To prepare for an IVF cycle, you first meet with or talk to your
physician, a board certified reproductive endocrinologist. You physician reviews your
case, develops a treatment plan and recommends tests prior to starting IVF.
Our nurse coordinator meets with or talks to you to review IVF, answers
any questions, and schedules your medications. Medications include oral contraceptives
(birth control pills), started in the month before the treatment cycle, and Lupron or
Synarel, started just before finishing the oral contraceptives. Lupron or Synarel prevents
early egg release from the ovary, or ovulation. These medications prepare you for the next
phase, ovulation induction.
Fertility drugs stimulate multiple follicles in the ovaries, each
containing a single egg. Many fertility drugs are available, all of which share in common
the hormone Follicle Stimulating Hormone, or FSH. FSH can be injected with a small needle
just below the skin in the leg (Sub Q) or into the muscle of the buttock (IM). Different
stimulation protocols are used to produce the best number and best quality of eggs.
During oocyte retrieval the eggs are removed from the ovaries. A
needle is guided by ultrasound into each follicle in the ovary to remove the fluid
containing the egg. The ultrasound is performed vaginally; neither incisions nor surgery
are required. The eggs are collected into a test tube, and passed to an embryologist, who
prepares the eggs for insemination.
The eggs are inseminated, meaning they are mixed with a sperm sample.
This begins an amazing cascade of events which ends in a fertilized egg, known as a
zygote, or embryo, the earliest stage of the developing human being.
Sperm samples which are not expected to fertilize on their own may be
assisted by sperm injection, or Intracytoplasmic Sperm Injection, more commonly known as
ICSI (ick-see).
Photos of the five stages of development: Ultrasound of an
ovary, a fertilized oocyte, a four cell embryo, an eight cell embryo and an emryo
hatching.
Embryos are placed into the uterus or womb using a catheter, a
hollow plastic tube. The catheter is designed to be small and flexible so it slips easily
through the cervix. This is a minor procedure that seldom requires anesthesia or sedation.
Recent breakthroughs in the embryo laboratory allow us to grow embryos
to the blastocyst stage. The biggest single advantage of the blastocyst transfer is a
significant reduction in the rates of multiple pregnancy greater than twins.
Another advance in reproductive technology is cryoperservation &
frozen embryo transfer . If a pregnancy does not
occur in the "fresh" IVF cycle, the patient can return at a later time for
transfer of the remaining frozen embryos.
The important days following embryo transfer, when the embryo begins
developing and implants in the lining of the uterus, is the luteal phase. Progesterone, a
natural hormone, helps the lining of the uterus develop and support the pregnancy.
Supplemental progesterone is given by injection, vaginal suppository, or vaginal gel. At
the end of the luteal phase a pregnancy test is performed.
Once you are pregnant, you will remain on medication as prescribed until
one week after your second ultrasound at 10 weeks from your last menstrual period. At that
time, we individualize the remaining course depending on your age , whether you have
multiple embryos, and your general ovarian health. You return to your obstetrician at
around 10 weeks gestation.
If you do not conceive, you should schedule a follow-up visit with your
doctor at our clinic so we can review the cycle and make plans for the future. This
follow-up visit is very important to all of us.
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