In Vitro FertilizationIVF is a process that stimulates a number of eggs using drugs called gonadotropins that are akin to the hormones in the body that make eggs grow (FSH). Each developing follicle has one egg, and ultrasound examinations are used to keep track of them. The follicles are extracted, or harvested, at the proper time when they reach the proper size. Following egg collection, the sperm and eggs are mixed together in a dish (traditional insemination) or the sperm is injected directly into the sperm (ICSI, or intracytoplasmic sperm injection). The resultant embryos are grown (cultured) for 5–6 days after laboratory fertilization. It has been shown that stimulating multiple eggs during the IVF process can make the uterine lining less favorable for transfer. Pregnancy rates can be significantly increased by freezing all of the embryos and transferring them later via a process known as frozen embryo transfer, or FET. |
Participants in IVF
For a number of different scenarios, in vitro fertilization may be the best reproductive therapy option. IVF is becoming common as a main kind of infertility therapy as its success rate keeps rising. Among the justifications for IVF are:
While some people may know they want to pursue IVF before meeting with a fertility specialist, all patients will begin with a consultation with one of our doctors. Following a review of the patient's medical history, a diagnostic plan is developed for each individual patient. Following the completion of all diagnostic testing, the physician advises on the best options for fertility treatment. Patients are then given the option of choosing the treatment that best meets their needs and desires. Our facility does not screen out or decline patients who are unlikely to conceive. There are no attempts to turn away couples in order to keep good statistics. Patients who have the lowest chances of conceiving are often the ones who benefit the most from aggressive fertility treatment. Having said that, realistic expectations must be established. The physician will discuss your individual treatment options and the likelihood of success during the consultation and subsequent visits.
For a number of different scenarios, in vitro fertilization may be the best reproductive therapy option. IVF is becoming common as a main kind of infertility therapy as its success rate keeps rising. Among the justifications for IVF are:
- Significant adhesions (scar tissue) in the abdomen or around the fallopian tubes
- A history of fallopian tube damage, including previous surgeries
- Endometriosis
- Low or abnormal sperm parameters on a sperm analysis. Intra Cytoplasmic Sperm Injection, or ICSI, is another treatment option.
- Attempts at other types of infertility treatment that have failed
- COH cycles reduce the risk of larger-than-twin pregnancies.
- Fertility preservation
- Gender selection or genetic screening of embryos
- Desire to use the most effective fertility treatment without using donor eggs
While some people may know they want to pursue IVF before meeting with a fertility specialist, all patients will begin with a consultation with one of our doctors. Following a review of the patient's medical history, a diagnostic plan is developed for each individual patient. Following the completion of all diagnostic testing, the physician advises on the best options for fertility treatment. Patients are then given the option of choosing the treatment that best meets their needs and desires. Our facility does not screen out or decline patients who are unlikely to conceive. There are no attempts to turn away couples in order to keep good statistics. Patients who have the lowest chances of conceiving are often the ones who benefit the most from aggressive fertility treatment. Having said that, realistic expectations must be established. The physician will discuss your individual treatment options and the likelihood of success during the consultation and subsequent visits.
Process
On the surface, the IVF process may appear to be overwhelming. Completing a series of classes designed to cover the details of the IVF process is part of the preparation for IVF. Coordinators are on hand to help patients through each step of the IVF procedure and answer any questions that may arise. California IVF has seen consistent improvements in IVF treatment success rates while maintaining a patient-centered approach to treatment. We also encourage patients to ask questions at every stage of the process so that they are fully informed about their journey to parenthood.
Before beginning any type of treatment, one of our doctors will meet with you to discuss your medical history and goals. Any fertility blood tests or imaging studies that are recommended will be completed first. When your evaluation is finished, the IVF coordinator will inform you about the IVF process and schedule an IVF information session for you. Patients learn about the IVF process, medications, and risks during this IVF information session. Patients are also taught how to self-administer the fertility medications required for the IVF procedure. In addition to learning about injections, patients will also learn about the medications' purposes, potential side effects, and any other questions they may have. Individualized treatment calendars with all of the details required to complete the IVF cycle are provided. Another class is planned to go over the embryology process. Details about the IVF laboratory process, from egg collection to embryo transfer, are reviewed during the meeting with the embryologist. Patients should keep all documents provided during their visits and refer to them as they progress through treatment.
There are various treatment plans or protocols with fertility medications that can be used to prepare the eggs for the IVF cycle. Each patient receives detailed instructions tailored to their specific plan, which are outlined on the medication calendar. Patients are subjected to a baseline ultrasound before beginning medications. This initial ultrasound is comparable to a "before" image of the ovaries prior to starting medications. The baseline ultrasound may reveal ovarian cysts or other abnormalities that could cause the IVF cycle to be postponed or cancelled. A trans-vaginal ultrasound probe is used to perform ultrasounds during the IVF process. A vaginal ultrasound probe is smaller and more comfortable than a speculum (used for gynecologic exams). Trans-vaginal ultrasounds are best performed with an empty bladder.
Typically, medication protocols include two types of medications. There are medications that prevent ovulation and others that stimulate the ovaries. Patients must adhere to their medication schedules in order for the follicles and eggs to develop properly. Gonadotropins are hormones that stimulate the development of eggs. Gonal-F and Follistim are two of the most commonly used brand names. Additional ultrasound exams are used to monitor the outcome of the egg stimulation. The monitoring ultrasound will assess the size and number of follicles, or fluid sacs containing eggs, as well as the uterine lining. Before the egg collection procedure, the monitoring phase of the IVF cycle usually necessitates 2-3 visits. The endometrial lining will also be examined during the monitoring ultrasound. The endometrium should be thicker than 8 mm, and the follicles should be 18-20 mm in diameter for the lead, or largest follicle, and 14-15 mm in diameter for the other follicles.
When the follicles are thought to be mature, patients are instructed to discontinue all medications and use a medication to time the egg collection process. HCG, Ovidrel, and Lupron are the most commonly used medications to prepare eggs for collection. Patients will be given written instructions on how to prepare for the retrieval. Approximately 36 hours before the scheduled egg retrieval, or harvest, medications are administered to tune the egg collection. This injection is timed to coincide with the retrieval so that the oocytes are "released" from the follicle wall but not from the ovary into the abdomen. Detailed instructions, including when to stop eating and drinking, are reviewed during the pre-operative process. Patients should generally avoid eating and drinking for 8 to 10 hours before the procedure.
A sperm specimen is collected on the day of the retrieval in order to fertilize the eggs. The sperm sample will be prepared for fertilization, which may or may not involve injecting the sperm directly into the eggs - ICSI. Due to the importance of identity, we will require photo identification and a signature before accepting the specimen. There is a collection room available for privacy. Materials are available in the collection room to provide the visual stimulation that males frequently require.
When patients arrive at the clinic, they will be identified and the final consent process will be completed. Once identities have been verified, an identification band will be worn. For the egg collection procedure, an anesthesia provider will insert an intravenous catheter (IV) and administer sedatives. During the procedure, sedatives and pain relievers will be administered as needed. Women are sleeping and will have little to no recollection of the procedure. During the egg collection procedure, no breathing tube is required. While the procedure can cause a lot of anxiety, most women are pleasantly surprised at how "easy" it can be.
Once patients are situated and prepared in the procedure room, the egg retrieval procedure takes about 10-15 minutes. A transvaginal ultrasound with a needle guide is used in the procedure. The guide directs the needle into the follicles, allowing the eggs to be collected while the ultrasound machine monitors the process. The fluid from the follicles in both ovaries is aspirated using a needle. The fluid is collected in test tubes before being transported to the embryology lab. An embryologist uses a microscope to identify the eggs, or oocytes, in the follicular fluid. The patient is returned to the recovery room once all of the follicles have been aspirated. The total number of eggs collected during the oocyte retrieval procedure will be reported by the embryologist.
Patients are usually able to walk out of the procedure room after 30 minutes. The nurse will give you discharge instructions. Because the medications used for retrieval frequently cause memory impairment and drowsiness, you should plan to spend the rest of the day doing nothing. Most importantly, you will not be permitted to drive yourself home and must be accompanied by an adult at the time of discharge. Following egg collection, patients may experience mild cramping and bloating. The majority of patients are able to resume normal activities the next day.
After that, the embryos will be cultured, or grown, for 5 days. Embryos were traditionally transferred during the same cycle that eggs were collected. Egg stimulation is harmful to the uterine lining, according to newly developed freezing techniques. Most patients are now advised to freeze all embryos after extended culture to the blastocyst stage on day 5 or day 6. Patients can begin the frozen embryo transfer process after menstruation. In general, patients can expect a 15% to 20% increase in pregnancy rates. Because not all embryology laboratories have perfected the more advanced freezing techniques, freezing the embryos may not provide the same benefit. Patients should discuss the recommended treatment plan with their doctor.
Before beginning any type of treatment, one of our doctors will meet with you to discuss your medical history and goals. Any fertility blood tests or imaging studies that are recommended will be completed first. When your evaluation is finished, the IVF coordinator will inform you about the IVF process and schedule an IVF information session for you. Patients learn about the IVF process, medications, and risks during this IVF information session. Patients are also taught how to self-administer the fertility medications required for the IVF procedure. In addition to learning about injections, patients will also learn about the medications' purposes, potential side effects, and any other questions they may have. Individualized treatment calendars with all of the details required to complete the IVF cycle are provided. Another class is planned to go over the embryology process. Details about the IVF laboratory process, from egg collection to embryo transfer, are reviewed during the meeting with the embryologist. Patients should keep all documents provided during their visits and refer to them as they progress through treatment.
There are various treatment plans or protocols with fertility medications that can be used to prepare the eggs for the IVF cycle. Each patient receives detailed instructions tailored to their specific plan, which are outlined on the medication calendar. Patients are subjected to a baseline ultrasound before beginning medications. This initial ultrasound is comparable to a "before" image of the ovaries prior to starting medications. The baseline ultrasound may reveal ovarian cysts or other abnormalities that could cause the IVF cycle to be postponed or cancelled. A trans-vaginal ultrasound probe is used to perform ultrasounds during the IVF process. A vaginal ultrasound probe is smaller and more comfortable than a speculum (used for gynecologic exams). Trans-vaginal ultrasounds are best performed with an empty bladder.
Typically, medication protocols include two types of medications. There are medications that prevent ovulation and others that stimulate the ovaries. Patients must adhere to their medication schedules in order for the follicles and eggs to develop properly. Gonadotropins are hormones that stimulate the development of eggs. Gonal-F and Follistim are two of the most commonly used brand names. Additional ultrasound exams are used to monitor the outcome of the egg stimulation. The monitoring ultrasound will assess the size and number of follicles, or fluid sacs containing eggs, as well as the uterine lining. Before the egg collection procedure, the monitoring phase of the IVF cycle usually necessitates 2-3 visits. The endometrial lining will also be examined during the monitoring ultrasound. The endometrium should be thicker than 8 mm, and the follicles should be 18-20 mm in diameter for the lead, or largest follicle, and 14-15 mm in diameter for the other follicles.
When the follicles are thought to be mature, patients are instructed to discontinue all medications and use a medication to time the egg collection process. HCG, Ovidrel, and Lupron are the most commonly used medications to prepare eggs for collection. Patients will be given written instructions on how to prepare for the retrieval. Approximately 36 hours before the scheduled egg retrieval, or harvest, medications are administered to tune the egg collection. This injection is timed to coincide with the retrieval so that the oocytes are "released" from the follicle wall but not from the ovary into the abdomen. Detailed instructions, including when to stop eating and drinking, are reviewed during the pre-operative process. Patients should generally avoid eating and drinking for 8 to 10 hours before the procedure.
A sperm specimen is collected on the day of the retrieval in order to fertilize the eggs. The sperm sample will be prepared for fertilization, which may or may not involve injecting the sperm directly into the eggs - ICSI. Due to the importance of identity, we will require photo identification and a signature before accepting the specimen. There is a collection room available for privacy. Materials are available in the collection room to provide the visual stimulation that males frequently require.
When patients arrive at the clinic, they will be identified and the final consent process will be completed. Once identities have been verified, an identification band will be worn. For the egg collection procedure, an anesthesia provider will insert an intravenous catheter (IV) and administer sedatives. During the procedure, sedatives and pain relievers will be administered as needed. Women are sleeping and will have little to no recollection of the procedure. During the egg collection procedure, no breathing tube is required. While the procedure can cause a lot of anxiety, most women are pleasantly surprised at how "easy" it can be.
Once patients are situated and prepared in the procedure room, the egg retrieval procedure takes about 10-15 minutes. A transvaginal ultrasound with a needle guide is used in the procedure. The guide directs the needle into the follicles, allowing the eggs to be collected while the ultrasound machine monitors the process. The fluid from the follicles in both ovaries is aspirated using a needle. The fluid is collected in test tubes before being transported to the embryology lab. An embryologist uses a microscope to identify the eggs, or oocytes, in the follicular fluid. The patient is returned to the recovery room once all of the follicles have been aspirated. The total number of eggs collected during the oocyte retrieval procedure will be reported by the embryologist.
Patients are usually able to walk out of the procedure room after 30 minutes. The nurse will give you discharge instructions. Because the medications used for retrieval frequently cause memory impairment and drowsiness, you should plan to spend the rest of the day doing nothing. Most importantly, you will not be permitted to drive yourself home and must be accompanied by an adult at the time of discharge. Following egg collection, patients may experience mild cramping and bloating. The majority of patients are able to resume normal activities the next day.
After that, the embryos will be cultured, or grown, for 5 days. Embryos were traditionally transferred during the same cycle that eggs were collected. Egg stimulation is harmful to the uterine lining, according to newly developed freezing techniques. Most patients are now advised to freeze all embryos after extended culture to the blastocyst stage on day 5 or day 6. Patients can begin the frozen embryo transfer process after menstruation. In general, patients can expect a 15% to 20% increase in pregnancy rates. Because not all embryology laboratories have perfected the more advanced freezing techniques, freezing the embryos may not provide the same benefit. Patients should discuss the recommended treatment plan with their doctor.
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