away eggs that you would otherwise have and diminish your reserve?
At the beginning of each cycle, your body produces several eggs that may develop, with just one that is mature enough to result in a pregnancy. Normally only one matures and ovulates while the others die. With IVF, all the eggs that are naturally recruited that month get stimulated so they all get an opportunity to mature. Nothing happens to all of the other eggs that are in the ovaries for subsequent menstrual cycles, which does not diminish your ovarian reserve or impair your future fertility.
It’s best to have both partner’s fertility evaluated if the female partner is under 35 years old and the couple has been having unprotected intercourse without conception for 1 year, after 6 months if the female is between the ages of 35-39, and after 3 months if the female is 40 and over. A consultation with a fertility specialist will help you get your questions answered and determine the course of action for you.
Are babies born through IVF different?
Children born through IVF are no less real than any other child. They come from an egg and a sperm, they’re healthy, and they bring joy to their families.
Does undergoing IVF treatment mean that you will have multiples (twins, triplets, etc.)?
In the early days of fertility treatment, it was certainly more common for women to have multiples. In the last 10 years, however, technological advancements have drastically reduced the potential for multiples, with the twin rate decreasing to around 16 percent and triplets to less than 1 percent of live births in women under 35. We continue to make great strides in this area, and through elective single embryo transfer (eSET), the incidence of multiple pregnancy has continued to drop at our practice.
Is it possible to evaluate fertility center IVF success rates objectively?
It can be difficult to interpret all of the various statistics quoted by fertility programs. However, there is a mechanism in place to help understand statistics associated with IVF and other assisted reproductive technologies (ART). Fertility centers report (in a standardized format) their annual statistics to the Society for Reproductive Medicine (SART). This report is comprehensive and provides valuable information about a program including:
- Number of cycles performed
- Pregnancy rates by age, with or without male factor infertility
- Miscarriage rates
- Average patient age
An analysis of this data will reveal trends or patterns that will provide insight as to the quality, stability, and experience of the programs being considered, especially if evaluated over time.
How do I evaluate fertility centers on their current statistics?
It is reasonable and recommended that you request documentation on the statistics being discussed as well as a breakdown by age and diagnosis. Since the inception of our IVF program in 1991, Shady Grove Fertility has remained committed to providing to the public a comprehensive statistical analysis of all ART performed in our center and their outcomes. This information is updated annually and is available in our patient packets upon request. We strongly encourage anyone considering advanced fertility treatment to obtain the same comprehensive information from each program they are considering.
Have additional questions? Contact one of our New Patient Liaisons at 1-877-971-7755 or click here.