Have you heard those 3 letters? I.V.F? IVF stands for invitro-fertilization. Sounds confusing enough, but it is actually a type of assistive reproductive technology. Many women and men have difficulty conceiving and IVF is one of the procedures that these couples will go to in order to have a baby of their own. IVF does not require the female to have to function fallopian tubes to do this procedure. Many women that have blocked tubes, due to infections, birth defects or even tubal ligation surgery are able to conceive with this method. Men that have very low sperm counts are also able to conceive a child with their partner using IVF.
The basics:
IVF requires medications and some slightly invasive procedures for the woman. Most facilities will run basic tests on the couple to test their blood work. This blood work includes tests required by the FDA along with some hormone testing for both partners. The female will have an ultrasound performed by the physician to test her uterine cavity and also look at her ovaries to see how active they are (this helps the physician determine your medication dosage). The male will have a semen analysis, SCSA(sperm chromatin structure assay, which is the technical term for looking at the sperm’s DNA structure) and a backup sperm freeze. The backup sperm freeze is a safeguard should the male have any issues collecting his sample when the female’s eggs are retrieved.
When the IVF cycle starts and what it consists of:
The cycle begins with an ultrasound and blood work on day 2 of menses for the female. If blood work and ultrasound are okay, the female will begin injections of medications. The ultrasound and blood work will continue for approximately the next 10 days(not continuously, but when a physician deems ultrasound and blood work to be necessary.) At the conclusion of this period, a procedure is done in the operating room under light anesthesia to retrieve the eggs through an instrument that uses suction to draw eggs out of your ovaries through the vaginal wall. After the procedure (roughly 10-15min), you are taken back to the recovery room to go home.
Following the operating room procedure, the eggs are taken to the lab and using the sperm collected that day(or the frozen back up is thawed should something happened and a fresh sample was unable to be collected), the sperm is injected into the egg using ICSI (intracytoplasmic sperm injection, which means injecting sperm into egg cytoplasm). The egg and sperm are then left in an incubator to hopefully fertilize into an embryo. The embryos are monitored in the incubators for a period of 5-6 days. Ideally, they will grow to what is called a blastocyst, a big clump of cells. If the embryo doesn’t form into a blastocyst within this period, the embryo will usually be discarded as it has stopped growing. For those that have made it to the blastocyst stage, they will be vitrified, a type of rapid freezing so that ice crystals aren’t able to form, for the next cycle.
What’s Next?
Once the embryos are vitrified by the lab, you are notified as to how many embryos that survived to vitrification. The female will begin another cycle called a FET cycle or frozen embryo cycle. This is done because the lining of the uterus needs time to be made favorable for the embryo to implant. So, on cycle day 2 of menses, the ultrasound and blood work begins again. The medications for this cycle are different though. These medications are preparing your uterine lining for the embryos rather than ramping up your ovaries to produce eggs. After 21 days, a transfer is done.
The transfer consists of the thawed embryo being inserted into the uterus. It requires just an ultrasound and you are awake for the procedure. The procedure is probably no longer than 10 minutes but requires you to lay in the room afterward for 15 minutes. You would require 3 days of bed rest following this procedure for the optimum opportunity of allowing the embryo to implant in the uterus. Approximately 5-7 days following the transfer, you would come to the office for a progesterone test to make sure the progesterone injections you are taking to help supplement the embryo are working. On day 14, you would take a quantitative HCG test.
If your HCG levels are greater than 5, it is considered a positive test. Ideally, you would desire levels greater than 75 to start, but it is not necessarily required. You would repeat the HCG test every other day for at least 3 tests. As long as your HCG numbers continue to rise by doubling after each test, you would be able to have an OB ultrasound 2 weeks later.
Our physicians would continue to monitor your pregnancy in the first trimester to make sure you continued to progress accordingly. After about 10-12 weeks, you would be able to see your regular OB. After 12 weeks, you would be able to discontinue all the hormone injections and you will continue to see your regular OB.
