In Vitro Fertilization

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 In-Vitro Fertilization (IVF) is a highly successful treatment that introduces the female egg and male sperm together in a specialized culture medium to dramatically enhanced the chances of successful pregnancy; importantly IVF allows for genetic testing (PGS and PGD) of the embryo(s) and even more significantly higher pregnancy rates. Given its success and high pregnancy rates some studies have demonstrated an overall cost-savings for patients moving quickly to IVF. 

IVF involves stimulating the ovaries (gonadotropins) to produce multiple eggs; removing those eggs and combining them with carefully selected sperm and observing the fertilized embryos until they are ready for embryo transfer, cryopreservation (embryo freezing), or embryo biopsy.

1. Ovarian Stimulation
2. Egg Retrieval
3. Fertilization and Embryo Culture
4. Embryo Biopsy (or Transfer)
5. Interval Frozen Embryo Transfer (if indicated)

Ovarian Stimulation During this phase of your treatment, you will be placed on a individualized combination of medications that your team has developed based upon your pre-cycle testing as well as your history. Your progress will be monitored by both ultrasound and blood tests to optimize your ovarian response. This phase of your treatment can take several weeks and during some time intervals, you will be seen frequently.

Egg Retrieval After several days of ovarian stimulation, eggs will be obtained by undergoing a short usually outpatient procedure known as egg retrieval. While under anesthesia and with ultrasound guidance, a small needle is passed through the vagina and into the ovaries. Eggs are obtained by removing (aspirating) the fluid in most follicles. An egg retrieval typically takes around 30-45 minutes and once you are awake and fully recovered, patients are usually discharged home. Please be prepared to limit your activity for several days after your egg retrieval.    

After your eggs have been retrieved, our experienced team will evaluate your eggs to determine maturity (unfortunately, not all eggs are mature) and then attempt to fertilize (unfortunately, not all egg will fertilize) each egg.  Fertilized eggs (now known as embryos)  will be cultured for the next five to six days in our laboratory (unfortunately, not all embryos continue to grow in culture). ICSI increases fertilization rates for most patients and is recommended for male infertility, or for couples that have failed fertilization in a prior IVF cycle. ICSI involves the microscopically guided injection of a single sperm into a mature egg.

Embryo Testing and Freezing Embryos that progress to the blastocyst stage may be either transferred back to the uterus or biopsied for genetic testing. In most cases, we recommend genetic testing of your embryos because it improves your chances of success, decreases your chances of miscarriage, and decreases your chances of multiple gestations. Please discuss these options with your physician. Embryos that have been biopsied will then be frozen and transferred back into the uterus several weeks later.

Frozen Embryo Transfer (FET) In 2011, new data appeared to demonstrate that pregnancies resulting from a frozen embryo transfer MAY be heathier than after a fresh transfer. Specifically, some data babies conceived after frozen embryo transfer demonstrated less pre-delivery bleeding during pregnancy, a lower risk of preterm birth, decreased risk for small for gestational age baby/low birth weight and a lower infant mortality. Of course, more research is needed but some infertility professionals have speculated that interval frozen embryo transfer creates a more physiologic (think “normal”) environment for implantation.