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IVF: In-Vitro Fertilization
The IVF Treatment Program at San Diego Fertility Center
In-Vitro Fertilization (IVF) is a technology that introduces the female egg (oocyte) and male sperm together in a specialized culture medium where the chances of successful fertilization are greatly enhanced. The embryos are observed and grown in our IVF laboratory, where they are graded for quality and reintroduced to the recipient's uterus at a multicell embryo stage or later at the blastocyst embryo stage. All procedures required during an IVF cycle, including ovarian stimulation and monitoring, egg retrieval, and embryo transfer, are performed on-site in our state-of-the-art facilities.
What are the steps of the IVF process?
Our fertility specialists will provide you with the highest quality fertility care for your IVF cycle. The San Diego Fertility Center's IVF treatments encompass the following steps:
Your Initial Consultation
You will meet with one of our physicians, at which time we will review your medical history and establish your unique IVF treatment plan. At this appointment, you also will have the opportunity to meet with one of our financial counselors to review your insurance and financial options.
Pretreatment testing will include blood work to determine hormone levels, blood tests required by California state law , a semen analysis (if applicable), and a uterine assessment. In order to have the optimal outcome with your IVF treatment, we review your medical history and the results of your pretreatment testing before we finalize a protocol that is tailored for you.
Start of Pills
Oral contraceptive pills will begin on day two to four of your cycle after all pretreatment testing has been completed. You will take birth control pills anywhere from two to five weeks. Birth control pills will reduce the risk of ovarian cysts forming, aid in the synchronization of follicular growth, and help in the coordination and planning of your fertility care.
IVF Coordinator Consultation
You will watch a 30 minute video which will provide an overview of the IVF process. Once the video is complete, you will meet with one of our IVF coordinators to review your protocol and plan your calendar.
Controlled Ovarian Hyperstimulation
An IVF cycle begins with ovarian stimulation and ultrasound monitoring. A baseline pelvic ultrasound will ensure a healthy starting point before initiating medication for the stimulation and assessment of egg production. You will take hormone injections to recruit multiple eggs from your ovaries. During this time, follicular development and hormone levels will be monitored for appropriate growth for several days. Once your follicles have reached the ideal size, you will be ready for egg retrieval.
Approximately three to five office visits will be conducted for ultrasounds and for the assessment of blood hormone levels in order to accurately assess egg maturity.
Ovidrel or Lupron/hCG
A special medication will be administered 36 hours prior to the retrieval of your eggs.
Transvaginal Retrieval of Eggs and IVF Laboratory
Ultrasound-guided, transvaginal egg retrieval is a procedure in which a long, thin needle is passed through the vaginal wall into the ovary. The physician aspirates the follicles from each ovary and the follicular fluid is collected in test tubes, where the embryologist carefully searches for the eggs. The eggs are cleaned, counted, and placed in an incubator. Later that day, the eggs are fertilized with sperm either by standard insemination or Intracytoplasmic sperm injection (ICSI). Injuries during this procedure are extremely rare. Structures near the ovaries, such as the bladder, bowel, or blood vessels, could possibly be injured and require further surgery. Limited bleeding from the ovaries may occur, but the need for transfusion is extremely rare. Infections following transvaginal egg retrieval are also possible, but are rare.
Embryo Culture and Assessment
During IVF, your embryos are cultured for up to six days in a temperature-controlled incubator. Each day the embryos are evaluated for quality and development. This information is shared with the doctors to help determine the appropriate day for embryo transfer, which is typically performed on day three or day five of embryo culture or day six in the case of PGS/PGD. Our embryologists will call you each day to update you on the embryo quality and to answer any questions you may have.
Embryo or Blastocyst Transfer
Embryos are typically transferred back to the uterus on day three, when the embryo is at a multicell stage, or day five or six, when the embryo is at a blastocyst stage. This simple procedure usually requires no anesthesia. Your doctor and embryologist will discuss the number of embryos to transfer that will provide you the highest probability of success and the lowest probability of high-order multiple births. You will be given ample time to discuss your embryos and decide on the number of embryos to transfer. You also will receive pictures of your embryos being transferred. Once you have decided on the number of embryos to transfer, you will see your embryos being loaded into the embryo catheter via microscopic video. You will relax in the room for a short period of time once the embryo transfer is complete. The transfer itself may cause mild irritation to the cervix or uterus.
We will schedule your pregnancy test 10-12 days after your transfer. When your first pregnancy test is positive, a repeat value will be obtained approximately 48 to 96 hours later. To confirm the positive pregnancy test, we will schedule an obstetrical ultrasound two weeks following the second pregnancy test. At this visit we will be confirming the implantation of embryo(s) and fetal heart motion.
What are the risks with In-Vitro Fertilization (IVF)?
The medications and procedures required for In-Vitro Fertilization (IVF) are rarely associated with complications. However, as with all medical treatments, there are potential problems that may occur.
Ovarian hyperstimulation syndrome can occur whenever women use ovarian stimulation medications, especially injectable gonadotropins, such as Gonal-F, Bravelle, Follistim, or Menopur. This complication occurs in less than one percent of women who have egg retrieval with IVF. When severe, ovarian hyperstimulation can lead to dehydration, large amounts of fluid accumulation in the abdominal and lung cavities, and blood- clotting disorders. IVF cycles may be cancelled or embryo transfers postponed in order to prevent ovarian hyperstimulation syndrome.
Controversial studies link ovarian stimulation drugs to the development of ovarian cancer. Although studies are contradictory, some researchers have reported an increase in borderline ovarian cancer in women who have used fertility drugs. Until further research is available, careful use of ovarian stimulation drugs is reasonable, but it also is important to note that pregnancy reduces the lifetime risk of developing ovarian cancer.
What are the risks with IVF and a healthy pregnancy?
There is not an increased risk of birth defects in children conceived through IVF. The rate of pregnancy loss or miscarriage (about 20 percent) is similar to that of the general population and is related to the age of the female partner. The risk of ectopic (tubal) pregnancy is about 2 percent.
The risk of multiple gestation—twins, triplets, and higher order multiple pregnancies— is more common in women who undergo IVF. The rate of having twins with IVF is approximately 25 percent and the rate of having three or more babies is approximately 5 percent. Multiple pregnancies are complicated by an increased risk of premature labor, premature delivery, maternal hemorrhage, cesarean delivery, pregnancy-induced high blood pressure, and gestational diabetes.