Ovarian Follicle Development
Women usually grow a single egg in a month. In order to increase the chances of pregnancy occurring, the patient takes medication that can be utilized alone or in combination to induce several follicles to develop. A follicle is a fluid filled sac that houses the egg and is usually visualized on the video screen of an ultrasound machine. The monitoring of the egg development is accomplished in three ways:
- Ultrasound monitoring of follicle growth
- Monitoring of blood or urinary estrogen (E2), progesterone (P4), and luteinizing hormone (LH)
- Physician’s interpretation of the cycle data
The IVF team evaluates this data on an ongoing basis for the appropriate timing of the administration of the human chorionic gonadotropin (hCG) injection to trigger final stages of ovulation. The hCG injection is usually given about 35 hours before egg retrieval is scheduled.
Egg Harvesting – Oocyte Retrieval
In the early days of IVF, the eggs were retrieved by laparoscopy. Today, they are collected by transvaginal ultrasound-guided oocyte aspiration. This is a simple technique which involves the introduction of a fairly small needle through the vaginal wall guided by the ultrasonic probe. This technique is easy to perform and has been utilized by our group since its introduction in the US in 1985. The vast majority of Innovative Fertility Center’s patients undergo the egg harvesting procedure in our office under local anesthesia and IV sedation. In this way, there is no hospital fee and Innovative Fertility Center does not charge a facility fee for the aspiration.
In Vitro Fertilization Laboratory
After the oocyte collection procedure, a “baby incubator” which houses a powerful dissecting microscope receives the follicular fluid containing the eggs. This fluid is placed in a special culture medium which consists of several essential chemicals. The eggs remain in the carefully-controlled extracorporeal system for 4-6 hours before the embryologist adds the specially-processed sperm to allow the fertilization process to occur. (If there is male factor infertility, we would probably perform ICSI to assure fertilization).After a period of 16-20 hours, the eggs are examined and checked for the first signs of fertilization. At this time, the embryologist can observe under the microscope “two pronuclei”. The egg essentially looks like a “round ball with two eyes” and they represent the genetic material from the partners. After two to three days, if the embryos are growing normally, they are ready for the embryo transfer.
Uterine Embryo Transfer
The embryo transfer is not a complicated procedure and is performed in our office without anesthesia. The embryos are placed in a catheter (a tubular instrument) and then the tiny plastic tube is introduced into the uterus through the cervix and the embryo(s) are transferred into the endometrial cavity. The woman is required to stay in a gynecological position for a few minutes, then her legs are repositioned to be more comfortable. We require the patient to remain lying down for about an hour after the embryos have been replaced into the uterus.After the embryo transfer, we request patients relax 30 minutes post transfer and to absolutely restrict their physical activities for the first 24-72 hours and until a pregnancy test is performed approximately 9-12 days post transfer to moderately restrict their activities.
Luteal Phase Monitoring & Support
This phase consists of monitoring of blood levels of progesterone, estradiol, and BhCG (pregnancy tests). If there is a positive pregnancy test, close monitoring of the early pregnancy is highly advisable. At Innovative Fertility Center, we continue to perform the blood tests plus the first pregnancy ultrasound for detection of the baby’s heartbeat and evaluation of the number of embryos implanted is usually done between the 2th and 4th week post transfer.
In the event of an unsuccessful cycle, Innovative Fertility Center’s patients are encouraged to talk to their physician for understanding of the cycle and to actively participate in planning for future treatments. During a treatment cycle, we gather an substantial amount of information and this is frequently beneficial to tailor a patient’s future treatments.