Most IVF cycles commence at the time of the women’s menstrual period. The details that follow are grouped into the three Basic Principles of the IVF process and may be adjusted based on the individualized needs of the patient.
Ovarian Stimulation & Egg Retrieval
Baseline Test: Day 1
Office visit is scheduled day 2 or day 3 following onset of menses for the purpose of a baseline ultrasound examination and a blood test (usually for follicle stimulating hormone (FSH) and estradiol.)
Ovarian Suppression: 2 – 4 Weeks
Oral contraceptives are begun to help begin the ovarian suppression process. They are continued for two to four weeks.Overlapping with the oral contraceptives, Lupron is begun about two weeks before the start of ovarian stimulation. Lupron is a daily injection that is used to complete the pre-stimulation ovarian suppression. Down-regulation with Lupron takes about two weeks to achieve. For this reason, Lupron is begun 14 to 17 days before the anticipated start of stimulation. At the end of this time, another office visit is scheduled and an ultrasound and blood test performed to ensure that down-regulation has been achieved.
Ovarian Stimulation: 8-12 Days
Ovarian stimulation is started with injectable fertility medications on a day that is chosen by the cycle coordinator. Lupron is continued at a lower dose and a precise dosage of fertility medications (Follistim, Menopur, Gonal-F, Bravelle, Repronex or a combination of these) per day is begun. Since we may need to change the dose of medication during the day, it is most convenient if the patients take their injections in the evening.
Cycle Monitoring: Starting Day 5
Regular office visits are now begun, starting with day five of stimulation and then continuing every one to two days until follicle aspiration. During each office visit, an ultrasound and blood test for estradiol are performed. You must call at the end of the day (about 3:00 p.m.) to obtain the results of your blood test and to receive further instructions for continued medication.
Ovulation Induction: Between Day 8 and 12
Ovulation is triggered with an injection of human chorionic gonadotropin (HCG), administered when the follicles are judged to be mature. HCG is most often prescribed between 8 and 12 days after the start of injectable fertility medications. The timing of the HCG dose is very important, because follicle aspiration is performed 36 hours after the HCG.
Egg Retrieval: 36 Hours After HCG
On the day of follicle aspiration, you will be asked to come to the office about one hour before your scheduled retrieval procedure. You will go home approximately two hours afterwards. For example, for a 10:00 a.m. aspiration, you should come to the office at 9:00 a.m. and expect to go home sometime after 12:00 noon. The aspiration procedure itself takes less than 30 minutes.
Fertilization & ICSI
Sperm Collection: Day of Egg Retrieval
Sperm are obtained from the male partner on the day of egg retrieval, typically about 12:00 noon. In about 50 percent of cases, an additional specimen is obtained 48 hours prior to follicle aspiration, on the day of HCG. Occasionally, a final specimen may be requested on the morning after egg retrieval, if fertilization is sub-optimal and the embryologists have reason to believe that an additional sperm specimen would be useful.In order to optimize sperm quality, it is best to abstain from ejaculation for two to seven days prior to the first sperm specimen. In most cases, this will mean abstinence after the seventh day of fertility medications to the woman.
Day of Egg Retrieval> Sperm are then joined with the eggs to allow fertilization. In most cases, sperm solution is added to the eggs and fertilization occurs naturally.If Indicated: Intra-Cytoplasmic Sperm Injection (ICSI) will be conducted.
Assisted Hatching: Day of Egg Retrieval> If Indicated: Assisted Hatching is conducted to facilitate fertilization.
PGD: 3 Days After Retrieval> If Indicated: PGD (testing for genetic conditions and/or gender determination) is done when the embryo is at the 8 cell stage, typically 3 days following fertilization. Results returned within 24 – 48 hours.
Embryo Transfer & Luteal Phase Support
Embryo Transfer: 3-5 Days After Egg Retrieval
(Note: Tubal transfers are done within 24-48 hours of aspiration.) This is a simple procedure, which does not require anesthesia, but the patients are given Valium to help relax the muscles. Therefore, it is important that each patient have someone to drive them home afterwards. Patients are asked to arrive 30 minutes prior to embryo transfer and must remain in bed for 30 minutes afterwards.Excess Embryo
Cryopreservation> Any viable embryos in excess of those transferred back to the patient’s uterus may be cryopreserved (frozen) at this time.
Luteal Phase Support: Day of Transfer
The first progesterone suppository is placed in the vagina at the time of embryo transfer. Thereafter, patients are asked to use the suppositories twice a day until the end of the first trimester of pregnancy, or when the second blood pregnancy test is negative.
Pregnancy Testing: Day 14 and Day 21
Two pregnancy tests are typically done. Blood is drawn in the morning on Day 9 and again on Day 12 following transfer. Your Physician will contact you with the results, which are typically available later that afternoon.