IVF Phase 1: Pituitary and Ovarian Suppression
The suppression at the Mesa, Scottsdale, or Phoenix Arizona offices of Advanced Fertility Care occurs for the month prior to your scheduled retrieval. The Doctors use oral contraceptive pills and/or leuprolide acetate (Lupron) shots to suppress your natural hormonal surges and “take control” of your stimulation with gonadotropins (injectable fertility medication). By suppressing or “down-regulating” your pituitary (which releases hormones) and ovaries, the formation of naturally occurring ovarian cysts may be minimized and the FSH and LH receptors on the ovaries may become more sensitive and require less medication to stimulate them. In certain circumstances, a different protocol called an antagonist protocol may be recommended and this phase of IVF may not be necessary. Drs. Zoneraich, Larsen and Kummer use the antagonist protocols in their practice when there is a timing issue with a certain cycle.
Phase 2: Ovarian Stimulation
During the stimulation phase, you will give yourself daily injections of fertility medications (gonadotropins) for 9 to11 days. These injections stimulate the development of multiple ovarian follicles which contain the eggs. Careful monitoring with ultrasounds and blood hormone levels allows Drs. Zoneraich, Larsen, and Kummer to make necessary adjustments to your treatment regimen and minimize any complications from the powerful fertility drugs. Once the follicles have reached their ideal size, a subcutaneous (under the skin) or intramuscular injection of HCG mimics your own body’s hormonal LH surge which causes final maturation of the eggs prior to harvesting (retrieval).
One key difference at Advanced Fertility Care is that our physicians will personally do ALL of your ultrasound monitoring. They believe that it is critical that a physician monitor your progress. In many other practices, this is not done by a physician, compromising your care and greatly reducing success rates from IVF.
Phase 3: Egg Retrieval
Occurring 35-36 hours after receiving the HCG shot, the egg retrieval is performed in our on-site dedicated procedure room. A board certified anesthesiologist will provide intravenous sedation to prevent any pain or discomfort during the procedure. Under ultrasound guidance, a very thin needle is passed through the upper portion of the vagina into the ovary and into the individual ovarian follicles. The fluid containing the egg is aspirated and subsequently identified by our embryologist in the adjoining laboratory. In general, the recovery from an egg retrieval procedure is rapid and you will be monitored by one of our registered nurses for 30 to 60 minutes after the procedure prior to being sent home. Since anesthesia is used on the day of retrieval, someone must be available to drive you to and from our facility. Some women may experience mild cramping on the day of retrieval which usually subsides by the evening of retrieval. In some cases, a sensation of fullness or pressure may last for up to one week following the procedure.
Phase 4: Fertilization
Once the follicular fluid is removed from the follicle, the eggs are identified and isolated by the embryologist and placed into an incubator. The eggs are fertilized with sperm later that day by conventional insemination or by Intracytoplasmic Sperm Injection (ICSI). For conventional insemination, the sperm obtained from the male partner is placed into a specialized culture solution with the egg and then placed in a specially regulated incubator. If intracytoplasmic sperm injection (ICSI) is to be performed, this is when it will occur. Under the microscope, the embryologist picks up a single sperm and injects it directly into the cytoplasm of the egg using a small glass needle. ICSI allows couples with very low sperm counts or poor quality sperm to achieve fertilization and pregnancy rates equal to traditional IVF. It is also recommended for couples who have not achieved fertilization in prior IVF attempts. Special urological procedures are available to you for cases where it is difficult to obtain sperm or for men with no sperm in the ejaculate.
The eggs will then be checked within 18-20 hours later to document fertilization. The embryologist will check the eggs again the next day to evaluate for early cell division. Once a sperm fertilizes an egg, it is considered a zygote which then develops into an embryo. The embryos are then transferred to a different culture media and grown over the next 2-6 days. On day two or three after fertilization, the embryos will be evaluated for blastocyst culture. If there is a sufficient number of dividing embryos they will be placed in special blastocyst media and grown for two or three additional days. Ideally, the embryos will have grown for five or six days until they reach the blastocyst stage. For many couples these blastocysts have the greatest chance of implantation. This allows us to transfer fewer embryos, in some cases onlyone,and lower the risk of multiple births while increasing the chance of pregnancy.
Any additional procedures (i.e. assisted hatching or PGD) prior to transfer of the embryo(s) into the uterus will be determined on an individual basis. Some embryos may also be cryopreserved (frozen) at the end of the culture period.
Phase 5: Embryo Transfer
This brief, painless procedure involves the use of ultrasound guidance while the embryo(s) are placed into the endometrial cavity of the uterus either 3 or 5 days (blastocyst transfer) after fertilization, using a small highly specialized plastic catheter. No sedation is necessary for this procedure, although we do recommend and prescribe diazepam (Valium®) to ensure overall relaxation. After transfer, progesterone supplementation via injection and/or vaginal suppository will be taken for the next 10-12 days and a blood pregnancy test will be performed approximately 2 weeks from the retrieval date.
Phase 6: Pregnancy Test and Early Obstetrical Care
The initial pregnancy test will be performed in our office 2 weeks after your retrieval date. Blood hCG levels will then be checked every 2-3 days for those who do have an initial positive pregnancy test. An ultrasound will be performed at approximately 5-6 weeks of pregnancy (2-3 weeks after embryo transfer) and repeated one to two more times during first trimester until a normal healthy heartbeat is confirmed. Once viability is confirmed, you will be referred back to your Ob/Gyn for appropriate obstetrical care.