Typically, we begin IVF cycles at the beginning of the woman’s menstrual period. While details may vary based on the individualized needs of the patient, the following may serve as a general guideline.
On day 2 or day 3 following onset of menses, a baseline ultrasound examination and blood test is done in our office.
Ovarian suppression – 2 to 4 weeks
Ovarian suppression can commence at any one of the three following times: During the second phase of a natural cycle (luteal phase) using a single injection of Lupron; at the time of your period using oral contraceptive pills and daily injections of Lupron; or at the time of your period using oral contraceptive pills and injections of Ganirelix (a GnRH antagonist) once your follicles reach 14 mm in size. Your doctor will discuss each protocol with you in order to choose the most appropriate.
Ovarian stimulation – 8 to 12 days
We begin ovarian stimulation with injectable fertility medications on a day chosen by the cycle coordinator. The medications are usually self-administered under the skin (subcutaneous) using a short needle. Occasionally, we may need to change the dose of medication during the day, therefore, we recommend that patients take their injections in the evening.
Cycle monitorin – Day 5
On day five of stimulation, you begin regular office visits. These continue every one to two days until follicle aspiration takes place. An ultrasound and blood test for estradiol are performed at each visit. You must call at the end of the day for results and to receive further medication instructions.
Ovulation induction – Between day 8 and 12
When the follicles are large enough, final egg maturation is triggered with an injection of human chorionic gonadotropin (hCG). The timing of the hCG dose is very important, as follicle aspiration is performed thirty-six hours later.
Egg retrieval – 36 hours following hCG injection
The aspiration procedure takes less than fifteen minutes, however, the entire appointment will take approximately two hours.
Sperm collection – Day of egg retrieval
Sperm are obtained from the male partner on the day of retrieval and occasionally the morning after egg retrieval if fertilization was suboptimal.In order to optimize sperm quality, it is recommended that the male partner abstain from ejaculation for two to seven days prior to the first sperm specimen. Typically, this will mean abstinence after the seventh day that the woman takes fertility medication.
Fertilization – Day of egg retrieval
Sperm are placed in a dish with the egg or, if necessary, injected directly into the egg (ICSI) to achieve fertilization. The eggs are checked the next day to determine which ones are fertilized. Excess fertilized eggs, now called embryos, can be frozen at this time.
Assisted hatching – Day of embryo transfer
If indicated, assisted hatching is conducted in order to facilitate embryo hatching and implantation. This is accomplished by making a small hole in the outer shell of the egg.
Preimplantation Genetic Diagnosis (PGD) – 3 days after retrieval
If indicated, PGD is done when the embryo reaches the 8-cell stage—generally three days after fertilization occurs. PGD can reveal certain genetic conditions and gender with results in one to two days.
Embryo transfer – 3 to 5 days after egg retrieval
The embryo transfer is a simple procedure performed by placing a soft catheter containing embryos through the cervix under ultrasound guidance. It does not require anesthesia, however, patients are given Valium to help relax the pelvic muscles. Patients are asked to arrive thirty minutes prior to embryo transfer and must remain in bed for fifteen minutes following the transfer. Because of the medication, it is important that the patient arrange for a ride home.(If you are undergoing a tubal transfer, you will return to the operating room to undergo laparoscopic placement of gametes or embryos within 24-48 hours of egg retrieval. The majority of patients will undergo transcervical embryo transfer.)
Progesterone support – Day of transfer
The first progesterone suppository is placed in the vagina at the time of embryo transfer. Patients then must use the suppositories twice a day until the end of the first trimester of pregnancy, or when a second blood pregnancy test comes back negative.
Pregnancy testing – Day 14 and 21
Blood is drawn on the morning of day 9 and day 12 following the transfer. You will be contacted later in the day with the results.