The IVF process involves the following steps:
1. Ovarian Stimulation and Egg Development
During the first half of a normal cycle, follicles (the fluid-filled sacs that contain the eggs) develop, and a single egg is released. The chances of success with IVF increase if there is more than one oocyte (immature egg) available for use in the laboratory.
A combination of fertility medications and hormones is routinely administered during the early part of an IVF cycle. The goal is the synchronous development of multiple follicles and eggs. The most commonly used combinations include purified or synthetic forms of pituitary hormones (FSH and LH). An additional medication is used to prevent women from ovulating early during the stimulation process.
The response to the medications is monitored through a combination of blood tests and pelvic ultrasounds. Once this monitoring suggests that the eggs have reached maturity, a trigger shot is administered (human chorionic gonadotropin [hCG] or Lupron). The egg retrieval is scheduled 35-36 hours after hCG administration.
2. Egg Retrieval
The mature eggs are removed from the ovaries with a needle that is inserted through the vagina. This procedure is performed using ultrasound guidance, which allows precise placement of the needle into each follicle. Intravenous sedation makes this a painless procedure – general anesthesia is not required. The contents of each follicle are collected into a test tube and immediately transferred to the laboratory, where the eggs are identified, isolated, evaluated and placed into an incubator in less then two minutes.
3. In The Laboratory
The eggs, sperm and embryos are handled under sterile conditions at all times. Once an egg is identified, it is placed into a special culture medium for two to six hours before it is inseminated. At the time of the egg retrieval, the man will be asked to obtain a sperm sample. If you are using donor sperm, it will also be prepared during this time.
The sperm are then isolated from the remainder of the ejaculate and added to the eggs to allow fertilization to occur. After 18 to 24 hours, the first signs of fertilization occur. The laboratory personnel will notify you at this time as to how many of the eggs successfully fertilized. The embryos are watched in an incubator in the laboratory for an additional five to six days, depending on when your doctor is recommending the embryo be transferred.
4. Embryo Transfer
The embryo transfer is performed in a small room adjacent to the laboratory. It is an essentially painless procedure. During the procedure, an appropriate number of embryos are loaded into a small catheter. This catheter is then introduced through the cervix and into the uterus. A physician will use ultrasound guidance to check the placement of the catheter. Once the catheter is placed, the embryo(s) are gently deposited into the uterus.
You will be released to go home right after your transfer. After you return home, we suggest very minimal activity for the first 24 to 48 hours.
5. After the Transfer
Progesterone, the hormone responsible for preparing the lining of the uterus to accept a pregnancy, is administered for 10 to 14 days following the transfer and continued for the first part of pregnancy.
The first pregnancy test can be done as early as 10 days after the transfer. If the results are positive, a pregnancy test is repeated two days later. If these tests are positive, we will continue to provide your care, including ultrasounds, for the next several weeks and then refer you back to your obstetrician.
If the tests are negative, we will arrange a post-cycle consultation, at which time the events of the cycle will be analyzed and plans made for the future. If unsuccessful, an attempt may be repeated in two to three months.