There are several different protocols that can be used to perform IVF such as Lupron down regulation, microdose flare, and minimal stimulation IVF.
Lupron down regulation is the most common method that physicians employ. Although a patient's clinical circumstances may dictate exceptions, a Luteal Lupron cycle is performed in several stages as stated below. Microdose flare regimens and minimal stimulation regimens are designed for women with low ovarian reserve.
- Birth control and Luteal Lupron
Preparation-patients are pretreated with birth control pills for several weeks to prevent ovarian cyst formation and aid in egg synchronization. Lupron is initiated at the end of the birth control cycle and continued during stimulation, as it allows physicians to have better control of follicular (egg) development.
- Baseline Scan
Prior to completion of the birth control pill cycle, the patient is asked to come to the office for a so-called baseline ultrasound to ensure that the ovary is free of cysts and ready for stimulation.
- Stimulation with Gonadotropins
Stimulation begins with daily injections of follicle-stimulating hormone (FSH), which stimulates the development of multiple follicles in the ovary. Each follicle contains only a single egg. Patients undergoing IVF typically come to the office 3-5 times for ultrasounds and blood work (measurement of estradiol, progesterone, and luteinizing hormone levels) during a 10-14 day period. Once the majority of growing follicles approach 18-24 mm in size, an injection of human chorionic gonadotropin (hCG) is given to prepare the eggs for retrieval.
- IVF Egg Retrieval
The egg retrieval (harvesting) is usually performed 35 hours after the hCG injection as an outpatient procedure at our clinic. Prior to and during the retrieval the patient is given intravenous sedation (with an IV needle) by an anesthesiologist. The egg retrieval is performed using a transvaginal ultrasound for visualization of the follicles and a long needle to aspirate the eggs out of the follicles through the wall of the vagina. The eggs are then passed to the embryologist in tubes containing culture media. The procedure requires approximately 15-30 minutes and patients are monitored for approximately 1 hour to ensure safety.
- Fertilization of the Eggs
Once the embryologist receives the eggs, the eggs are removed from the follicular fluid and placed in the appropriate media where they complete their maturation. After several hours, the eggs are placed with the sperm; fertilization occurs and the eggs are placed in an incubator. If injection of the sperm into the egg (ICSI) is indicated, it will be performed at this stage.
- Day 1 After Retrieval
Approximately 24 hours after the retrieval, the eggs are checked to see if they fertilized properly and if development of the embryo (fertilized eggs) has begun. The embryos are allowed to develop inside of the incubator for 3-5 days after the retrieval. Incubators control environmental conditions such as temperature, air quality, acidity, and several other factors that may influence the embryos’ development.
- Embryo Development
Determination of stage and number of embryos to transfer typically occurs on day 3 or 5 after the egg retrieval and depends on the quality and number of embryos, as well as the treatment plan decided upon between the patient and physician. Embryos between day 1 and 3 after retrieval are called cleavage-stage embryos. On day 5, the embryos are called blastocysts. In some cases, embryos are cultured until day 6. The extended culture of embryos assists in selecting the best embryos for a transfer and limiting the number of embryos placed into the uterus to decrease the chance of multiple pregnancies.
The number of embryos transferred depends upon many factors including patient’s age, embryo quality, cause of infertility, previous IVF history, and other factors unique to each patient’s situation. Any extra embryos that are not transferred and are determined to be of good quality can be frozen (cryopreserved) and used for an embryo transfer at a later date.
- Embryo Transfer Procedure
The embryo transfer takes approximately 15-20 minutes to perform. Patients are asked to drink a lot of water prior to the procedure to help with ultrasound visualization of the uterus. During this procedure, a speculum is placed in the vagina and the cervix is cleaned. A catheter containing the embryos is placed inside the uterus under ultrasound guidance and the embryos are placed in the best position possible based on information gathered from the ultrasound. After placement of the embryos, patients are sent to the recovery area briefly, and then sent home to rest for the day. Patients should avoid strenuous exercise or heavy lifting for several days after the procedure.
- Hormone Supplementation and Pregnancy Test
Patients are given instructions on how to take estrogen and progesterone as well as other supplemental medications to improve their chances of getting pregnant. The pregnancy test is performed two weeks later and patients are called the same day with results. A consultation is set up within 2-3 days with the physician to review results and recommendations.
We also offer IVF with PGD to screen for genetic diseases and for gender selection. At Advanced Fertility Center of Texas, Same Day PGD™ allows patients to have their embryos tested and transferred on the same day. This is beneficial if a patient has a small number of good quality embryos or if the embryos were frozen prior to testing.
To learn more about traditional IVF or to schedule an appointment, please call (713)467-4488.