Reviewing the in vitro fertilization process
The in vitro fertilization process includes five different steps.
- Suppression: The first step of the in vitro fertilization process is suppression. The IVF cycle usually begins with your period. Hormone tests are performed during the first few days of your cycle, and an ultrasound is performed. You will then start on birth control pills, which suppress ovarian hormones and prevent ovulation. This will help to synchronize the eggs so that during stimulation more will mature at the same rate. You will be on these for 2-4 weeks. During this time some patients will start a daily shot of Lupron, which will prevent premature release of the eggs as they are growing. Once the birth control pill is stopped, most people will have a period.
- Ovarian stimulation: The ability to produce multiple eggs is one of the requirements for a successful IVF cycle. It will also increase the chance of having extra embryos available for freezing, which can be used for additional attempts at pregnancy. During the stimulation stage of IVF, you will begin daily shots of one or more medications that will cause the ovary to produce multiple eggs. At MRC, we use different combinations of fertility medication to optimize growth of the eggs. Dr. Gehlbach will individualize the choice of medications based on your medical history, hormone testing, and appearance of your ovaries on ultrasound. For most women it will take 9 or 10 days of shots for the eggs to mature, although in some cases it may require several more days. During the stimulation period, you will be monitored closely in our office by ultrasound and hormone levels, and once the follicles are mature, we will schedule you for egg retrieval.
- Egg retrieval: We are fortunate at MRC to have our own private, state-of-the-art IVF suite situated in a comfortable office setting. During the retrieval steps of the in vitro fertilization process, your eggs will be removed by transvaginal ultrasound aspiration. In the procedure room an anesthetist will administer sedation by IV. Once you are asleep, Dr. Gehlbach will place an ultrasound probe into the vagina to easily identify the follicles; then he will guide a needle into each follicle and remove the fluid within. The egg is located in the follicular fluid and the embryologist will work carefully to identify them. The egg retrieval process usually lasts no longer than 30 minutes. Because the procedure is performed transvaginally, you will have no outside incisions from the procedure.
- Fertilization: After the eggs are retrieved, they are carefully examined in the laboratory by the embryologist. Typically, the male partner provides a sperm specimen the morning of the oocyte retrieval, although in some cases sperm are retrieved prior to egg retrieval by a testicular biopsy performed by a urologist in our procedure room. The embryologist will evaluate the specimen and prepare it for the fertilization process. Fertilization is accomplished either by insemination, placing the sperm in the fluid surrounding the eggs, or by intracytoplasmic sperm injection (ICSI), a process where the sperm is injected directly into the egg.
The embryologist will continue to observe the growth of the embryos per laboratory protocol and will keep you updated on the progress of your developing embryos.
- Embryo transfer: Transfers routinely occur on either day 3 or day 5 of the cycle. Dr. Gehlbach and the embryologist will carefully monitor the growth and health of the embryos as they progress from retrieval to transfer and decide the best possible time to transfer them to your uterus. Day 5 transfers allow for additional time to select between multiple embryos. When there are fewer embryos to choose from, a Day 3 transfer is preferred because it transfers them to the best incubator available – your uterus.
The embryo transfer is a painless procedure similar to an intrauterine insemination (IUI) or pelvic exam.
Several factors will influence the number of embryos transferred. Such as:
- Age of the female partner
- Infertility history
- Previous pregnancy and IVF history
- Date of transfer and quality of the embryos
At MRC we respect the guidelines from the American Society for Reproductive Medicine on the number of embryos to transfer, which are provided to you at the beginning of the IVF process. Dr. Gehlbach will discuss his recommendations for the number of embryos with you on the day of your embryo transfer, and together you will make the decision.
Two weeks from the day of your egg retrieval, you will be scheduled for a blood pregnancy test to determine the success with the in vitro fertilization process.
Embryology Lab Supervisor, Tiffany Thompson
Tiffany Thompson discusses new research on preimplantation genetic testing.