What to Expect During the IVF Process

Video: In Vitro Fertilization (IVF)

For the more severe forms of infertility, Laurence A. Jacobs, M.D. offers In Vitro Fertilization. By using a multiple step process Dr. Jacobs can determine why a couple has a difficult time getting pregnant. IVF is an effective solution to infertility.

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At Fertility Centers of Illinois, one of the most common and successful procedures we perform is In Vitro Fertilization (IVF). 20 to 30 percent of the people who come to us for help getting pregn will undergo IVF. We have 30 years of experience in the field of reproductive health, and we specialize in IVF. To learn more about the IVF process, contact our Chicago office today.

IVF was developed to help women carry children who couldn't conceive due to things such as damaged fallopian tubes. Eggs are collected from the woman, and sperm is collected from the man, and the eggs are fertilized outside of the woman's body. One or more embryos are then transferred to the woman's uterus, and from there nature takes over. The entire procedure involves:

The woman is first prepared for receiving fertility medication by giving her contraceptives to let the body rest from natural hormone processes for a while. That helps the body respond better to the medication once it's given. During the rest period both partners will be tested to make sure they're healthy. The woman's ovarian reserve will be tested, as well as the condition of her uterus. Once ready, the woman will be given medication to stimulate ovulation, and the eggs will be harvested. Once the eggs are fertilized, the embryology staff will check for embryonic development and then Dr. Jacobs will transfer one or more healthy embryos to the woman's uterus. See below for detailed steps.

For a Chicago fertility clinic that you can count on, the place to contact is Fertility Centers of Illinois. When you come to us, you know right away that you're with experienced, skilled professionals who care about helping you have a child! Call us today.

PREPARATION CYCLE

After the decision is made to proceed, the couple begins the IVF preparation cycle at the beginning of the next menstrual period. During this stage, the woman is given oral contraceptives, better known as birth control pills, or natural progesterone, in order to suppress her natural hormonal processes. This gives the body a chance to "rest" and improves the response to fertility medications during the next stage of stimulation.

While the couple is in the preparation stage of the IVF process, several lab tests will be performed to screen both partners for infectious diseases and evaluate the woman's ovarian reserve. Read Dr. Jacobs' article about ovarian reserve (PDF). These tests will also help to determine the dosage of fertility medications that will be administered during the stimulation cycle and the type of protocol used. The stimulation protocols are individualized for all patients based on age and ovarian reserve. If the condition of the uterus has not been assessed within the previous twelve to eighteen months, ultrasounds and other physical examinations will also be performed at this time.

After an IVF consultation with the physician, the couple should already be somewhat familiar with the various stages of in vitro fertilization. Before making the decision to proceed, you will have a one-hour consultation with an IVF nurse, and we will take this opportunity to go over the process very thoroughly and answer any questions that may arise. Injection training will also be given and consent forms will need to be signed.

Toward the end of the preparation cycle, the woman may begin injections of Lupron®, a medication to prevent ovulation from occurring before we are able to retrieve the mature oocytes. Read Dr. Jacobs' article about the IVF process (PDF).

OVARIAN STIMULATION

The stimulation cycle will start once the oral contraceptives are finished and menstruation begins. The first step in this stage of the in vitro fertilization process is to stimulate the ovaries. Gonadotropins are fertility medications that act directly on the ovaries and are used to induce the maturation of several eggs at once in a way that is easily monitored and controlled.

While the gonadotropins are being administered, the ovaries are monitored regularly via ultrasound to check the development of the follicles, or fluid-filled sacs, in which the eggs mature. During this stage of the IVF process, the thickness of the uterine lining is also monitored and blood tests are performed to check hormone levels. The stimulation process averages 10-14 days, with approximately six to eight office visits. When the follicles reach a certain size, a single injection of human chorionic gonadotropin (hCG) is administered in order to promote the final maturation of the eggs. The egg retrieval procedure will be scheduled for 36 to 37 hours after this final injection. On occasion due to the patient's diagnosis or her elevated estrogen levels, a "trigger" injection with Lupron®,  may be used instead in order to eliminate the risk of Ovarian Hyperstimulation Syndrome (OHSS).  If Lupron®,  is used, the uterine lining may not be as ideal so that freezing (Vitrification) of the embryos may be recommended. Transfer of the embryo(s) will then take place the following month.

EGG RETRIEVAL

Egg retrieval for in vitro fertilization is achieved through a procedure known as transvaginal ultrasound-guided aspiration. This is an outpatient procedure that is performed at one of our Chicago-area IVF centers and generally takes about 20 minutes to complete. During egg retrieval, the patient is under conscious sedation, which means that the patient will be sleepy and very relaxed and will experience minimal, if any, discomfort from the procedure.

To collect the eggs, an ultrasound probe is inserted into the vagina, which allows Dr. Jacobs to see the ovaries and other pelvic structures during the procedure. A needle is then directed through the vaginal wall and into each ovarian follicle. The egg and fluid from each follicle is collected with gentle suction and given to the embryologist in order to identify the eggs under the microscope. Once all of the eggs are collected, they are sent to our laboratory where they will be examined and prepared for in vitro fertilization. Fertilization of the eggs may be accomplished by ICSI or the regular method in a Petri dish.

ASSISTED HATCHING

Embryos are covered by a zona pellucia, or protein shell. In a small percentage of patients, the embryos have difficulty shedding this shell, which is essential before they can attach to the uterine wall. Assisted hatching is a process in which Dr. Jacobs creates a small opening in the zona pellucia that allows the embryo to more easily shed it. This process takes place in our laboratory just before the embryo is inserted within the uterus during the last step of IVF.

EMBRYO TRANSFER

Following successful in vitro fertilization of the eggs and confirmation of normal embryonic development, the embryo transfer procedure is performed three to five days after egg retrieval. One to three embryos are placed inside the uterus through a thin, soft catheter that is threaded through the cervix. This process takes only a few minutes and involves very little discomfort.

After the embryo transfer procedure, it is recommended that the woman spend one to two days resting and relaxing to avoid any undue stress on the body. A pregnancy test will be scheduled to take place two weeks after the transfer. Because in vitro fertilization patients are given hCG during the ovulation stimulation process, at-home pregnancy tests are not reliable and can produce a false positive. The pregnancy test must be performed in the laboratory, where we are able to measure the actual quantity of hCG in the patient's system, not just detect the presence of it.

Pregnancy success rates are determined by embryo quality, the number of embryos transferred, and the woman's age, among other factors.

PREIMPLANTATION GENETIC DIAGNOSIS

When undergoing IVF, preimplantation genetic diagnosis (PGD) can provide insight into your embryo’s genetic health and gender. This reduces the risk of sex-specific disorders and aneuploidy (abnormal chromosome count). It also allows patients to select the sex of their embryos with more than 99 percent accuracy.

CRYOPRESERVATION (VITRIFICATION) AND SUBSEQUENT CYCLES

Ovarian stimulation is designed to promote the maturation of multiple eggs, improving the chances of successful conception. However, only one or more embryos will be transferred into the uterus after in vitro fertilization, to minimize the chances of multiple pregnancy. Additional embryos that develop normally can be cryopreserved (vitrified), or frozen, if they meet certain strict criteria.

The major benefit of freezing embryos is that, if the initial IVF cycle does not result in successful pregnancy, the preserved embryos can be thawed and transferred during subsequent cycles without requiring the patient to repeat the ovarian stimulation and egg retrieval processes. IVF cycles using frozen embryos are far less expensive and easier on the woman's body. In fact, Frozen Embryos may often result in higher pregnancy rates compared to Fresh Embryos due to the ability to wait for an ideal uterine lining.  Frozen (vitrified) embryos are viable for at least five years.

For more information, visit our Cryopreservation (also Vitrification) page.

CONTACT OUR CHICAGO, ILLINOIS-AREA IN VITRO FERTILIZATION (IVF) CENTER

Contact one of our offices in the Chicago, Illinois area to schedule an in vitro fertilization (IVF) consultation.