To prepare for an IVF cycle, you first meet with or talk to your physician, a board certified reproductive endocrinologist. Your physician reviews your case, develops a treatment plan, and recommends tests prior to starting IVF.

You are assigned to one of our nurse coordinators, who meets with or talks to you over the phone to review IVF, answers any questions, and schedules your medications. Medications include oral contraceptives (birth control pills), started in the month before the treatment cycle, and Lupron or Synarel, started just before finishing the oral contraceptives. Lupron or Synarel prevents early egg release from the ovary, or ovulation. These medications prepare you for the next phase, ovulation induction.

Fertility drugs stimulate multiple follicles in the ovaries, each containing a single egg. Many fertility drugs are available, all of which share in common the hormone Follicle Stimulating Hormone, or FSH. FSH can be injected with a small needle just below the skin in the leg (Sub Q) or into the muscle of the buttock (IM). Different stimulation protocols are used to produce the best number and best quality of eggs.

During oocyte retrieval the eggs are removed from the ovaries. A needle is guided by ultrasound into each follicle in the ovary to remove the fluid containing the egg. The ultrasound is performed vaginally; neither incisions nor surgery are required. The eggs are collected into a test tube, and passed to an embryologist, who prepares the eggs for insemination.

The eggs are inseminated, meaning that they are mixed with a sperm sample. This begins an amazing cascade of events, which ends in a fertilized egg, known as a zygote, or embryo, the earliest stage of the developing human being.

Sperm samples that are not expected to fertilize the eggs on their own may be assisted by a procedure in which the sperm is injected into the egg by one of our embryologists, this is known as Intracytoplasmic Sperm Injection (ICSI).

Five stages of development occur before the embryos are transferred into the uterus. This link provides pictures that capture the various phases: An ultrasound of an ovary, a fertilized oocyte (egg), a four-cell embryo, an eight-cell embryo and an embryo hatching.

Embryos are placed into the uterus or womb using a catheter, a hollow plastic tube. The catheter is designed to be small and flexible so it slips easily through the cervix. This is a minor procedure that seldom requires anesthesia or sedation.

Recent breakthroughs in the embryo laboratory allow us to grow embryos to the blastocyst stage. The biggest single advantage of the blastocyst transfer is a significant reduction in the rates of multiple pregnancy greater than twins.

Another advance in reproductive technology is cryopreservation & frozen embryo transfer. If a pregnancy does not occur in the "fresh" IVF cycle, the patient can return at a later time for transfer of the remaining frozen embryos.

The important days following embryo transfer, when the embryo begins developing and implants in the lining of the uterus, is the luteal phase. Progesterone, a natural hormone, helps the lining of the uterus develop and support the pregnancy. Supplemental progesterone is given by injection, vaginal suppository, or vaginal gel. At the end of the luteal phase, a pregnancy test is performed.

Once you are pregnant, you will remain on medication as prescribed until one week after your second ultrasound at 10 weeks from your last menstrual period. At that time, we individualize the remaining course depending on your age, whether you have multiple embryos, and your general ovarian health. You return to your obstetrician at around 10 weeks gestation.

If you do not conceive, you should schedule a follow-up visit with your doctor at our clinic, so we can review the cycle and make plans for the future. This follow-up visit is very important to all of us.