In Vitro Fertilization

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What You Need to Know About In Vitro Fertilization(IVF)

What is In Vitro Fertilization?

IVF is the Process where the female patient is stimulated with medication to make several eggs grow within the ovary. The eggs are then collected through the vagina using a sonogram-guided needle under sedation. Sperm is then added to the eggs to allow fertilization to take place. Fertilized eggs are then placed back in the uterus a few days later. IVF is effective for different types of infertility including tubal disease, male factor, ovulation disorders, endometriosis and unexplained infertility.

How much does it cost?

The amount will vary as each patient/couple receives a customized treatment plan. We verify insurance coverage prior to your initial visit.  After meeting with your physician and establishing a plan, the costs associated can be determined.  IFC offers a single priced IVF, multi-cycle and refund programs. We also offer third party financing and discount programs. Please speak to our financial counselor for additional questions.

The In Vitro Fertilization Cycle

Evaluation

A full evaluation confirms the need for IVF and prepares for the cycle, which includes extensive patient education and a few diagnostic tests at one of our clinic (or at one of our out of state offices). This preparation may take 1-2 months.

Ovulation stimulation

Beginning with the onset of a woman’s menstrual cycle, two hormonal medications are given, one to control when a woman will ovulate and the other to stimulate production eggs. These daily hormonal injections occur over 10 to 12 days. Two or three transvaginal ultrasounds are performed to assess the growth and maturity of the follicles containing the eggs. Once mature (ready to ovulate), a third hormone is given to trigger the eggs’ release (ovulation). This is usually cycle day 10 – 12.

Oocyte retrieval

One hour prior to the eggs releasing from the ovary, they are aspirated through a needle into a test tube. Anesthesia provides no pain, while the transvaginal ultrasound guides the needle into the separate follicles to aspirate the eggs. An average egg yield is about 15, but varies widely.

Laboratory

The eggs are mixed or injected (ICSI) with the husband’s sperm. The lab is equipped with state-of-the-art instruments, microscopes, incubators, airflow hoods, and room filters to ensure the highest quality outcomes. Typically 60-70% of eggs retrieved will become fertilized (the same as in nature). These fertilized eggs are incubated over 3 to 5 days, until ready to enter the uterus.

Embryo transfer

Three to five days after the egg retrieval, following evaluation of the quality of the developing embryos, a decision is made by the patients and the physician as to how many to transfer to the uterus. Your doctor will discuss the number of embryos to transfer that will provide the highest probability of the success of a healthy pregnancy, while still trying to minimize the probability of a high order multiple pregnancy. You will receive information on your embryos and a picture of your embryos. Usually, patients decide to transfer 1 to 2 embryos. In an atraumatic catheter, embryos are transferred through the cervix into the uterus under ultrasound guidance. The procedure is pain-free. It is often a very reassuring experience to see the embryos placed into the womb. High quality embryos that remain from the cycle can be cryopreserved on day 5 or 6 and stored for future attempts.

Luteal phase monitoring

The patient takes progesterone daily while waiting for the pregnancy test. We typically wait 10 days after the embryo transfer to determine whether an embryo implanted. Once it takes hold, the hormone it produces is detected in the mother’s blood stream. This confirms an early pregnancy.

Implantation

Successful implantation marks the beginning of a 9-month gestation. The mother-to-be will return to her personal physician at 9 weeks gestation for prenatal care. If an embryo did not implant, the patient can use the frozen embryos or begin a new treatment cycle.

IVF Frequently Asked Questions.

What effect does female age have on getting pregnant and staying pregnant?

A woman’s fertility begins to fall in her early to mid- thirties, mostly due to a decrease in the number and quality of eggs in your ovaries. This varies from woman to woman; unfortunately, there is no way to reliably predict fertility decline. The condition of your eggs also changes as you age; they have a higher rate of chromosomal anomalies.

Am I a good candidate for IVF?

If you have any of the following conditions, you may be a good candidate for IVF:

  • Ovulatory dysfunction
  • Male factor infertility
  • Blocked, diseased, or absent fallopian tubes
  • Pelvic inflammatory disease
  • Unexplained infertility
  • Failed conventional fertility methods with Clomid, injectable drugs, and/or intrauterine insemination (IUI)
  • Endometriosis
  • PCOS
  • Uterine factors or cervical mucus problems

On which day should the embryos be placed back into the uterus?

We will contact you to schedule the embryo transfer date. The options are a day three transfer or a day five transfer (blastocyst transfer). The final decision is made on day three (72 hours) when we will make an assessment together as to the best option possible.

How many embryo’s should we implant?

An advantage of IVF is the ability to control the number of embryos to be transferred and helps to avoid the complication of a multiple pregnancy. According to your particular treatment goals, you and your physician will discuss recommended number of embryos to transfer.

What is Elective Single Embryo Transfer (eSET)?

This relatively recent procedure involves the elective transfer of only one embryo to the uterus, with other viable embryos set aside for future use or cryopreservation.

Should we have genetic testing or Preimplantation Genetic Diagnosis (PGD)?

PGD can be used to target specific genetic diseases when one or both parents are carriers of, or affected by, a known genetic diagnosis. In some circumstances, PGD may be appropriate to select embryos for HLA-typing or for the detection of genes associated with devastating chronic diseases and some types of cancer.

What is the difference between PGD and PGS?

PGD stands for Preimplantation Genetic Diagnosis. This entails screening embryos for specific gene mutations for which the parents may be carriers. As an example, if both parents carry a gene mutation for Cystic Fibrosis, you can screen the embryos to ensure that the embryo transferred will not be affected with the disease. PGS stands for Preimplantation Genetic Screening. This involves screening embryos to ensure that the embryo transferred is genetically ‘balanced’, meaning that there are no extra or missing pieces of chromosomes. This can be very helpful for couples with a history of recurrent pregnancy loss, multiple failed IVF cycles, or in older couples. This does not screen for specific disease mutations.

If pregnancy does not occur in the first IVF cycle, is there reason to try again?

In-Vitro Fertilization is a gold standard of treatment for infertility and increases the likelihood of pregnancy well above the natural monthly conception rate.   UFC achieves exceptionally high success rates but we acknowledge that not all patients find success on their first attempt.

Three things help us evaluate and determine if another round of IVF is right for you.

  1. Quality of Embryos
  2. Receptivity of Uterus
  3. Embryo Transfer Technique

How is the gestational age of my pregnancy calculated?

Gestational age is normally calculated by a woman’s Last Menstrual Period (LMP). That means that she is considered 2 weeks pregnant at ovulation (which is the same time as your egg retrieval). So to calculate your gestational age, know that you are 2 weeks pregnant at your egg retrieval.

What are the potential risks of IVF?

OHSS and Other Rare Complications

It is very rare to have a complication from your infertility medications and/or your IVF treatment cycle. However, as with most medical treatments, there are potential problems that can occur. Rarely, infection and significant bleeding can occur as a result of the egg retrieval. Ovarian hyperstimulation syndrome (OHSS) can occur whenever women use ovarian stimulation medications, especially injectable gonadotropins. This complication occurs in less than 1 percent of women who have egg retrievals with IVF. When severe, OHSS can cause severe dehydration with fluid accumulation in the abdominal and lung cavities, and blood-clotting disorders. OHSS symptoms typically last 1-2 weeks and the majority of cases resolve without treatment. Often pain medication and antinausea medication are needed to help alleviate the pain and nausea associated with OHSS. IVF cycles may be cancelled or embryo transfers may be postponed in order to prevent ovarian hyperstimulation syndrome.

Multiple Gestations

The risk of multiple gestations is more common in women who undergo IVF and fertility treatments. The rate of having twins is approximately 25% and the rate of high order multiples (three or more babies) are 2%. Our goal is to have one, healthy baby. Multiple gestation pregnancies have more risks associated with them including: premature labor, premature delivery, maternal hemorrhage, pregnancy-induced high blood pressure, cesarean section delivery, and gestational diabetes. The risks involve both the babies and the mother. The risk of ectopic (tubal) pregnancy is 1-2% with invitro fertilization.

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