In Vitro Fertilization (IVF)
In Vitro Fertilization (IVF) was first utilized in 1978 and today, is undoubtedly, the most successful form of fertility treatment provided. Often, IVF is also the most cost-effective treatment, too. IVF consists of a multi-step process which includes:
- Controlled Ovarian Hyperstimulation (COH)
- Ultrasound Monitoring
- Bloodwork Monitoring
- Egg Retrieval (ER)
- Nanobead Sperm Selection*
- Intra-Cytoplasmic Sperm Injection (ICSI)
* Utilized on a case-by-case basis
- Intra-Cytoplasmic Morphological Sperm Injection (IMSI)
- Assisted Hatching
- Embryo Transfer (ET)
- Embryo Freezing**
** Utilized when additional embryos remain post ET
In the simplest definition, IVF is the process by which an egg is injected with sperm in a laboratory dish for fertilization to occur outside of the body.
IVF is the recommended method of assisted reproduction for:
- Severe Male Factor
- Diminished Ovarian Reserve (DOR)
- Multiple Combined Factors including both Male and Female Fertility Factors
- Tubal Factor
- Endometriosis
- Multiple Miscarriage
Resource Quick Links
IVF Timeline and Process
After you have completed the initial diagnostic screening process:
- Initial Consultation
- Diagnostic evaluation of both the Male and Female Fertility Factors
- Reviewed evaluation results
it will be time to decide on a treatment process that is most suitable for your particular situation. If you choose to utilize In Vitro Fertilization (IVF), you can expect to follow through a process that includes multiple stages.
Determining Course of Treatment & YOUR IVF Coordinator
Initially, upon the determination to proceed further with IVF, you will meet with our office manager to discuss financial obligations and pricing. At MCRM Fertility, we batch our monthly IVF patients into one cycle period which lasts about two weeks per month. Each of these monthly IVF treatment cycles are limited to a set number of patients; therefore, individuals are able to secure a spot within a particular cycle by providing a security deposit. Once a patient provides their deposit, they are placed into the requested treatment cycle and their information is provided to the clinical manager and the IVF coordinating team.
The clinical manager and IVF coordinating team regularly meet with Dr. Ahlering and review individual cases for upcoming cycles. Each IVF patient is dedicated an IVF coordinator, whom will work with the patient to make their individual treatment plan and care easy and comfortable. YOUR IVF coordinator will contact you shortly after you have been placed into a particular treatment cycle to welcome you and introduce themselves. At this time, you might also be provided some initial medications and information regarding the upcoming process. YOUR IVF coordinator will always be there for you and will be a great individual for you to lean on as you continue through your journey. Upon receiving your specific treatment protocol from Dr. Ahlering, YOUR IVF coordinator will create a treatment calendar personalized for YOU, YOUR coordinator will also assist with your medications and prescriptions that you might require. From the beginning of the treatment process until your last appointment before returning to the care of your OBGYN, YOUR clinical coordinator will walk along side with you.
Baseline
The treatment cycle is based around a specific cycle week. The cycle week begins with Cycle Day 9Monday ( CD9 ). This date/day will typically be the date/day you will most often hear referred back to you and is a critical day in the treatment process. Ten days prior to CD9, the first major day arrives, Baseline. At baseline, you will undergo a transvaginal ultrasound and have some bloodwork drawn and tested. These steps will allow Dr. Ahlering to evaluate your current condition and process and provides him the opportunity to modify your protocol, if required. YOUR coordinator will assist in explaining the evaluation and any required modifications.
Cycle Day 9 (CD9)
On CD9, every patient undergoing treatment within the set treatment cycle will visit MCRM and have an ultrasound completed and same-day blood tests drawn. Dr. Ahlering will review your ultrasounds and lab results with YOUR coordinator to evaluate your status. Dr. Ahlering may modify medication dosages and/or timing of medications based on the information obtained during your CD9 visit. You may also be requested for further evaluation and ultrasounds prior to having an Egg Retrieval (ER) date scheduled. These could occur over the course of the next few days following CD9. Once it has been determined that you are ready for ER, YOUR coordinator will inform you of your scheduled date and time and also discuss the administration of HCG, sometimes referred to as the “Trigger Shot”.
Egg Retrieval (ER)
This is the day you have been working so hard towards for the past month. On ER day, you will arrive at MCRM an hour prior to your scheduled appointment. This will allow the anesthesia team to begin to prepare you for the upcoming procedure. When ready, you will walk from pre-op to the MCRM procedure room and prepped for Dr. Ahlering and the egg retrieval by the anesthesiologist. During the procedure, Dr. Ahlering will utilize vaginal ultrasound to guide a sterile needle through the vaginal wall and into the ovary. Once at the ovary, Dr.Ahlering will pierce the individual follicles and utilizing suction will collect the follicular fluid that contains the egg from within. As each follicle is aspirated, the follicular fluid will becollected into a tube. Dr. Ahlering will continue this process for each follicle per ovary. The follicular fluid collected is passed through a window from the procedural room to the lab where the embryology team will be prepared to evaluate the fluid for the individual eggs. The egg retrieval procedure approximately last 20 to 30 minutes.
In the Lab, Fertilization to Blastocyst
Once the lab has prepared the collected sperm and eggs, the next step is to inject an individual sperm into each egg for fertilization. This is completed through one of two methods:
- Intracytoplasmic Sperm Injection (ICSI)
- Intracytoplasmic Morphologically Selected Sperm Injection (IMSI)
ICSI is simply the injection, under microscope, of a single sperm into an egg for the process of fertilization. IMSI is a similar process to ICSI with the main exception being the magnification of the microscope. When utilizing IMSI, the sperm is viewed under 6000x magnification versus 600x magnification with ICSI. IMSI allows the embryologist to evaluate the individual sperm with much more detail. Defects of the sperm become visible and therefore the embryologist is able to select the most “visually perfect” sperm for injection.
Once the eggs have been injected, they are placed in one of two locations: 1) Standard Incubator or 2) the EmbryoScope to allow for growth and development. The embryos will be allowed to develop and grow for the next several days. The development process will be observed, closely, over the next three to five days to determine the individual quality of each embryo.
Embryo Transfer (ET)
When Dr. Ahlering and the embryologist have determined that it is time to transfer YOUR embryo(s), your coordinator will schedule your embryo transfer (ET). In most cases, this will take place on the fifth day post your ER with day one (D1) being the day after your egg retrieval. On ET day, the embryologist and Dr. Ahlering will review your embryos and determine the “BEST” one(s) for transfer. The additional remaining embryos will be cryopreserved for potential future usage. When YOUR ET time arrives, the selected embryos will be loaded into the transfer catheter by the embryologist and provided to Dr. Ahlering for transfer. The ET will take place in the procedure room but the process is painless and requires NO anesthesia. Initially, a speculum will be placed inside your vagina to keep you vaginal wall open. This is similar to having a PAP test.
Using ultrasound guidance, Dr. Ahlering will gently place the transfer catheter through your cervix and place the embryo(s) into the womb. Post ET, it is advised that one is on modified bedrest for twenty-four hours.
Determining Pregnancy
While it will be enticing for you to want to take at-home pregnancy tests to verify your pregnancy, post ET, it is advised that YOU DO NOT take at-home tests. This is because of the medications you have recently taken may provide false test results. That is why we will have you wait to have any pregnancy test done until seven to ten days post ET. At this time, an initial BETA will be tested via bloodwork. A secondary BETA test will be taken two days later. Based on these results, the determination of pregnancy will be made.
