Over the past 3 decades, In Vitro Fertilization, IVF has become a proven treatment for many types of infertility.
IVF is the most effective therapy for infertility due to tubal blockage, severe endometriosis and unexplained infertility. When used in combination with ICSI (intracytoplasmic sperm injection, where a sperm is injected into an egg), IVF is also the best treatment for severe male factor fertility challenges. With growing understanding and advances in technology, we have been able to reduce the number of embryos transferred, thereby reducing the number of multiples, especially higher-order multiples (triplets and more), without compromising success rates.
Prior to beginning IVF, every couple will meet with Dr. Hudson to learn about the process and the different IVF options available. You will have some testing performed to prepare for IVF, including infectious disease testing (to know how to store your embryos), a trial embryo transfer, and a saline ultrasound. You will also have an education class to learn about your medications, your calendar and to review your consent forms. Often women will start birth control pills in preparation for their cycle.
Injectable IVF medications
At a certain point, you will be given instructions to start injectable medications. These are given with a very small needle, just under the skin (like an insulin injection). The type of injectable medication will vary, depending on the type of stimulation. When starting gonadotropins, you will be monitored by ultrasound and blood tests. These will occur prior to starting gonadotropins, then approximately every other 2 to 3 days. As the follicles grow and approach 18-20 mm, a decision for when your “trigger” injection will be given will be made.
When you receive your trigger injection of either Ovidrel® or Lupron®, you may be scheduled for labs the following day to ensure that your body has responded appropriately to the medication. In rare cases, a repeat injection may be necessary that may postpone egg retrieval. In most cases, egg retrieval will be scheduled approximately 35 hours after the trigger injection.
The egg retrieval process
During the egg retrieval, you will receive IV sedation that induces a deep sleep and prevents you from having any pain. Because of this, you should not have anything to eat or drink after midnight prior to your procedure. Therefore, when you arrive at the IVF center, you will be asked to change into a gown, your vitals will be taken, your history will be reviewed, and an IV will be placed. You will also meet the anesthesiologist. Medicine will be placed in your IV, and you will drift to sleep. The retrieval process takes approximately 30 minutes in a procedure room. Following the procedure, you will awaken and rest for approximately an hour before you are discharged home. Under most circumstances, the male partner will also provide a semen sample the same day for the insemination.
Fertilization, the IVF lab & embryo transfer
The eggs that were retrieved are exposed to sperm later that day through either standard insemination or ICSI. In standard insemination, the egg is exposed to many sperm and, ideally, one sperm fully penetrates the zona pellucida (the shell), resulting in fertilization. Often, a process called ICSI is used where the embryologist selects a normal-appearing sperm and gently injects it into the egg to increase the chances of successful fertilization. The recommendation of standard insemination vs. ICSI is based on multiple factors, which Dr. Hudson will be happy to discuss with you in regards to your specific situation.
The next day (day 1), the eggs are checked to see how many have been fertilized. Usually not every egg will fertilize, and this is expected. The fertilized eggs are then called embryos and are allowed to grow to either day 3 or day 5, depending on the clinical circumstances. When the embryos are transferred, a tiny catheter is placed in the cervix under ultrasound guidance and the embryo(s) are gently injected into the endometrium (lining) of the uterus. In preparation for embryo transfer, you will start progesterone supplementation (either suppositories or injections), which will continue until about 10 weeks of pregnancy.
Dr. Hudson and her team at Texas Fertility New Braunfels know that infertility is a highly personal and emotional journey, and want to guide you through it to a successful pregnancy. Call today to discuss your options.