The IVF Process
There are several different protocols that can be used to perform IVF such as conventional IVF, microdose flare and minimal stimulation IVF.
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Birth control Phase
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Prior to the 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), and a combination of follicle- stimulating hormone and luteinizing hormone used to stimulate 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 ovaries and a long needle is used to aspirate the eggs (oocytes) 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 20-30 minutes and patients are monitored for approximately 1 hour to ensure safety.
Fertilization of the Eggs
Once the embryologist receives the eggs they are than removed from the follicular fluid and placed in the appropriate media where they complete their maturation. After several hours, the sperm is injected into the eggs (ICSI); fertilization occurs and the eggs are placed in an incubator.
Day 1 After Retrieval
Approximately 24 hours after the oocyte retrieval, they are examined for fertilization and if development of the embryo (fertilized eggs) process has begun. The embryos are allowed to develop inside of the incubator for 3-6 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 and Genetic screening
Embryos between day 1 and 3 after retrieval are called cleavage-stage embryos. On day 5,the embryos are called blastocysts but 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.
On day 5 or 6, a biopsy of the outer coat of the embryo (trophectoderm) performed by removing 5-10 cells. This process is called PGS or PGT-A (complete chromosomal testing) or for PGD (Preimplantation genetic diagnosis to screen a specific genetic disease). This method allows us to select the best genetically normal embryos for transfer while minimizing the chance of a pregnancy loss. Dr. Dmitri Dozortsev is one of the leading expert in embryo biopsy has developed a unique method of performing the biopsy to ensure minimal impact on embryo viability.
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