IVF – Process And Success Rates

In Vitro Fertilization (IVF): Process And Success Rates

What Is IVF?

IVF (in vitro fertilization) is an assisted reproductive technology (ART) procedure. IVF uses medications to suppress a woman’s natural menstrual cycle and stimulate her ovaries to produce multiple follicles that will contain many eggs. In a standard IVF procedure, the eggs are retrieved then placed in a special culture medium, along with sperm, that encourages fertilization and growth of high-quality embryos.

Sperm from the male is collected on the day of egg retrieval, in some cases we also require a frozen sperm sample as back-up. In any case, the sperm is washed to remove semen before it is added to the culture medium with the eggs and fertilization can occur in just a few hours.

Following fertilization, the embryos that are created are then followed by the IRMS Embryology Team to determine if the embryos are developing normally. It is important to note that this level of attention to each embryo is not necessarily “standard of care” within all Embryology Labs but it is here at IRMS. Certain stages of development are looked for, such as developing to 8 cells by Day 3 or the blastocyst stage of development by Day 5 or 6. Though as recently as a few years ago a successful IVF cycle likely consisted of a fresh transfer of two or more embryos, that is no longer the standard in IVF practice today particularly here at IRMS.

All patients are counseled as to whether genetic testing of their embryos would increase their chance of a successful pregnancy and we now recommend (SET) Single Embryo Transfer whenever possible. All other high-quality embryos will be cryopreserved, or frozen, for future use in a Frozen Embryo Transfer (FET) cycle.

This shift in the way IVF treatment is practiced is from years of our own data demonstrating that the fastest way to a healthy baby is IVF with SET. At IRMS we have lead the charge to reduce multiple births. We have found this methodology, when possible to employ, yields the highest success rates.

But we also realize not all cycles can be the ideal and that is why IRMS does not choose to institute hard and fast protocols applied across all patients. That approach is not in the best interest of our patients overall and fails to recognize the variability in our patient population. There are patients where a fresh embryo transfer is in their best interest. These are also patients with a potentially poorer prognosis for success, possibly having only a few eggs or subsequent embryos or are of advanced maternal age. For these patients pushing embryos to longer culture development and subsequent biopsy may not be ideal. These are decisions best discussed with your IRMS physician and why we feel so strongly about an individualized approach to care.

IVF Process: How Does IVF Work?

Preparing For IVF

To begin your infertility treatment, you will call us on the first day of your period before your scheduled IVF cycle. On day 3, you will visit our office for a blood test to determine your FSH level, an indicator of ovarian function. You may receive instructions to begin taking a prenatal vitamin, and possibly birth control pills and/or Lupron, designed to “turn off” your body’s natural ovarian stimulation process. This is so we can prepare you for the stimulation phase of your IVF cycle with the use of gonadotropin medication.

Stimulation

During a natural ovulation cycle, a woman usually produces one egg each month. At various points in your IVF cycle, you will take different prescribed hormones – your medication protocol – designed to either suppress your own reproductive cycle, stimulate your ovaries to produce multiple follicles and eggs, promote the ripening of the mature eggs, or prepare your body for implantation and pregnancy.

Stimulation medications, called gonadotropins, are taken by subcutaneous injection (under the skin) once or twice daily. They replace your natural follicle stimulating hormone (FSH) to trigger a very precise, uniform stimulation. If they are successful, the ovaries will produce multiple follicles and high quality, mature eggs. Because these powerful hormones produce significant changes in your system, their effects are tracked by blood tests and ultrasound. Your hormone levels and follicular development are tracked throughout a stimulation cycle. If required, your medication protocol (the type and dose) may be altered for optimum results. When the follicles are mature, usually between 16 and 20 millimeters in diameter depending on your stimulation medication, you will take an intramuscular injection of HCG to prepare for egg retrieval. A variety of IVF medications are available and your IRMS Physician will choose the drug or combination of stimulation drugs that are best in your case.

During your stimulation cycle, the male partner will begin antibiotics to protect against bacteria that may be present in semen. He also will be given specific instructions for semen collection.

For more information about infertility medications, visit the medications page in our web site.

Cycle Monitoring

You will be required to visit an IRMS location for Morning Monitoring as instructed by your Nurse. Different locations provide monitoring during weekdays and or weekends so please consult our website or discuss with your Nurse which locations are most convenient for you.

Monitoring hours are between 6:30 and 8:00 a.m. The frequency of these visits is every one to four days, depending on how you respond to the medications and is always communicated by your IRMS Nurse. Ultrasounds will track the number and size of your follicles, and bloodwork will indicate estrogen levels, allowing your IRMS Physician to determine when your eggs are ready for retrieval.

Egg Retrieval

Egg retrieval is the procedure where your eggs are retrieved from your ovaries by an IRMS Physician at the OR attached to the IRMS Lab at 101 Old Short Hills Road (across the street from Saint Barnabas Medical Center).

Egg retrieval occurs 34.5 to 39 hours after the administration of the HCG injection which triggers the final stages of egg maturation.

While the patient is under mild sedation, an IRMS Physician uses a transvaginal ultrasound probe to aspirate your eggs from the follicles within the ovary. The procedure usually takes less than 20 minutes, with a recovery period of approximately an hour. We do require that you be driven home due to the fact that you have had anesthesia.