In Vitro Fertilization (IVF)

What are IVF Treatments?

In vitro fertilization is the most effective and efficient form of the assisted reproductive treatments, with success rates well over 50% for many patients. At PREG, we use the most advanced technology and latest research to help you achieve your dream of building a family. IVF can be performed in many different ways:

• Using your own eggs and your partner’s sperm
• Using eggs, sperm or embryos from a known or anonymous donor
• Using a gestational carrier – a woman who will carry the pregnancy if the female partner is not able to do so

Your physician along with your fertility care team will recommend a course of treatment that is unique to you, based on your medical history and diagnostic testing results. Sometimes the recommended type of IVF treatment you have may change over time due to a variety of factors including past cycle response, egg quality, and medication response.

Preparing for your IVF cycle

In preparation for an IVF cycle, you and your partner will undergo pre-cycle testing. Here are some basic tests that will likely be performed:

• Blood tests for both male and female partner
• Transvaginal ultrasound for an evaluation of the uterine cavity and ovaries for the female partner
• Semen analysis for male partner

Once the diagnostic testing has been completed, your doctor will review your test results and plan your treatment protocol. You will be connected with an IVF Coordinator, who will be communicating with you frequently to answer any questions, create a calendar for your IVF cycle, and ensure you understand your medications.

IVF Stimulation

A normal, unmedicated, ovulation cycle typically produces one mature egg per month. In an IVF cycle, the goal is to generate as many mature eggs as possible.
In the IVF stimulation phase, injectable medications are used for approximately 10 to 14 days to stimulate the ovaries. These medications are based on Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH), which are hormones the body already uses for ovulation.

The stimulation phase ends with a “trigger shot” that causes developing follicles to mature. Timing of this injection is very important in order to have as many mature eggs as possible for the scheduled retrieval.

Egg Retrieval

Approximately 36 hours after your final trigger shot, you will present for your egg retrieval at one of our state-of-the-art IVF labs in either Greenville, Columbia, or the Lowcountry offices.

During the egg retrieval procedure, you will be given some sedation to keep you comfortable. Your physician will use the transvaginal ultrasound to assess the ovaries and aspirate the eggs from each follicle inside the ovaries. The fluid containing the eggs will be carefully passed to the embryologist inside the IVF lab in order to identify each egg under the microscope.

It is typical to have minimal discomfort after the procedure, and given that you will be receiving anesthesia, we recommend you take the day off of work on the day of your egg retrieval. Since you will have received sedation, you will need a family member to bring you to the procedure and drive you home afterwards. Most patients feel well enough to return to work the next day, while others may experience bloating or discomfort for a few days after. The clinical team will give you instructions before you leave.

Development of the Embryos

After the eggs are identified and prepared, your embryologist will begin fertilizing the eggs in the IVF lab. There are two ways that fertilization can occur.
Conventional fertilization – the embryologist isolates healthy sperm and exposes them to each egg for natural fertilization.
Intracytoplasmic sperm injection (ICSI) – the embryologist selects a single, healthy sperm and injects it directly into each egg, increasing the odds of fertilization. ICSI is used to overcome many sperm issues and is our standard of care for all patients.

Once fertilized, the embryos begin to develop. Over the next five to six days, the embryologist will take the appropriate measures to ensure your embryos are progressing properly and update you accordingly. Approximately one week after your retrieval, you will be notified as to how many embryos developed from your IVF cycle and were frozen for future use.

Embryo Transfer

Because it is likely to increase your odds for a successful pregnancy, we generally recommend freezing the embryos developed from your IVF cycle and delaying the embryo transfer until your hormone levels have returned to normal. The embryo transfer is a simple procedure that takes about ten minutes. No anesthesia or recovery time is needed. Your partner will be able to accompany you to watch the transfer being performed.

The morning of the transfer, your embryologist will make a final assessment of the embryos and recommend which to thaw for subsequent transfer. This recommendation is based on overall embryo quality as well as PGT results if PGT was performed. We strongly encourage single embryo transfers (eSET) to decrease the risk of twins and triplets.

Inside the IVF lab, your embryologist will locate the embryo(s) to be transferred and verify all identifiers—including your name and identification number—and compare them to the embryo culture dish and corresponding lab identifiers.

Finally, the transfer catheter is loaded with your embryo(s). During the transfer, your doctor will insert a small catheter through the cervix and into the uterus using ultrasound guidance. Once the catheter is in the correct place, your REI will place the embryo into the uterus.

Once the transfer is complete, your doctor will remove the catheter from the uterus. Because the embryo is not visible to the naked eye, your embryologist will check the catheter under a microscope to ensure that the embryo was released.

After Your Embryo Transfer

About two weeks after your embryo transfer, we will check the level of hCG (the pregnancy hormone) in your blood to determine if your embryo implanted successfully.

Some patients may have vaginal spotting or bleeding prior to the pregnancy test, especially if using vaginal progesterone suppositories. However, do not assume that this is a period. We will perform the serum pregnancy test to be sure as to the outcome of your transfer. It is important to continue all of your medication during this time. This is true regardless of the symptoms you may experience or whether a home pregnancy test is positive or negative. Please contact your IVF coordinator if you have any questions or concerns, or before you make any changes to your medication.

If your pregnancy test is positive, we will trend your hcg level over 48 hours to ensure that the hCG levels are rising appropriately. Monitoring these hormone levels helps confirm the progress of an early pregnancy.

At about 6-7 weeks of pregnancy, we will perform an ultrasound to access the following:

• If the pregnancy is located inside the uterus
• If the pregnancy is located outside the uterus (known as an ectopic pregnancy, which will require careful monitoring and treatment)
• If the scan reveals a pregnancy of uncertain viability (i.e., a small gestational sac, no obvious yolk sac or fetus, an abnormally small fetus, or no fetal heartbeat). In these instances, we will repeat the ultrasound as needed before making a final diagnosis
• If there is more than one fetus

If your pregnancy is progressing normally, we will repeat another ultrasound around 8-9 weeks to ensure proper development. After this scan, we will refer you to your OB/GYN for the remainder of your maternity care. We encourage you to keep in touch with us during your pregnancy as well as after delivery!

IVF Success Rates

There are many factors that can influence your individual success rate for treatment. These include the age and health of the female partner, the presence of genetic abnormalities in either partner, and the type of treatment that the couple is undergoing. It is important to speak with your PREG physician about your case, the recommended treatment, and the expected success. Your doctor will be able to give you your individual likelihood of success based on a Univfy prediction report. This report uses our patients’ labs, age, partner’s semen analysis, and medical history to analyze IVF statistics and predict each patient’s personal likelihood of success compared to other patients with similar characteristics who have undergone IVF at PREG.

IVF at PREG

Your happiness and experience at PREG is very important to us. We understand that undergoing fertility treatment can cause significant stress, confusion, and anxiety. We want to make the process as easy as possible. We are completely dedicated to providing the best possible care for our patients with clear communication and guidance throughout the entire IVF process.