In-Vitro Fertilization (IVF)

1. Ovarian stimulation

Injections of fertility medications called gonadotropins are taken daily by the woman, which causes the growth of multiple follicles. At the same time, additional injections of medications called GnRH agonists or antagonists are also taken daily to prevent ovulation. During ovarian stimulation, progress is monitored with a series of blood tests and vaginal ultrasounds. Lastly, an injection of a hormone called ovidrel or human chorionic gonadotropin (hCG) is taken to cause final maturation of the eggs in preparation for the egg retrieval procedure. The timing of this “trigger” injection is determined by egg follicle sizes.

2. Egg retrieval and sperm collection

Approximately 36 hours following the “trigger” injection, patients will have their egg retrieval procedure. An ultrasound probe is placed in the vagina and a needle is passed through it, into the ovary. The eggs are collected from the follicles. Although there can be some discomfort, medication is given to minimize pain and the egg retrieval is generally well-tolerated. Most commonly, men will provide an ejaculated sperm sample for use, just before the egg retrieval procedure. In other situations, previously cryopreserved sperm, donor sperm or surgically retrieved sperm will be used for fertilization.

3. Fertilization and embryo culture

After a period of incubation in the lab, each egg is placed in a dish with a large number of moving sperm and fertilization is allowed to occur. If the sperm are low in number or movement, a single sperm can be selected and injected into each egg using a technique called intracytoplasmic sperm injection (ICSI). After eggs and sperm are combined, fertilization may occur. The resulting embryos are allowed to grow in the lab until ready for transfer into the uterus.

4. Embryo transfer

One or more embryos are placed into the uterus using a soft, flexible catheter or tube that is guided through the cervix by ultrasound. The discomfort of an embryo transfer procedure is similar to that of having a pap test, but with a full bladder. After the embryo transfer, following 15 minutes of rest, patients return home and are advised to rest for that day. Any good quality embryos remaining after the transfer may be cryopreserved for future use.

5. Progesterone supplementation and pregnancy test

Starting the day of the egg retrieval procedure, progesterone tablets are placed in the vagina in order to support a developing pregnancy. Occasionally, progesterone is given as an injection. A pregnancy test is performed approximately 17 days after egg retrieval. If positive, an ultrasound is performed to assess the health of the pregnancy, which is usually done two to three weeks after a positive pregnancy test.