The Vitro Fertilization (IVF) Cycle
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.
Ovarian Stimulation and Egg Retrieval
On day 2 or day 3 following onset of menses, a baseline ultrasound examination and blood test is done in our office.
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.
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.
On day five of stimulation, you begin regular office visits. These continue every one to two days until egg retrieval 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.
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 egg retrieval is performed thirty-six hours later.
Thirty-six hours following hCG injection
The retrieval procedure takes less than fifteen minutes, however, the entire appointment will take approximately two hours. Your eggs will be frozen 2-4 hours after egg retrieval.
Fertilization and Embryo Culture
Day of egg thawing
Sperm is needed on the day of egg thawing. In order to optimize sperm quality, it is recommended that the male partner abstain from ejaculation for two to seven days prior to providing the specimen. If frozen sperm is used, it should be delivered to the clinic no later than the day prior to egg thawing.
Day of egg thawing
Sperm is injected directly into the egg (ICSI) to achieve fertilization. The eggs are checked the next day to determine which ones are fertilized. Fertilized eggs, now called embryos, are typically grown in the laboratory for two more days prior to transfer to the uterus.
Embryo Transfer and Progesterone Support
One to three days after thawing
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 thirty 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 embryos [ZIFT] within 24-48 hours of egg thawing. The majority of patients will undergo transcervical embryo transfer.
Day of transfer
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 embryo prior to embryo transfer.
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.
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.