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.
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Advanced IVF Treatments
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Egg Retrieval Guide
Stimulated IVF vs Natural Cycle IVF
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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:
  • 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.

IVF process

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

In the days following fertilization, an embryologist will monitor for progressive embryo development using a system we call embryo grading. Rapid cell division continues as the embryo enters the blastocyst stage around days 5 or 6. The goal is to transfer 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.

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Reach out to our New Patient Center to schedule your appointment. SGF is proud to welcome 100,000 babies born, and yours could be next.

Success rates

Jan 1, 2019 – Dec 31, 2019 Preliminary Data – Primary Outcome Per Egg Retrieval Cycle
View SGF’s most recent SART data for Rockville, MD
<3535-3738-4041-42>42
Cycles627367371186105
Retrievals59032431815781
Transfers4511961174418
Live Birth per Intended Retrieval38.5%20.7%13.8%5.7%1.2%
Live Birth Rate per Transfer50.1%34.2%37.6%20.5%<1%
Mean Number of Embryos Transferred1.01.11.41.82.1
Implantation Rate55.9%41.4%36.6%19.0 %13.2%
Cancellation Rate5.9 %11.7 %14.3 %15.6 %22.9%

Data shown only reflects results from fresh embryo transfers (it does not include PGS cycles that require frozen embryo transfers (FET).

“A comparison of clinic success rates may not be meaningful because patient medical characteristics, treatment approaches, and entry criteria for ART may vary from clinic to clinic.”

Jan 1, 2019 – Dec 31, 2019 Preliminary Data – Primary Outcome Per Egg Retrieval Cycle
View SGF’s most recent SART data for Towson, MD
<3535-3738-4041-42>42
Cycles22089673115
Retrievals21179562314
Transfers1764324118
Live Birth per Intended Retrieval38.4%22.8%14.3%8.7%<1%
Live Birth Rate per Transfer46%41.9%33.3%<1%<1%
Mean Number of Embryos Transferred1.11.11.72.21.9
Implantation Rate47.1%46.8%32.5%20.8%<1%
Cancellation Rate4.1%11.2 %16.4%25.8%<1%

Data shown only reflects results from fresh embryo transfers (it does not include PGS cycles that require frozen embryo transfers (FET).

“A comparison of clinic success rates may not be meaningful because patient medical characteristics, treatment approaches, and entry criteria for ART may vary from clinic to clinic.”

Jan 1, 2019 – Dec 31, 2019 Preliminary Data – Primary Outcome Per Egg Retrieval Cycle
View SGF’s most recent SART data for Chesterbrook, PA
<3535-3738-4041-42>42
Cycles763726168
Retrievals643421147
Transfers203110
Live Birth per Intended Retrieval15.6%8.8%0%1/140/7
Live Birth Rate per Transfer50.0%2/30/11/10/0
Mean Number of Embryos Transferred11220
Implantation Rate50%2/30/21/20/0
Cancellation Rate15.8%8.1%19.2%2/161/8

Data shown only reflects results from fresh embryo transfers (it does not include PGS cycles that require frozen embryo transfers (FET).

“A comparison of clinic success rates may not be meaningful because patient medical characteristics, treatment approaches, and entry criteria for ART may vary from clinic to clinic.”

Jan 1, 2019 – Dec 31, 2019 Preliminary Data – Primary Outcome Per Egg Retrieval Cycle
View SGF’s most recent SART data for Atlanta, GA
<3535-3738-4041-42>42
Cycles3819281310
Retrievals351522107
Transfers246432
Live Birth per Intended Retrieval28.6%3/150%0/100/7
Live Birth Rate per Transfer41.7%3/60/40/30/2
Mean Number of Embryos Transferred1.01.21.823
Implantation Rate52%3/70/70/60/6
Cancellation Rate7.9%4/1921.4%3/133/10

Data shown only reflects results from fresh embryo transfers (it does not include PGS cycles that require frozen embryo transfers (FET).

“A comparison of clinic success rates may not be meaningful because patient medical characteristics, treatment approaches, and entry criteria for ART may vary from clinic to clinic.”

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. More than 80% of applicants qualify for the Shared Risk 100% Refund Program. Eligibility and cost are determined by your age as well as your ovarian, uterine, and sperm function.

The flat fee for the Shared Risk 100% Refund Program also includes the cost of vitrification (flash-freeze technology) and unlimited frozen embryo transfers (FETs) from your qualified cycles. If you do not take home a baby as a result of your cycles, or the transfer of any frozen embryos, or you choose to withdraw from the program before the end of your remaining cycles, we will refund 100 percent of the deposit*, preserving your resources for other family-building options.

* Some exclusions apply.

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FAQs

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.

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.
Research actually suggests that there is little to no difference between IVF and non-IVF babies born with a disease/defect.

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.

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.

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).

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.

In addition to having the ability to choose the Shared Donor Egg Program, you can also participate in the Shared Risk 100% Refund Program for donor eggs. Many insurance companies do not cover the cost of donor egg treatment, but the combination of these two programs can help you significantly save on costs. The Shared Risk 100% Refund Program entitles the patient to undergo up to six cycles of fresh or frozen donor egg treatment, as well as any subsequent frozen embryo transfer (FET) cycles and receive a 100 percent refund if a baby is not delivered (some exclusions apply).

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.

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 assisted reproductive technologies (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.

Intracytoplasmic sperm injection (ICSI) is performed as part of IVF, if medically indicated. It is a process in which an embryologist injects a single sperm into the cytoplasm (center) of each egg. After the embryologist fertilizes the egg with the sperm, they will observe the egg over the next day or so. If fertilization occurs and the embryo matures properly, a physician can transfer it into the uterus.

ICSI is recommended in cases of male factor infertility resulting in low motility (movement) or low sperm count. ICSI is especially useful in cases where the sperm cannot penetrate the egg or if the sperm is abnormally shaped.

IVF is usually not the first choice for many patients. However, if you’ve undergone IUI, ovulation induction, and you still can’t get pregnant even though your partner’s sperm/semen are healthy, then you may benefit from our donor egg program.

Because it is so popular, many people think IVF is undeniably the best infertility treatment. In reality, we have patients that didn’t need IVF to get pregnant and benefitted from IUI (Intrauterine Insemination) or ovulation induction. Everyone’s fertility journey is different, which is why the treatment we recommend depends on your personal situation.

IVF might be right for you if you and/or your partner suffer from:
  • Damaged fallopian tubes
  • Endometriosis
  • Poor semen quality
  • Low sperm count

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How to get started

Shady Grove Fertility has treatment options to help almost everyone build the family of their dreams. And it all starts with one call:

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