Beginning an IVF procedure can be nerve wracking but an exciting experience. Normally, IVF treatment is sought after once other treatments have failed. IVF or In Vitro Fertilization is the very first procedure done when an egg donor is being used. IVF treatment can be very successful, but it can take more than one try to achieve pregnancy.
Don’t feel sad if you are feeling overwhelmed. IVF treatment can feel very stressful. There are schedules of ultrasounds, lab work, injections to deal with and patients can feel a bit fragile.
Step by Step IVF Treatment:
If you are wondering how everything will be organized, keep reading. Our protocol is adjusted a bit for each couple’s individual needs. Here’s a step by step look at what normally takes place during an IVF treatment cycle.
One Cycle before your IVF is schedules, your doctor will more than likely have you taking birth control pills. Are you not trying to get pregnant? This may seem strange. Using birth control pills before a treatment cycle is to decrease the risk of ovarian hyperstimulation and might improve your success rate.
The doctor may also ask you to do is to get an ovulation predictor kit. Let your doctor know once you detect ovulation. After ovulation, your doctor will have you start to take a GnRH antagonist or a GnRH agonist such as Lupron. They want to have complete control over your ovulation once your treatment cycle begins. If patients do not have a regular cycle, there are medications such as Provera to take to bring on menses. Your doctor will ask you to begin taking the GnRH agonist or antagonist six days or more after your first Provera med. Always follow your doctors orders.
The day you get your period is considered the “first official day of your treatment cycle”. The second day of your period, your doctor will want an ultrasound and some labwork to be completed. This is what we will call your baseline ultrasound and your baseline labwork. Your doctor is ookijng for your estrogen levels or your E2 or Estradiol. He wants to see that your ovaries are asleep. This is what Lupron is supposed to do. Your ultrasound will check how big your ovaries are and if you have any ovarian cysts. If you have any cysts, how they are dealt with is up to your doctor. Sometimes cysts will take care of themselves with time. Your doctor may want to suck the cysts out with a needle. Once these tests are fine, the process moves on to the next step.
With your labwork and your ultrasound looking normal, it’s now time to stimulate the ovaries with fertility drugs. This can suggest from one to four injections every day for approximately a week to ten days. You will become a professional at injection yourself. Our IVF Cancun Clinic will teach you how to give yourself injections every day even before you need to start injecting.
Your doctor will watch the development of the follicles during your ovarian stimulation period. The can once again include lab work every couple of days to check on the estradiol levels. It may also include another ultrasound to monitor the oocyte growth. It’s important to monitor your cycle because it will give the information your doctor needs to increase or decrease your medication dosage.
When your biggest follicle is 16 to 18mm from side to side, our IVF Cancun Clinic will ask for you to visit on a daily basis.
Next up is triggering the oocytes to pass through the final stage of maturation before they can be retrieved or collected. This is triggered with human chorionic gonadotropin (hCG). This medication can be called Ovidrel, Novarel and Pregnyl.
The timing of this injection is very important. Given too early, the eggs won’t have matured sufficiently. If the injection is given too late, the eggs might be too old and they won’t be able to fertilize properly. Daily ultrasounds during the final step are going to time the trigger injection properly. When your estradiol levels are greater than 2,000pg/ML is usually when the gCG injection will be given. This is a one time injection. It’s very important that the timing of this injection is perfect and it will be based on your ultrasounds and labwork.
If you are at risk for ovarian hyperstimulation syndrome, and if not enough follicles have grown, the treatment may be canceled and the HCG injection will not be given. If your ovaries did not react well to the medications and treatment is canceled, your doctor will suggest a different course of action and different meds on the next cycle. It’s not common but a cycle may be canceled if your ovulation happens prior to retrieval. The eggs cannot be retrieved if they ovulate on their own.
The hCG injection is given and 36 hours later the eggs will be retrieved. To feel nervous is normal. It can be a bit nerve wracking. There is almost no pain involved with the procedure. An anesthesiologist will provide medication intravenously and patients feel relaxed. Sometimes a mild sedative is used and patients sleep during the procedure. When the sedation has taken effect, the doctor uses a transvaginal ultrasound to push a needle to the back side of the wall of the vagina and up into the ovaries. The needle will then be used to aspirate the follicle. The lab will receive the oocytes for fertilization. Your doctors can tell you prior to the procedure the number of oocyte that they will retrieve. After the retrieval you will need to spend a few hours to recover from the procedure. Some patients experience light abdominal cramping and this is considered normal.
Once you are recovering post egg retrieval, the follicles that were aspirated will be checked for oocytes. Not all follicles will have an oocyte. When the oocytes are discovered, they will be checked by our embryologist. If the eggs are too mature, the fertilization might not be successful. If they are under mature, the lab may be able to coax them into maturity in a lab setting.
Within 12 to 24 hours the fertilization of the oocytes needs to happen and your partner will need to give us a semen sample on that same morning of the retrieval. The day can be very very stressful so your partner can feel free to provide a semen sample for backup purposes that can be frozen and used if fresh semen cannot be produced. We put the semen sample through a special wash that separates the sperm from the other material found in sperm. The embryologist chooses the nicest looking sperm. The embryologist will place 10,000 sperm in each petrie dish with an oocyte. These dishes are in a special incubator and 12 to 24 hours later are checked for signs of fertilization. 70% of these oocytes will be fertilized.
Three to five days after the retrieval it’s time to transfer the fertilized eggs. You won’t need anesthesia and the procedure is called embryo transfer. A think tube is passed through your cervix during the transfer. The embryos are mixed with a small amount of fluid and then deposited through the cervix. There will be 2 to 5 embryos transferred depending on your age. Patients need to lay still for a few hours post procedure so we suggest bringing along your computer or book to read. If you have some good embryos left over we can freeze them to be used later if this particular cycle is not successful.
If they are not needed, they can be donated.
Before the embryo transfer and after the day of the retrieval, it’s time to start giving yourself progesterone injections. There is really nothing else to do for the next two weeks. At times the two weeks post transfer is the most emotionally difficult two weeks of treatment. All you need to do is wait and see if this treatment was successful.
Twelve days after the embryo transfer it’s time to do your at home pregnancy test. If it’s positive, chances are you need to continue taking progesterone for a few weeks more. The doctor will also monitor if the treatment led to multiple pregnancy. If the pregnancy test is negative 14 days post transfer , the doctor will request that you stop taking progesterone and wait for your period to start and discuss the next steps.