As you may already know, for a pregnancy to occur, a number of events must come together in perfect alignment. First, a mature egg must be released from the ovary into the fallopian tube where it gets fertilized by the timely deposited sperm. The resulting healthy embryo will travel to the properly primed uterus where implantation takes place. Once implanted, the embryo will continue to grow and develop into a fetus. Any interruption in this natural process can cause infertility. We can help in identifying and solving any problem with this process.
The majority of women can get pregnant by having unprotected intercourse around the time of ovulation. But, approximately 12 to 15%, are not able to conceive after 12 months of trying. Fertility specialists will often perform fertility evaluations of both the woman and the man.
The simplest fertility solution is ovarian stimulation with timed intercourse or with intrauterine insemination (IUI). If that fails, then the most advanced form of intervention called in-vitro fertilization (IVF) is used.
In-Vitro Fertilization (IVF) simply means fertilization that occurs outside of the woman's body as opposed to in-vivo fertilization wherein fertilization happens inside the body. In the early years of IVF, the eggs and sperm were combined in a laboratory test tube, and the resulting embryos were also grown in a test tube, so the resulting babies born used to be called "test tube babies". We no longer use test tubes for these purposes, we currently use Petri dishes instead.
In this section, we will examine the steps involved in the IVF process.
THE IVF PROCESS
The IVF process is based on your menstrual cycle so we will discuss the IVF events accordingly.
First, you will be taking ovarian stimulation medications starting on either day 1 or day 3 of your menstrual cycle, except for patients undergoing "natural cycle IVF" where no ovarian stimulation medications are used.
You will need to go to the clinic for a blood test and ultrasound exam (sono) about 3 to 5 times depending on how your ovaries are responding to medications. When the ovarian follicles are almost mature based on the ultrasound measurements, you will be asked to take the trigger shot at a predetermined time, usually between 34 to 36 hours prior to your egg retrieval procedure.
On the day of your egg retrieval, your ovarian follicles are aspirated and collected into several test tubes and are then sent to the IVF Laboratory where the follicular fluids are examined for the presence of eggs.
From the day of your egg retrieval and up to 8 days afterward, this part of your IVF cycle will take place inside the IVF Laboratory. The eggs are isolated from the follicular fluids and placed in the incubator. Semen sample is collected, processed, and prepared for the insemination of the eggs. The eggs are inseminated (or frozen if egg freezing is requested) and the resulting embryos are kept in culture in the IVF Lab for up to 6 days until the time of Embryo Transfer, Embryo Freezing, or discarded if they stop developing.
The Egg Retrieval Procedure
Egg retrieval is performed by puncturing ovarian follicles with aspiration needle, guided by ultrasound probe, and aspirating their contents into a test tube which the lab personnel examines for the presence of eggs.
Events in a IVF cycle
Day 1 Start of Menstrual Cycle
Day 3 At home, Start medication to stimulate ovaries to produce more than one egg
Day 5 Clinic visit for Blood Test and SONO to check the number of follicles (sacs that contain the eggs)
Day 7 Clinic for Blood and Sono to check for size of follicles
Day 9 Clinic for Blood and Sono to check if follicle sizes show if the eggs inside are almost mature
Day 10 At home, Trigger Shot to induce ovulation
Day 11 (LAB Day Minus 1 - Preparation of retrieval and insemination dishes, sperm preparation media, etc.)
Day 12 (LAB Day 0 - Egg identification, isolation and insemination via IVF / ICSI, or Egg Freezing) Clinic, Egg Retrieval and partner produce sperm sample for IVF
Day 13 (LAB Day 1 - Check for fertilization, etc.)
Day 14 (LAB Day 2 - Check if embryo is undergoing division, etc.)
Day 15 (LAB Day 3 - Assessment of embryo quality, Assisted Hatching, Embryo Freezing, etc.)
Day 16 (LAB Day 4 - Assisted Hatching, Embryo Freezing, etc.)
Day 17 (Lab Day 5 - Blastocyst Biopsy, Embryo Freezing, etc.) Clinic, Blastocyst Embryo Transfer
Day 18 (Lab Day 6 - Biopsy, Embryo Freezing, etc.)
Day 19 (Lab Day 7 - Blastocyst Biopsy, Embryo Freezing, etc.)
Day 25 Clinic, First Pregnancy Test
Day 27 Clinic, Second Pregnancy Test
Day 28 If pregnancy doesn't occur, endometrium in your uterus will get ready to shed to start a new cycle
Up To A 9-Day Event
As discussed above, events are happening in the embryology laboratory for "up to 9 days" in your IVF cycle.
Starting one day before your egg retrieval procedure, retrieval dishes, pipets, tubes, worksheets, and others are prepared.
On the day of your egg retrieval, eggs are isolated and inseminated.
When the eggs get fertilized, we refer to them as zygotes. Afterward, the zygotes will start splitting from a single cell into 2 smaller cells, at this point they are referred to as embryos.
Embryos are nurtured and carefully monitored for up to the next 7 days until their final disposition - which are either transferred, frozen, or discarded.
THIS IS THE REASON WHY WE SPEND A LOT OF EFFORT IN THE LABORATORY PORTION OF YOUR CARE!
Your eggs are precious and so is your time and effort in going through an IVF cycle - the least we can do is give you our very best to make the most out of your cycle and get you to share your success story.