Without success for one in five couples in the U.S., infertility is real. If you and your partner have tried to conceive without success for 12 consecutive months (6 months for those women over 35), it may be time to schedule an evaluation with your doctor.
Once you’ve been through an evaluation and any necessary tests, you’ll receive a diagnosis. Depending on the source of your infertility, your doctor will present you with some solutions, or treatments, to help you achieve your goal of growing your family.
In-vitro fertilization, (a.k.a. IVF), is one of the more successful treatment options. But what is IVF, and what does the process entail? We’re here to answer all of your questions, and we’ll start with a step-by-step explanation of a standard IVF cycle from start to finish.
IVF is a treatment that falls under the umbrella of assisted reproductive technology (ART). According to the CDC, ART includes all infertility treatments that involve handling eggs or embryos. For example, with IVF, a doctor retrieves the eggs and combines them with sperm in a laboratory setting. But we’re getting ahead of ourselves. Below is the step-by-step IVF timeline.
It may sound slightly counterproductive to begin with contraceptives when you’re trying to conceive. However, IVF is a controlled process, and your doctor must predict your ovulation with the utmost accuracy. Oral contraceptives suppress the ovaries, so they respond better to stimulation, with added benefits below:
- Improved ovarian response during the stimulation stage, which results in better, and increased egg recovery.
- Uniform follicle growth enables all eggs to develop at the same time.
- Decreased risk of ovarian cysts.
- Shortened amount of time you’ll need to take ovarian-suppressive drugs such as Lupron.
While you’re taking oral contraceptives, your doctor will schedule a transvaginal ultrasound around the time you expect your period. This procedure assesses your ovaries to ensure they aren’t producing eggs at the time. Your doctor also looks for ovarian cysts or anything that may delay stimulation.
Most women take ovarian stimulating hormones for 8-14 days, with an average duration of 10-11 days. Ovarian stimulation helps your body produce more eggs, and the more eggs you have for fertilization, the higher your odds for success.
Your doctor will formulate a specific protocol to maximize egg production while guarding against uncomfortable side effects and risks.
With our instructions, you inject the stimulating medication yourself, and your doctor monitors you regularly with a vaginal ultrasound to visualize your ovaries and blood tests to assess your hormone levels and look for signs of ovulation.
Once your doctor determines ovulation is imminent, you receive a shot of a triggering hormone, usually human chorionic gonadotropin or hCG. HCG spurs the maturation of your eggs and prepares them for fertilization. Now it’s time for your egg retrieval.
Within 36 hours of your triggering hormone shot, just before you ovulate, your doctor performs the egg retrieval. This procedure takes the eggs directly from the follicles using a very small needle, guided by ultrasound, inserted into each ovary. You are sedated and monitored during this process.
The needle goes directly into the follicles and, using slight suction, draws out the fluid containing the egg. Your doctor performs this procedure for each mature follicle. You may experience mild cramping the next day and pressure and fullness in your pelvic region from your swollen ovaries.
Now it’s time for an embryologist to take over. First, the embryologist will record each egg retrieved, including the number and viability of the eggs. (Age and ovarian reserve influence both the number and viability of your eggs, as well as your response to the ovarian stimulating medication.) Once the embryologist confirms your eggs are viable, it’s time for fertilization.
The lab will place your eggs in an incubator and combine them with your partner’s sperm, or donor sperm, within a few hours of retrieval. Depending on your partner’s semen quality, the lab fertilizes the eggs in one of two ways: intracytoplasmic injection (ICI) or conventional fertilization.
When your partner’s sperm count is an issue, or you’ve experienced a failed prior IVF cycle, your doctor will opt for ICI. For this process, the lab injects a single sperm directly into the egg, facilitating fertilization, in contrast to the conventional method allowing the sperm to enter the egg on its own. The egg(s) and sperm remain overnight; the following day, the lab checks for fertilization. Success means your embryo transfer is on the calendar!
Depending on the advice of the embryologist and physician, your embryo transfer will occur between day three and day six following retrieval. You may choose preimplantation genetic testing prior to your transfer so you know of any chromosomal or genetic issues.
In the case of multiple viable embryos, your doctor will advise implanting just one. Because pregnancy with multiples carries its own set of risks to both babies and mother, it’s required as best practice to implant one embryo at a time. Of course, you can always choose to freeze, or cryogenically preserve, the remaining embryos.
Guided by ultrasound, your doctor will insert a small catheter directly into the uterus. Using the catheter, your doctor will place the embryo into your uterus, where it ideally grows and develops into a healthy baby over the next nine months. Patients often compare implantation to a pap test in terms of discomfort, and there is no need for sedation.
After your egg retrieval and continuing into the early stages of your pregnancy, your doctor may prescribe progesterone. Progesterone supports a healthy uterine lining, and a healthy uterine lining promotes implantation.
Now we wait.
About two weeks post embryo transfer your doctor will conduct a blood test. The blood test measures rising hormone levels for hCG, an indicator of pregnancy. Your doctor will follow a positive test with another blood test a few days later to ensure hCG levels continue rising.
Remember that typical pregnancy signs and symptoms aren’t reliable at this stage.
About two to three weeks post-transfer, and following two positive blood tests, your doctor will perform a transvaginal ultrasound. Once the ultrasound confirms fetal development, you’ll continue to see your fertility team until around week ten, when you’re then referred back to your obstetrician.
We Strive for Your IVF Success
At Reproductive Health and Wellness, we are a comprehensive fertility clinic and provide expert care for our patients. We offer state-of-the-art fertility treatments in our special boutique setting. If you’re interested in exploring IVF in more detail, contact Reproductive Health and Wellness.