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

Stimulated IVF vs Natural Cycle IVF

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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