Treatment Options

The In Vitro Fertilization (IVF) Procedure

During In Vitro Fertilization (IVF), medications are often used to help stimulate the development and release of a woman’s eggs. The eggs and sperm are then collected and placed together in a laboratory dish to fertilize. If the eggs are successfully fertilized, the embryos are then transferred into a woman’s uterus or fallopian tubes. Hopefully, one of the fertilized eggs will implant and develop just as in unassisted conception.

An IVF cycle at NCCRM

Initial phase:

  • The goal is to create a large number of mature follicles so as to increase the chances of fertilization. Since a woman’s body normally releases one mature egg every month, medications are used to stimulate the ovaries to develop more follicles. Follicles are fluid-filled sacs in which eggs mature. During this stage, we may use ultrasound to monitor the number and size of maturing follicles in your ovaries. Blood tests may also be used to monitor hormone levels which will help determine the best time to administer medication and to retrieve the eggs.

Second phase:

  • A medication is used to stimulate the release of mature eggs. Our staff will identify the mature follicles using ultrasound, and then, with a needle, withdraw as many eggs as possible from both ovaries.
  • A few hours before the eggs are retrieved, a semen sample is collected. Thousands of sperm are placed with each egg in the laboratory where they will hopefully form an embryo. When only a few or poor quality sperm is available, Intracytoplasmic Sperm Injection (ICSI) is attempted. In this procedure, a single sperm is injected into an egg to facilitate fertilization. The next day, the eggs are examined under a microscope to determine whether fertilization has occurred. If it has, the embryos will be ready to cryopreserve on day 5 or 6.  This cycle allows the stimulation medicines to get the ovaries prepared for eggs, although it seems to have an adverse effect on the uterus due to the medicines having an adverse effect on the patient’s uterine lining, as well as having high estrogen levels placing the uterus out of sync with the embryos.** With this, we have changed our protocol so that our second cycle allows the patient to prepare her uterus for implantation with a much lower dose of estrogen to mimic a more natural cycle.

**This type of cycle is called a “freeze all cycle”. Only centers that have a great freezing program can perform this, as the quality of embryos after thaw is critical. Our practice is one of the best at the new technique, known as vitrification. This is the method we use in our egg bank. Eggs are very sensitive to freezing and we have had wonderful success with frozen eggs. Embryos are less sensitive to vitrification, so it has made frozen embryos a much more successful procedure than in the past.  Freeze all cycles also allow us to be more aggressive with stimulation since we trigger in a manner that will never cause hyperstimulation and hyperstimulation is the riskiest part of IVF. This cycle allows a patient to stimulate once and transfer embryos as needed in the future. (NCCRM can usually freeze 8-10 embryos after one stimulation cycle.) In addition, freezing all your eggs allows those worried about having too many frozen embryos for the future, to only fertilize a couple of eggs and freeze eggs for future use as needed. Finally, research has also shown that frozen cycles have resulted in healthier babies that have a higher birth weight.

Third phase:

  • After embryos are frozen, we wait for the female to start her menses to prep her uterus for embryo transfer. The first phase allows the stimulation medicines to get the ovaries prepared for eggs, while the first and second phases combined seem to hinder the uterus in preparation for transfer due to the medicines having an adverse effect on the patient’s uterine lining.  The patient will begin roughly a 21 day regime of estrogen/progesterone to prepare the lining of the uterus.

 Fourth phase:

  • The embryo will be ready for transfer into the uterus. The embryos are placed in a tube and transferred back into the uterus. The procedure is usually painless, though some women may experience some cramping. The number of embryos transferred depends on a woman’s age, cause of infertility, pregnancy history, and other factors. Post transfer requires 3 days bed rest and a two week waiting period for pregnancy testing.

Making an Informed Decision

Societal changes over the past two or three decades have led to an increasing number of women who postpone childbearing to a later age. The purpose of this article is to assist older, infertile couples to make an informed decision about treatment. The important issues to be considered are discussed below:

  • Advancing age is associated with a progressive decline in a woman’s fertility. This is true whether considering natural conception or assisted conception.
  • All forms of infertility treatment, including in vitro fertilization and embryo transfer (IVF/ET), have reduced pregnancy rates in women over 40 years of age.
  • The likelihood that IVF/ET represents the only opportunity of achieving pregnancy is greater for women over 40 years. This is because many diseases such as endometriosis and tubal disease, which lead to infertility, are more common at this age.

The cost of IVF/ET is likely to be greater for older women because reduced success rates and higher miscarriage rates.

National statistics show low pregnancy and birth rates for women over 40 years of age who undergo IVF/ET. However, it is possible to do testing to identify those women whose prognosis is especially poor and suggest other options, such as the use of donor eggs.

Learn more about Success rates and Factors that affect success rate.

Learn more about Multiple Gestation