IVF & Genetic Testing

What Is In Vitro Fertilization (IVF)?

In vitro fertilization (IVF) is a technique in which eggs are retrieved from a woman’s ovaries and fertilized with sperm outside the body. Stimulation of the ovaries occurs with injectable medication, and the eggs that develop are aspirated from their follicles and placed in a dish (“in vitro” is Latin for “in glass”). Insemination then occurs, either by placing sperm in the dish with the egg, or by injecting one sperm directly into each egg (intracytoplasmic sperm injection, or ICSI). The resulting embryo or embryos are then transferred back into the uterus where hopefully, implantation occurs.

IVF is the most effective means of achieving pregnancy for many patients, and in some cases may be the only reasonable means for achieving pregnancy (e.g., if the fallopian tubes are blocked). IVF success rates are higher than rates for IUI or any other treatment because the technique overcomes most factors that contribute to infertility. The technique allows us to directly observe the growth of early embryos to gain valuable information about possible causes of infertility. IVF also allows for genetic testing of the embryos prior to transferring them back to the uterus (see section on preimplantation genetic testing).

BASIC STEPS

The basic steps in an IVF cycle are:

1. Preliminary blood work is done for both partners.
2. A hysteroscopy or hydrosonogram (water ultrasound) and a mock embryo transfer (trial-of-transfer) are performed to assess the size and shape of the uterine cavity. This step ensures the uterus is normal prior to transferring the live embryos and provides valuable information to assist with the transfer procedure.
3. The patient and partner view the IVF orientation video to learn about the process. They also attend an injection class to learn how to properly mix and administer the medication.
4. Once all of the preliminary items have been completed, we will be ready to start the cycle. There are several different IVF protocols. Your doctor will select one based on your personal test results. Some protocols involve starting a medication to suppress your natural cycle first, followed by the stimulation medication. Other protocols involve taking pills before starting the stimulation medication. Your doctor and nurse will review your particular protocol and will give you clear instructions for when to start each particular medication.
5. Once you start your stimulation medication (gonadotropins), periodic ultrasounds and blood work are performed to monitor your response. These visits are frequent and may ultimately be required daily for several days as the follicles get larger. Medication is typically taken for 7–14 days.
6. Once the follicles are large enough, an injection of HCG is given to trigger the final maturation of the eggs.
7. The surgical egg retrieval occurs 34 hours after the HCG injection.
8. Insemination occurs in the embryology lab on the same day as the retrieval. The eggs are checked the following day to determine how many fertilized correctly, and the embryo development is closely monitored.
9. If we are performing a fresh embryo transfer (i.e., no preimplantation genetic testing), the embryo or embryos are transferred back into the uterus 5 days later. If we are performing preimplantation genetic testing on the embryos, they are biopsied on Days 5–7 and we wait for the results to determine your next steps.
10. If a fresh embryo transfer is performed, a pregnancy test is taken approximately 2 weeks later.