In Vitro Fertilization (IVF) - Detailed Summary

IVF (in vitro fertilization) is among the most successful treatment interventions available to assist infertile couples become parents. The first successful IVF procedure was performed in England in 1970 by Drs. Steptoe and Edwards. The procedure has been performed successfully throughout the world and has had such as important impact on society that in 2010, Dr. Edwards was awarded the Nobel Prize for his work. IVF has been found to be useful in treating infertility regardless of the cause.

IVF consists of fertilizing the egg with the sperm outside of the body and then transferring the resultant embryo into the uterus. Since its introduction, the technique and technology utilized in IVF have been altered vastly to improve the success rates.

Couples considering IVF should undergo an initial fertility evaluation, even if a known cause for infertility exists as co-factors may be identified that could decrease success rates if unidentified and therefore not addressed.

As with many clinics throughout the U.S., patients planning to undergo IVF with The Reproductive Medicine Group will attend an evening IVF group class during which time the IVF procedures and protocols will be explained in detail. These classes are given by one of the RMG physicians and currently are held in the evening, the 3 rd Tuesday of every other month. A schedule of classes is posted in each RMG office.

Following the class, the couple will have an appointment to have the woman’s uterine cavity length measured, “mock transfer” and to sign consent forms. You should have a full bladder for the “mock transfer”. During that appointment, the physician will review information about IVF and answer your questions. The number of embryos to be transferred and plans to freeze embryos of high quality beyond the number to be transferred will be discussed at that appointment. ( It is critical that both you and your spouse read the IVF consent forms prior to that appointment!) The consent forms are extremely detailed and contain critically important information. Please do not leave that appointment without having all of your medical questions regarding IVF addressed.

You are expected to pay all fees not covered by your insurance at that appointment as well. As such if you have not received your bill, please contact the billing office prior to your appointment.

At your mock transfer/consent form signing consultation appointment, if your protocol includes down regulation with a birth control pill, you should be sure to pick up your pill pack. You are to call the ART nurse with the onset of your menses. You will be instructed when to begin your birth control pill and an appointment will be set up with the IVF nurses for you and your spouse to learn how to administer the IVF medications as well as to receive your personalized, detailed calendar which outlines expected appointments and timing of your medications.

You will begin your IVF stimulation medications according to your calendar after that appointment. Once you begin your stimulation medications, you will come into the office periodically for blood work and ultrasounds. These appointments are in the early morning usually between 7:30a.m. and 9:00a.m. The results will be ready in the mid afternoon and reviewed by the physician who will determine what your medication dose will be and when you will need to return for further monitoring. The IVF nurse will then contact you with instructions. For your convenience, monitoring is performed during the weekdays at all 4 of our locations. On weekends/holidays, monitoring is performed only at the North Tampa office. Oocyte (egg) stimulation medications (gonadotropins) are generally taken for 8-12 days (this does not include the days using the birth control pill or the days using only the lupron).

When the blood work and ultrasounds (sonograms) suggest that several eggs should be mature, you will be instructed as to the time to take the hCG injection. Approximately 36 hours after the injection, the egg aspiration procedure will occur. Several days prior to the egg aspiration procedure, you will have a pre-op appointment with your doctor. You will have the opportunity to ask your doctor any additional questions you may have and will receive prescriptions for pain medication to use if needed, after the egg aspiration and for valium to be used on the morning of the embryo transfer.

You will report to the RMG IVF/Surgery Center at the instructed time on the morning of your egg aspiration. You are to have nothing to eat or drink beginning midnight prior to your aspiration procedure. This includes water, gum, candies and tobacco (all patients MUST discontinue tobacco at least 3 months prior to their IVF cycle). You may brush your teeth.

Upon arrival to the IVF Center, you will be admitted and an IV will be started. Your partner/spouse may be with you until you go to the operating room. You will be seen by the pre-op and OR nurses, the anesthesiology physician and the RMG physician who will perform the procedure. Once in the OR, you will receive medication through your IV to make you drowsy and then asleep. You will not feel any pain. The procedure takes 15 – 20 minutes. You will be returned to the post-op area. Once you are awake, your partner/spouse will be asked to produce the semen sample. If your spouse has difficulty producing a specimen, PLEASE inform your physician or the IVF nurses in ADVANCE (at least a week if not more prior to the aspiration procedure) so we can arrange to have his sperm collected and cryopreserved in advance when he will feel less pressure. As this incurs additional cost, we do not routinely recommend freezing sperm in advance. Men who have extremely low counts and some men undergoing retrieval of sperm from the testes will have their sperm cryopreserved prior to the IVF cycle.

The sperm and the eggs are united in the petri dish several hours after the egg has been retrieved. Assessment for fertilization is performed the following day. You will be contacted as to the number of eggs that successfully fertilize. Usually, approximately 70% of mature eggs fertilize but this can vary depending on the health of the eggs and sperm.

You will be called again, the following day, to let you know how many embryos are dividing in the anticipated manner and the quality of the dividing embryos. This will determine if your embryo transfer will occur on day 3 versus day 5 post retrieval.

On the morning of your embryo transfer, you will fill your bladder, take your valium pill as instructed and report to the RMG IVF/Surgery Center at the time assigned to you. You will be admitted, speak with the nurse and the physician will discuss the quality of embryos to be transferred into the uterus. The number of embryos will be based on the grid previously discussed and determined at your consent form signing appointment. Your spouse/partner may accompany you throughout the procedure.

You will walk to the transfer room through the OR area (your spouse will be walked through the non-sterile hallway and meet you in the transfer room). Once in the transfer room, you will be asked to reverify your name and the number of embryos to be transferred. The procedure will be performed the same way the mock transfer was done by your doctor previously. An ultrasound will be performed while the physician places the transfer catheter and the embryos are inserted into the uterus. If your bladder is appropriately filled, you may be able to see the tip of the catheter on your smaller viewing screen. The lining closes around the embryos and, as such, you do not need to worry about the embryos falling out when you stand up or empty your bladder.

Many factors determine why some embryos implant while others do not. Success rates are directly related to the age and quality of the woman’s eggs. At The Reproductive Medicine Group it is our goal to give our patients the best chance for conception.