In Vitro Fertilization
What are IVF Treatments?
In vitro fertilization, or IVF, is a complex series of procedures that is used to treat infertility issues in patients who are struggling to conceive. It can also be used in same sex couples who will require assistance to start their family. It is the most effective, efficient form of 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 becoming getting pregnant. 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, who is 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 as time goes on due to a variety of factors including past cycles, egg quality and how well your body responded to the medications.
The IVF Process
IVF is a process that requires precise timing and several steps. It may seem like your given a lot of information but, let us help you fully understand the process.
Preparing for your IVF cycle
In preparation for an IVF cycle, you and your partner will need some pre-cycle testing. There are several different types of testing that may be performed
- Blood tests for both male and female partner
- Transvaginal ultrasound with an evaluation of the uterine cavity
Once the diagnostic testing has been performed, your doctor will review your test results and plan your treatment protocol. Your IVF Coordinator will be communicating with you frequently to answer any questions and make sure you completely understand your medications.
A normal 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 8 to 14 days to stimulate the ovaries. These medications are based from 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 and also triggers ovulation. Timing of this injection is very important to have as many mature eggs as possible for the scheduled retrieval.
Approximately 36 hours after your final trigger shot, we’ll have you come to either our Greenville or Columbia office for the retrieval at one of our state-of-the-art IVF labs.
During the egg retrieval procedure, you will be given some sedation to keep you comfortable. Your physician will use the ultrasound to look at the ovaries in order to aspirate the eggs from each mature follicle inside ovary. The fluid containing the eggs will be carefully passed to the embryologist inside the In Vitro Fertilization (IVF) lab to identify each egg with the microscope.
Some women have minimal discomfort after the procedure and will return to work the next day. Since you’ve been given sedation, you will need a family member to bring you to the procedures and drive you home afterwards. The nurse and physician 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) is a technique where 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 is our standard of care for all patients.
Once fertilized, the embryos begin to develop. Every morning for the next five to six days, the embryologist examines them to ensure they are progressing properly.
During this time, your physician will decide whether to recommend pre-implantation genetic diagnosis/screening (PGD/PGS). Genetic screening can identify embryos with chromosomal abnormalities, and can help to:
- Select for embryos that are not carriers for genetic disease markers.
- Maximize the likelihood of pregnancy by transferring only those embryos with the greatest chance of success.
- Reduce the risk for miscarriage.
The embryo transfer is a simple procedure that takes about five to ten minutes, with no anesthesia or recovery time needed. Because it is likely to increase your odds for a successful pregnancy, we generally recommend to delay the embryo transfer until hormone levels have returned to normal from the IVF cycle. Your partner may be able to go back to the transfer room with you to see the transfer being performed and may stay with you while you rest comfortably after the transfer.
The morning of the transfer, your embryologist will make a final assessment of the embryos and recommend which to transfer, based on overall embryo quality. Before the transfer, you and your REI will review your cycle together and make the final decision regarding the number of embryos to use. We strongly encourage single embryo transfers (eSET) to decrease the risk of twins and triplets. Remember, the goal with fertility treatments is one healthy full-term baby. How Many Embryos Should I Transfer?
Inside the ART lab, your embryologist will locate the embryos 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 embryos. 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 embryos have been transferred, your doctor will remove the catheter from the uterus. Because the embryo is invisible to the naked eye, your embryologist will check the catheter under a microscope to make sure the embryo was released. We’ll ask you to relax for about 30 minutes after the embryo transfer and then you’ll be allowed to go home.
After Your Embryo Transfer
About two weeks after your embryos are transferred, we’ll do a follow up blood test to check the level of hCG (the pregnancy hormone) to determine if your embryo implanted successfully and you’re pregnant.
Some patients may have vaginal spotting or bleeding prior to the pregnancy test especially if you’ve been using vaginal progesterone suppositories, but don’t automatically assume it is a period. We’ll still need to do the pregnancy test to be sure. 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 get contact your IVF nurse if you have any questions or concerns, or before you make any changes to your medication.
If your pregnancy test is positive, we’ll do repeat blood tests every two days to make sure that hCG levels are rising appropriately. Monitoring these hormone levels is the only way of confirming the progress of an early pregnancy.
At about 6 weeks, we’ll do an ultrasound to access:
- If the pregnancy is developing normally.
- If the pregnancy is located inside the uterus
- If the pregnancy is located outside the uterus or an ectopic pregnancy—if your pregnancy is ectopic, we will monitor it carefully
- If the scan reveals a pregnancy of uncertain viability (small gestational sac, no obvious yolk sac or fetus, abnormally small fetus, or no fetal heartbeat) we will repeat the ultrasound after seven to ten days before making a firm diagnosis.
- Whether there is more than one fetus.
If your pregnancy is normal, we’ll refer you back to your OB/GYN for maternity care between seven and ten weeks, depending on your individual situation. We will remain in contact with their office to follow your pregnancy through live birth. We encourage you to keep in touch with us during your pregnancy. We love seeing our patients come back to show off their baby bumps and after delivery make sure to come by with your baby to see us!
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 and the recommended treatment, and the expected success. Your doctor will be able to give you your likelihood of success based on the Univfy prediction report. This report uses our patients’ labs, age and medical history to analyze IVF statistics and predict each patient’s personal likelihood of success.
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, and 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.