In vitro fertilization, also commonly known as IVF, is the treatment of choice in cases of infertility when both fallopian tubes are blocked. However, IVF may also be used for unexplained infertility, endometriosis, cervical factor infertility, ovulation disorders, or when a man has a low sperm count. Basically, IVF involves taking mature oocytes (eggs) from the woman, fertilizing them with sperm in a petri dish in the IVF laboratory and then transferring the resulting embryos back to the woman's uterus two to six days after fertilization is confirmed. Pregnancy rates vary with the woman's age, ovarian reserve (day 3 FSH), and diagnosis.

IVF can be physically and emotionally draining, however, the stress and anxiety associated with IVF can be reduced if you and your partner have a clear understanding of the IVF procedure. It is important that you and your partner learn as much as possible about the IVF process, which includes the following steps after your pre-IVF lab testing is completed.

Stimulation of Ovaries
Every patient will receive a cycle plan sheet. This sheet will list the protocol medications and dates of the cycle. The purpose of medications is to stimulate the ovaries to form multiple oocytes (eggs). We will monitor this stimulatory process with blood tests and ultrasounds. Usually, you will receive a drug known as a gonadotropin-releasing hormone agonist (an example is Lupron) or a gonadotropin-releasing hormone antagonist (examples are Antagon and Cetrotide). These drugs prevent your ovaries from releasing eggs too early during your IVF cycle. In addition, you will then be given one or more medications known as human menopausal gonadotropins (hMG), which can stimulate your ovaries to produce many oocytes (eggs). This is important to increase your chance of getting pregnant. The gonadotropins are given daily as an injection in your abdomen, thigh, or upper arm. Your treatment plan will determine the most appropriate medication dose for you. Some hMG and ferti! lity drugs are Bravelle, Fertinex, Follistim, Gonal-F, Novarel, Ovidrel, Pregnyl, Profasi, and Repronex. The nurse at our fertility office will train you and your partner to give the shots.

Egg Retrieval and Fertilization
Egg retrieval is a surgical procedure performed in an operating room. A nurse anesthetist will be present during the procedure and may give you an intravenous sedation to make you sleepy or a spinal which will numb you from the waist down.

During the egg retrieval procedure, your doctor will place a needle along with an ultrasound probe into your vagina. The needle will be gently moved through the back of your vagina into each mature follicle in your ovaries. Since the retrieval of eggs is done through the vagina, you will not have a cut or incision in your abdomen. The fluid from each follicle, along with the egg, is drawn through the needle. The egg retrieval procedure usually takes about 20 to 30 minutes, depending on the number of mature follicles you have.

The eggs are placed in a special dish in an incubator for a minimum of three hours prior to insemination (exposing the eggs to sperm).

On the day of the egg retrieval, your male partner will need to produce a sperm specimen for the IVF laboratory to use to fertilize the eggs (or a frozen sample must be available). The man providing the semen should abstain from ejaculation for two to five days before the egg retrieval. In the case of male factor infertility, standard insemination techniques may not be successful. If the man's sperm counts are very low or fertilization has failed to occur with a prior IVF attempt, special egg insemination techniques may be used to help the sperm fertilize the eggs. After the egg retrieval procedure, you will most likely be asked to rest in the recovery suite for about 1 hour. You should arrange for someone to drive you home where you should rest for the remainder of that day. Some women experience light vaginal bleeding and lower abdominal pain after egg retrieval.

Starting the day after your egg retrieval you will need to start taking a progesterone supplement. This helps to prepare the uterine lining for attachment of the embryos. Progesterone is taken as a daily injection and should be continued until the day of your pregnancy test.

Embryo Transfer
The day after retrieval the inseminated eggs are studied for evidence of fertilization. To allow further cell division and growth, eggs are cultured for another 24 to 48 hours before the resulting embryos are considered ready for transfer. We will discuss the condition of your embryos daily during the process and how many embryos will be transferred into your uterus. In general, we may transfer two to four embryos, depending on your age and other factors, such as the condition of your uterus. The embryos are transferred to your uterus through the cervix using a special IVF catheter.

Following the embryo transfer procedure, we may recommend that you rest in bed for the remainder of the day. Following this, you should avoid strenuous exercise as well as not engage in sexual intercourse until the day of your pregnancy test.

Pregnancy Test
A pregnancy test is scheduled for about two weeks after your egg retrieval. The nurse will give you that date of the pregnancy test at your embryo transfer.

Frozen Embryo Transfers/Embryo Cryopreservation
Cryopreservation or freezing offers a way to store embryos for a subsequent IVF cycle. Couples who have extra embryos available after an IVF procedure need to decide what to do with them. The extra embryos may be frozen (cryopreserved) after fertilization. The embryos can be thawed and transferred into your uterus during a future hormone cycle.

Frozen embryos may be stored for five years. To use frozen embryos, they must be thawed and examined to see if they survived freezing. Typically, 10-20% of the embryos do not survive the freezing and thawing process. Pregnancy rates with frozen embryos have been shown to be similar to nonfrozen embryos of equal quality. Cryopreservation has several benefits. During a frozen embryo transfer cycle the woman does not need to use medications such as gonadotropins to stimulate her follicles, and the cycle is less physically demanding. In addition, the cost of a frozen embryo transfer cycle is much less than the cost of a regular IVF cycle.

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