What is IVF?
IVF puts science smack dab in the middle of procreation. In IVF, the eggs are removed from the female body, injected inside the lab with a single sperm provided by the male, left to grow for a couple days in an incubator, and then put back inside the female’s body to implant and grow. There is also an alternative method in which, after being allowed to grow for a couple days, the embryo/blastocysts are biopsied and then frozen. The biopsy tests for genetic abnormalities. Those that are normal are then thawed and placed into the uterus.
This method is highly effective. It takes much of the “chance” out of the equation. The genetic testing lowers the opportunity of miscarriages, as only the most medically sound embryos are transferred.
- Baseline & Suppression. This stage occurs the cycle before the egg retrieval. Birth control is prescribed to give the body a break and to also align your body onto a schedule, so the RE knows when to expect CD1, etc. There is also typically bloodwork to check various hormone levels and an ultrasound to check on the condition of the uterus and follicles.
- Stimulation. As soon as the next cycle begins, medications are started to stimulate the ovaries into making as many mature follicles as possible. Typically, gonadotropins (like Gonal-F) are taken in the morning, followed by an FSH (like letrazole) in the evening. Stimulation normally lasts about 12 days.
- Monitoring. Around SD3 (stimulation day 3) monitoring begins. US are taken to check on progression and medications are adjusted as needed. Monitoring typically occurs every other day. On SD5, another medication is added to prevent premature ovulation-you want as many mature follicles as possible, so it’s likely some will mature faster than others. We want to hit pause on those. On SD7, monitoring occurs daily, with a multitude of blood draws and US. The goal is to have 15-25 follicles averaging 18-22 mm in size.
- Triggering. Just like an IUI, a trigger shot is administered to tell the body to completely mature the follicles.
- Egg & sperm retrieval. 36 hours after the trigger, the egg retrieval is done. The female is put under sedation/general anesthesia. A long needle is guided by an ultrasound through the walls of the vagina, and into each follicle to suck out the eggs. The contents are taken to an embryologist, and the female is released. While this is occurring, the male ejaculates into a cup, and the contents are give to the embryologist. If opting for an immediate transfer after growth, estrogen is given to help thicken the uterine lining.
- Fertilization. Not all of the follicles contained a fully matured egg, so the embryologist picks out the mature, viable eggs from the rest. Fertilization occurs one of two way. Traditionally, the eggs are placed into a Petri dish with the sperm, and nature occurs, under observation of the embryologist. In ICSI (intracytoplastic sperm injection), the embryologist uses a needle to manually choose a single sperm and inject it into the egg.
- Growing. After the eggs are fertilized, they are placed into an incubator to “hatch.” The amount of time spent in this phase can depend. Embryos are typically transferred on either day three or five. The goal is typically three, as studies have shown they are more likely to implant.
6b. Option genetic testing. At this point, many opt for preimplantation genetic screening (PGS). In this case, a biopsy harvest cells on day 5 and then the embryo is frozen. The cells are tested for genetic abnormalities, and typically discarded if abnormalities are found. If this option is chosen, because of how long testing takes, the rest of the cycle proceeds as normal until a period occurs, and transfer takes place at a later cycle.
- Transfer. Transfer occurs 3 or 5 days after retrieval. A catheter is loaded with the embryo and is positioned up through the cervix and into the uterus. An ultrasound guides the RE, and he/she will scratch the uterine wall, apply a “glue” and then drop the embryo here.
- Betas. 9-11 days after transfer, blood is drawn to test for the presence of HCG. Levels greater than five indicate pregnancy, and should double over the course of 38 hours to indicate a viable pregnancy.