Beginning an IVF cycle is an exciting and anxious time for a couple. Our Center provides couples with the maximum amount of clinical, emotional, and administrative support they will need to complete their cycle successfully – whether it results in a pregnancy or not.
The following explanation is meant to simplify what occurs during various stages of IVF:
Ovarian Follicle Development through Controlled Ovarian Stimulation
Rotunda Fertility Clinic uses fertility drugs that stimulate the female partner’s natural hormones to develop several normal follicles in the ovaries. These medications are Clomiphene Citrate also called Siphene® or Ovofar®; Menogon (hMG), a 50:50 mixture of FSH and LH hormonal administered intramuscularly; Puregon® (PoFSH) administered subcutaneously; or Gonal-F (RecFSH). Any excess oocytes that fertilize and develop into embryos at fertilization may later be stored through cryopreservation.
Follicular growth, development, and maturity are evaluated through frequent hormone monitoring and by ultrasounds. Typically, the hormones estradiol, luteinizing hormone, and progesterone are measured through blood tests to evaluate ovarian response. Ultrasound is used several times during a cycle to measure accurately follicular growth and size.
These steps allow the physician team to modify the treatment in some cases and to stop the cycle if the response to stimulation is not satisfactory. Once follicular maturation is achieved, the patient receives an intramuscular injection of human chorionic gonadotropin (hCG), which triggers oocyte maturation and ovulation. Oocyte retrieval is performed approximately 34 hours later.
Oocyte Retrieval through Puncture/Aspiration
If the last hormone blood test and ultrasound evaluation indicates healthy growth of follicles, then aspiration of mature follicles takes place. This entire procedure takes approximately 20 minutes performed under short general anesthesia. The physician locates each follicle through ultrasonic guidance and carefully aspirates them. The contents of the follicles are immediately taken to the IVF lab. Patients usually recover within one to two hours following oocyte retrieval and are then discharged. Progesterone supplementation is initiated from the day of the retrieval.
Oocyte Culture, Insemination and Fertilization
In the IVF laboratory, follicular fluid is examined under a microscope to locate all eggs, which are then incubated in special media. Generally, semen collection occurs at about the time of the egg retrieval but, in some cases, may be several hours later. The sperms are then added to the eggs in culture, here fertilization occurs. Any resulting embryos are stored in the incubator, and maintained in culture until the time of embryo transfer and/or Cryopreservation.
Usually, transfer of the embryos takes place on day two or three post retrieval. The embryos are examined under the microscope and carefully aspirated to a thin transfer catheter. The loaded catheter is introduced under transabdominal ultrasound guidance through the cervix into the uterus where the embryos are placed. This procedure takes a few minutes and does not require anesthesia.
After the transfer, the patient rests for two hours prior to discharge. Twelve days after the embryo transfer, a serum based pregnancy test is taken. During this period, patients are advised to perform light activity and remain in contact with the Center. If pregnancy does not occur, our team reviews the IVF cycle and makes specific recommendations for follow-up. The patient will speak with the clinical staff to review and if necessary, to discuss other options.
Embryos of sufficient quality that are not transferred can be cryopreserved. The embryologist will select embryos that are suitable for freezing. Embryos that are ideal for freezing have blastomeres of equal size and display minimal or no fragmentation.
Ovarian Follicle: A small, fluid-filled structure in which eggs develop
Oocyte: An egg
Embryo: A fertilized egg that has undergone cleavage division