The IVF cycle involves multiple steps, and each occurs at a specific time during a six-week period. The process begins approximately one month preceding your IVF cycle.
Prior to starting treatment, you will receive a folder of information that discusses the IVF process and risks. Our staff will also teach you how to self-administer the medications you will be taking as part of the IVF process.
The following is the typical IVF procedure:
- Initiation of Birth Control Pills
In preparation for your IVF cycle, you will be given a date to start your birth control pills. Taking birth control pills will help to ready your ovaries for the stimulation process and may potentially optimize your IVF cycle outcome. Once you start the pill, you will take it every day, skipping the placebo pills at the end of the cycle. When you finish the active pills in the first pack, please start another new pack and continue as directed. Do not stop taking the pill until you are instructed to do so. Patients often experience “break through bleeding” when taking birth control pills. This is normal and does not compromise the success of your treatment cycle. - Lupron Administration
One week before the estimated onset of the following menstrual period, you will begin Lupron injections. Lupron functions to both synchronize egg follicle development during stimulation and prevent the premature release of the eggs from the ovaries prior to the egg retrieval procedure. The Lupron injections are given subcutaneously (just under the skin) and need to be done each morning. Your nurse coordinator will arrange classes regarding injection training prior to starting your cycle. Additionally, she will provide you with an up-to-date personalized calendar regarding the dosage, time and length of treatment injections involved.When you start your period on Lupron, you will need to call our office to schedule a baseline ultrasound. During the ultrasound, we will look at the endometrial lining as well as confirm the absence of any ovarian cysts that may compromise the success of your cycle. We will instruct you to reduce the dosage of Lupron by one-half on the day you begin ovarian stimulation. You will remain on Lupron until the day of hCG administration. Patients are treated with different dosages and schedules of Lupron, depending on their tailored fertility treatment plan. - Ovarian Stimulation
If the baseline ultrasound confirms the absence of significant ovarian cysts, we start ovarian stimulation after menstrual bleeding begins. Ovarian stimulation medications are preparations of naturally occurring hormones, which are used to develop and mature multiple follicles by directly stimulating the ovaries. Gonal-F, Follistim and Bravelle are the brand names for a group of medications known as gonadotropins, which contain only FSH (follicle stimulating hormone). Repronex and Menopur are the brand names for another group of medications known as human menopausal gonadotropins containing both FSH and LH (luteinizing hormone). Many protocols use a combination of both medications with specific tailored dosing.The follicle stimulating medication is given subcutaneously with a small needle. Typically the injections are given daily in the evening for 8-12 days, depending on how your body responds to the medications. This hormone will stimulate a multitude of follicles and eggs in a given cycle. The average number of eggs retrieved at IVF is between 8 and 15. Please keep in mind that egg quality is more important than the number of eggs retrieved. - Egg Retrieval
When we determine through an ultrasound that the eggs are mature, you will receive instructions on when to take your human chorionic gonadotropin, or hCG, shot. HCG is a drug that stimulates the final maturation of your eggs. If it is given too early, few, if any, eggs will be mature. If it is given too late, the eggs within the follicles may be postmature, impeding optimal fertilization. It is important that HCG be given 34-36 hours prior to the egg retrieval. We will notify you of the exact time that hCG is to be administered. Failure to take the hCG trigger injection correctly or at the specified time may significantly compromise the entire IVF cycle.Egg retrieval is performed via vaginal ultrasound, similar to the ultrasound used for monitoring your follicles during your stimulation. The egg retrieval is performed under conscious sedation anesthesia, taking 10-15 minutes on average. Learn more about egg retrieval. - Fertilization in the Lab
Earlier on the day of egg retrieval, your partner will provide us with a fresh semen sample. Appropriate purification procedures will be followed in order to optimize efforts at fertilization. If you are using donor sperm, our staff will arrange for the sperm to arrive at North Texas IVF at least seven days before retrieval.After the retrieval, the embryologists work diligently onsite to prepare the eggs for fertilization. In conventional fertilization, the eggs are incubated with an aliquot of sperm overnight and assessed the following day for fertilization. If you are having ICSI performed, a single sperm cell is injected directly into the egg cytoplasm. - Embryo Transfer
The embryo transfer is typically performed three days or five days after the egg retrieval. The embryo transfer procedure is usually painless and performed in-office without the need for anesthesia. You will be asked to drink a large amount of water prior to the transfer in order to distend your bladder. Having a distended bladder will facilitate visualization of the embryo transfer catheter as well as provide a more favorable angle for catheter insertion. The procedure is brief, lasting only a few minutes, and there is generally very little discomfort. So relax!During the procedure, a soft catheter is introduced into the uterus through the cervix and the embryos are injected while we watch on the ultrasound. Side effects of the procedure may include mild cramping and minimal bleeding.Following the embryo transfer, you will be instructed to remain lying down until directed otherwise. We then encourage you to rest at home for at least 24 hours. Please make arrangements for someone to accompany you the day of this procedure and drive you home. - Embryo Cryopreservation
Any surplus embryos resulting from the embryo transfer process may be cryopreserved (frozen) for use in subsequent frozen embryo transfer cycles, should you choose to continue to grow your family. A frozen embryo transfer is a lot less cumbersome compared to a fresh IVF cycle. Typically, Lupron is given to suppress the hypothalamus and pituitary. Estrogen is given for 10-14 days on average in order to prime the endometrial lining in anticipation for transfer. As a courtesy, the first year of cryopreservation of embryos is complimentary for our patients - Support for the Embryos
During a typical menstrual cycle, the latter half (known as the luteal phase), is progesterone dominant. Following fertilization, this progesterone functions to help maintain the early pregnancy state until the placenta achieves full functionality between 8 to 9 weeks of gestational age. Since some of your progesterone-producing corpus luteal cellsare removed during egg retrieval, it is necessary to supplement our IVF patients with progesterone in order to optimize the uterine lining for successful implantation and progression of the pregnancy.For this reason, you will take progesterone injections intramuscularly beginning the evening after the egg retrieval and continue daily until directed otherwise. Think positive! Blood work will be done even if you think your period has started. Please do not discontinue your progesterone until directed by our office. If pregnant, progesterone will be administered for a total of eight weeks. Natural progesterone is prescribed in many fertility treatments and virtually every IVF procedure for luteal phase support of implantation and early pregnancy. The progesterone prescribed is derived from natural sources and is virtually identical to that produced in your body. - The Pregnancy Test
Two pregnancy tests will be done, on approximately days 10 and 12 for a day three transfer and on days 8 and 10 after a day five embryo transfer. We will inform you of the results on the day of the second test. We encourage you to wait until the results of the second pregnancy test are available before forming any conclusions. This will allow us time to give you an accurate and comprehensive assessment.A preliminary obstetrical ultrasound will be scheduled at 6 ½ weeks gestational age. The purpose of this ultrasound is to confirm healthy gestational sac placement. A subsequent-interval ultrasound will also be performed at approximately 8 weeks. Once a healthy pregnancy with a documented heartbeat is documented on a sonogram, we will return your care back to your obstetrician. If your pregnancy test is negative, we would like you to schedule a follow-up visit with your physician to review your cycle and discuss subsequent options.