In Vitro Fertilization (IVF)
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 indicators 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:
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.
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.
Step 1A: Ovarian stimulation | Medications
The main goal of this phase is to help the patient’s ovaries produce eggs in preparation for retrieval. For about 8 to 14 days, a physician will prescribe injectable medications containing hormones naturally found in the female body, such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones help boost a body’s egg production.
Step 1B: Ovarian stimulation | Monitoring
Over the course of 7 to 8 in-person monitoring visits, consisting of hormone bloodwork and pelvic ultrasounds, a physician will closely track the cycle’s progress and adjust medication doses as needed. This all leads up to the trigger shot of either human chorionic gonadotropin (hCG) or Lupron to complete the maturation of developing eggs to prepare for retrieval.
Step 2A: Egg retrieval
On egg retrieval day, the patient will arrive at an SGF surgery center before their expected ovulation. The visit will last up to 3-4 hours in total. Anesthesia is used for the retrieval, so we ask patients to have a transportation plan in place for a safe return home. Before the retrieval, the patient will review the procedure with the OR physician and meet the anesthetist to review personal medical history. The anesthetist will administer intravenous sedation so the patient sleeps comfortably through the entire procedure. Using an ultrasound as a guide, the physician will use a needle to remove the egg-containing fluid in each follicle. The egg retrieval will take about 20 minutes, followed by a period of recovery before the patient can safely leave the center.
Step 2B: Sperm collection
If a fresh sperm sample is being used, a lab technician will accept the sample on the day of retrieval. If a frozen sperm sample or donor sperm is being used, the technician will confirm those details with the patient. Our andrology laboratory will wash and prepare the sample, so that the healthiest sperm are brought together with the eggs following the egg retrieval.
Step 3, Option A: Fertilization with conventional insemination
For conventional insemination, the embryologist incubates the sperm with the eggs in a Petri dish. This gives the egg and sperm the opportunity to come together and fertilize.
Step 3, Option B: Fertilization with ICSI
ICSI may be recommended to the patient by their physician in certain clinical situations, such as male factor infertility or preimplantation genetic testing. During ICSI, an embryologist injects a single, sperm into the center of each egg.
Step 4: Embryo development
For the 5 to 6 days following fertilization, an embryologist will monitor for progressive embryo development using a system we call embryo grading. For example, we’re looking for the embryo to contain 2-4 cells on day 2, and 6-8 cells on day 3. From there, rapid cell division continues as the embryo enters the blastocyst stage at days 5 or 6. The physician’s goal for the patient is to transfer the agreed upon amount of the highest-quality embryo(s) that offer the greatest chance of reproductive success.
Step 5: Embryo transfer
The embryo transfer is a simple, 5-minute procedure that doesn’t require anesthesia or recovery time. What the patient will need is a full bladder, which provides the physician good visualization of the uterine lining to ensure proper embryo placement. We ask the patient to drink the recommended amount of fluids about 30 to 40 minutes beforehand. Using an abdominal ultrasound for guidance, the physician will insert a catheter containing the embryo into the uterus, then slowly remove it. The physician’s goal for the patient is to transfer the highest-quality embryo that offers the greatest chance of reproductive success.
Step 6: Beta pregnancy test
Once the transfer procedure is complete, the wait begins. Approximately 10 days after the blastocyst embryo transfer, the patient will have a beta hCG blood test drawn. The test measures the hCG hormone produced by the developing embryo for the most accurate sign of pregnancy.
Cost of IVF
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 a wide network 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 or donor egg treatment.
Our Shared Risk 100% Refund Program financially ensures you against the risk of not being successful. We only earn our payment when you take home a baby. In this program, you will pay a flat amount that covers the medical cost of up to six cycles of IVF treatment. This amount 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, or 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 deposit*, preserving your resources for other family-building options.
* Some exclusions apply.