IVF Process

 
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IVF Process

This page describes the overall IVF process and the role played by donors, surrogates, and Intended Parents.

IVF (IN VITRO FERTILIZATION)

“In vitro” literally means outside of the body. IVF is a method of assisted reproduction in which the man’s sperm and the woman’s egg are combined outside of the body in a laboratory dish. If fertilization occurs, the resulting embryo is transferred to the woman’s uterus, where it will hopefully implant in the uterine lining and mature.

Reprinted from American Society for Reproductive Medicine (ASRM): A Guide for Patients, IVF AND GIFT: A GUIDE TO ASSISTED TECHNOLOGIES.

There are six basic steps to IVF:

  1. ovulation induction
  2. egg retrieval
  3. insemination
  4. fertilization
  5. embryo culture
  6. embryo transfer

DONOR ARRANGEMENTS

Sometimes a woman is unable to produce her own eggs. In this situation the couple may choose to work with an oocyte (egg) donor. A donor will participate in part of the IVF procedure. A donor’s participation includes the ovulation induction and egg retrieval.

Ovulation Induction

During ovulation induction, ovulation drugs, also known as “fertility drugs,” are used to stimulate the ovaries to produce several mature eggs rather than the single egg that normally develops each month. IVF specialists agree that the chances for pregnancy are better if more than one egg is fertilized and transferred to the uterus in a treatment cycle. Drug type and dosage vary depending on the program and the patient. Most often, ovulation drugs given by subcutaneous injections (shots) are given over a period of four to six weeks. A donor will most probably be given GnRH (Lupron®), follicle stimulating hormone (FSH) and human chorionic gonadotropin (hCG) (Profasi®).

Timing is crucial in an IVF cycle. The ovaries are scanned frequently with ultrasound to monitor the development of ovarian follicles, the fluid-filled cysts within the ovaries where the oocyte (eggs) grow. Blood samples are drawn to measure the serum levels of estrogen, progesterone, and/or luteinizing hormone (LH). Normally, estrogen production increases as the follicles develop. A surge of LH triggers ovulation, and progesterone levels remain low until after ovulation.

Through the use of ultrasound and blood tests, the physician can determine when the follicles are almost mature. This usually takes place about a day and a half before ovulation would normally occur. The patient is then given an injection of hCG. The hCG replaces the woman’s natural LH surge that would normally trigger ovulation in approximately 36 hours. This allows the IVF team to determine the appropriate time for egg retrieval.

Partially reprinted from American Society for Reproductive Medicine (ASRM): A Guide for Patients, IV F AND GIFT: A GUIDE TO ASSISTED REPRODUCTIVE TECHNOLOGIES.

Oocyte (egg) Retrieval

Egg (oocyte) retrieval is accomplished by one of two methods. In a donor arrangement the method most commonly used is transvaginal ultrasound aspiration. This is a minor surgical procedure that is usually performed in the physician’s office or outpatient surgical center with the use of painkilling medications and/or anesthesia. An ultrasound probe is inserted through the vagina. The probe emits high-frequency sound waves which are translated into images of the pelvic organs shown on a monitor screen. When mature follicles are identified in the ovaries, the specialist guides a needle through the vagina and into the follicles. The eggs are removed (aspirated) from the follicles through the needles by a suction device.

SURROGATE ARRANGEMENTS

Sometimes a woman may be able to produce her own eggs, but may not be able to carry a baby to full term. When this situation occurs, a couple may choose to work with a woman who is willing to carry their child for them.

SSA only works with surrogate arrangements whereby a surrogate does not carry her own biological child.

A surrogate will participate in two phases of IVF. First, the doctor will work with the surrogate and the mother to synchronize their cycles. This will require the use of hormonal drugs by daily injections for a designated period of time. Then the surrogate will undergo the embryo transfer of the IVF procedure.

Embryo Transfer

No Anesthesia is necessary for this procedure. The woman lies on her back or in the knee-chest position. Using a vaginal speculum, the doctor exposes the cervix. One or more embryos suspended in a drop of culture medium are drawn into a transfer catheter, a long, thin sterile tube with a syringe on one end. Gently, the physician guides the tip of the loaded catheter through the cervix and deposits the fluid containing the embryos into the uterine cavity. One or more embryos may be transferred during this procedure. The entire transfer procedure usually takes between 10 and 20 minutes. Some physicians recommend bed rest after the transfer.

Partially reprinted from American Society for Reproductive Medicine (ASRM): A Guide for Patients, IV F AND GIFT: A GUIDE TO ASSISTED REPRODUCTIVE TECHNOLOGIES.

In most cases, the surrogate mother will continue hormonal therapy post the transfer. This usually ends before or at the completion of the first trimester of pregnancy.

 
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