Learn About IVF: Page Contents
- What is in vitro fertilization (IVF)?
- Who may need IVF?
- What are the steps of IVF?
- The RMG IVF Laboratory
- IVF FAQs
What is in vitro fertilization (IVF)?
A very basic explanation of in vitro fertilization (IVF), which is an Assisted Reproduction Technology (ART) procedure is:
- Extracting a woman’s eggs
- Collecting a man’s sperm sample (or purchasing donor sperm)
- An embryologist manually combining egg and sperm in a laboratory to create embryos
- Implanting an embryo into a woman’s uterus.
When many people think of fertility treatments, they think of IVF (In Vitro Fertilization). It’s important to realize, however, that most patients get pregnant with less invasive fertility treatments. Only 10-15% of patients require IVF treatment in order to have a successful pregnancy. Here are some top questions you may have when first researching your treatment options.
Who may need IVF?
There are several instances where IVF may be appropriate. A reproductive endocrinologist will do a variety of tests to evaluate the right treatment for you. Some couples or individuals who may be recommended for IVF are:
- Women with tubal infertility factor (tubes blocked or non-existent)
- Women with endometriosis
- Women who have PCOS (Polycystic Ovarian Syndrome)
- Men who have poor or absent sperm
- Couples and individuals who are pursuing parenthood using donor eggs
- Aspiring parents who are at risk for known genetic disorders
- If a woman’s egg quality or reserve is too low for conventional IVF due to age or other factors, donor eggs may be successfully used for IVF
What are the steps of IVF?
Imagine IVF being a road trip to a destination. Just like any other trip you may take, there is certainly a route you will take, but there will also be other variables that you may experience. Will there be traffic? Are there any detours? Will there be any other unexpected delays?
IVF has several set stages, but it’s not always a straightforward process. It may not go the same for every individual or couple. Every infertility treatment plan is unique, fertility problems are different, and adjustments are made through each cycle to give patients the best chance to conceive.
Ovarian Stimulation and Trigger Shot
IVF is the process by which eggs (oocytes) are retrieved from the ovary, fertilized by the sperm in the laboratory, and cultured into early embryos. The embryos are then transferred into the uterus. Since multiple eggs are desired in order to enhance the likelihood of developing one to three healthy embryos, stimulation with injectable fertility drugs is usually required. Frequent monitoring is necessary with sonograms and blood tests. When these diagnostic methods indicated that the time is appropriate, a trigger injection is taken to mature the eggs.
Egg Retrieval, Evaluation, and Sperm Collection
The eggs are retrieved from the ovary just before they are ready to be ovulated. This is usually about 36 hours after the trigger injection. For IVF, the eggs are usually retrieved by ultrasound-guided needle aspiration through the vagina. Transvaginal egg aspiration is done using intravenous anesthesia, which is administered by an anesthesiologist. This outpatient procedure is performed at The Reproductive Medicine Group’s IVF and Surgery Center.
After aspiration, the embryologist determines the number of eggs obtained and classifies them as mature, immature, post-mature, or degenerative. Immediately following the egg aspiration, the spouse/partner (if applicable) will meet with the IVF Andrologist to provide a semen specimen. The sperm is then processed in our IVF lab in Tampa, Florida. If there is no male partner involved, then donor sperm can be used.
The sperm and eggs are placed in a dish and fertilization takes place (in vitro) outside the patient’s body in the laboratory. The fertilization process takes approximately 10-20 hours. Embryos are then cultured for 5 days before being transferred to the uterus using a catheter, similar to intrauterine insemination. Embryos can also be cryopreserved (i.e., frozen) so that they can be transferred at a later time. Before the embryos are cryopreserved, your fertility doctor may biopsy a few cells from the embryo’s outer layer for genetic testing, depending on the situation.
Embryo transfer occurs on day 5 at The Reproductive Medicine Group’s IVF and Surgery Center. Embryos are carefully placed into a special catheter and inserted into the uterine cavity. Generally, 1-2 embryos are transferred back into the uterus depending on the patient’s age, embryo quality, and physician recommendation. The Reproductive Medicine Group strives to transfer the lowest number of embryos possible to reduce the risk of a multi-fetus pregnancy but maintain the best chances for conception.
A serum progesterone level is checked several days after a completed IVF cycle, and the first pregnancy test is approximately 10-14 days following the IVF transfer procedure.
Many factors determine why some embryos implant while others do not. Embryo implantation 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.
The Use of Assisted Hatching in IVF
Assisted hatching through micromanipulation has been shown to increase the IVF embryo implantation rate of embryos that are being thawed for a frozen embryo transfer cycle. Even if sperm-egg interaction and embryonic development proceed normally, attachment of the pre-embryo to the uterus must still occur.
A layer covering the egg called the zona pellucida performs many crucial functions in the process of fertilization and development. However, in order for the embryo to implant into the uterine wall, it must hatch out from its zona pellucida with the help of substances produced by the embryo.
A number of findings suggest that human IVF pre-embryos sometimes lack the ability to thin and hatch through their zona pellucida. The pre-embryo is held by a micropipette while a specialized laser beam is utilized to create a small opening in the zona pellucida.
The Use of ICSI in IVF for Male Infertility
Intracytoplasmic Sperm Injection (ICSI) enables men with poor sperm quality to father children. ICSI is used when the male has a very low sperm count, if sperm motility is poor, or if there is a low percentage of normal-shaped sperm. It is used in some cases of unexplained failed fertilization in a prior IVF cycle. It is also used for sperm obtained through TESE (testicular extracted sperm) and for all cycles involving PGT (preimplantation genetic testing).
In the ICSI procedure, a microscopic hole is placed in the egg membrane with an instrument that resembles a needle. A single sperm from the male is inserted into the egg.
There is no difference between the offspring produced by ICSI and those conceived by other methods. There is now broad, successful, clinical experience with hundreds of ICSI patients and their children. Embryologists receive advanced training to enable them to perform this delicate procedure.
The RMG IVF Laboratory
Experience excellence in IVF and fertility care with the Reproductive Medicine Group’s ART Program and CAP-accredited Laboratory. Learn more about our state-of-the-art facilities. Discover your path to parenthood today. Explore our IVF laboratory.
For most couples, this is a 4-6 month process. This is mainly due to most steps having to align with a menses (period).
This varies by several factors. First of all, live birth rates are preferred over pregnancy rates, however, the data takes longer to report, due to the time of gestation.
Typically, our doctors encourage a single embryo transfer for many reasons, the main one being the goal of having a healthy pregnancy and a live birth. On average, the birth rate for multiple babies (i.e., twins or more) is just under 13%.
Long-term studies have shown no ill effects for children born via IVF.
IVF can be performed based on ASRM recommendations, up to age 55 if including the use of donor eggs. If egg quantity or quality is too low, donor eggs may be used for women of any age group.
According to the ASRM, gender selection for non-medical reasons is highly controversial and raises numerous ethical concerns including gender bias, sex stereotyping, and issues of social justice. Given the ethical controversies and potential repercussions, The Reproductive Medicine Group offers gender selection for only medically indicated reasons.
In many cases, it can be. Another option for some patients, if appropriate, is tubal reversal. Please consult with one of our physicians to explore which treatment path is right for you.
In many cases, if multiple embryos are created during an IVF cycle, one is selected for uterine transfer and the others are cryopreserved for future use or embryo donation. Some aspiring parents choose to discard their extra embryos or donate them to research.
The blood pregnancy test is performed 14 days after the egg retrieval.
If pregnant, you will be asked to return to the office for repeat blood work and eventually an ultrasound to ensure an ongoing successful pregnancy. After a fetal heartbeat has been confirmed, patients are referred to an obstetrician for the remainder of the pregnancy.
Usually, we ask that patients wait for one or two complete menstrual cycles before beginning another ART cycle. Sometimes tests are required that may delay subsequent cycles.
A high-risk OB/GYN is only needed when there are complications that put the mother or baby at increased risk, or in the case of multiple births. Other than a higher incidence of multiple births, ART does not increase the risk to the fetus.
The miscarriage rate is about the same for ART as the general population. Many times older females undergo ART and their miscarriage rates are naturally higher. Since pregnancy testing is done two weeks after embryo transfer, we often know about spontaneous miscarriages in the very early stages of pregnancy. These miscarriages would probably go unnoticed by the general population.
Your physician will discuss this with you at the time of consent signing, but we usually follow the recommendations of The American Society for Reproductive Medicine guidelines:
- Under 34 years old = 1-2 embryos
- 35-37 years of age = 2-3 embryos
- 38-40 years of age = 3 embryos
These numbers may vary depending on individual diagnosis and clinical circumstances.
A woman is born with a full complement of eggs. There are far more eggs than will ever be used during a normal lifetime and ART procedures have no measurable “lowering” effects.
Even in men with no sperm seen at the time of semen analysis, there may be sperm within the testes. This sperm can be removed by aspiration from the testes or epididymis in procedures called TESE (testicular sperm extraction) or MESA (microscopic epididymal sperm aspiration). TESE and MESA procedures combined with ICSI allow many men, previously considered sterile, to produce children.
- Smoking: Stop smoking before ovulation induction begins. It is best to discontinue tobacco at least 3 months prior to an IVF cycle. If you cannot stop “cold turkey,” seek the care of your primary care physician. By-products of tobacco have been demonstrated to be toxic to the oocyte (egg). Numerous studies have also demonstrated that smoking during pregnancy results in reduced birth weight and fetal compromise. There is some data that smoking can also lower pregnancy rates. We strongly recommend that all women, especially those undergoing fertility treatment, cease smoking.
- Drinking: Alcohol is a drug, and should be avoided during infertility treatment and pregnancy. Please do not drink alcohol from the time fertility medications are initiated until the pregnancy test.
- Medications: If you are taking any medication, prescription or over-the-counter, please inform your physician. Some medications may interfere with the fertility medications prescribed, some are not safe to use before an operation or medical procedure, and others might interfere with ovulation or pregnancy implantation. A prenatal or multivitamin will be prescribed; if you are not taking a vitamin with folic acid, please inform the ART nurses. Also, please note: DO NOT USE HERBAL SUPPLEMENTS DURING YOUR IVF CYCLE.
- Heavy exercise, such as aerobics, jogging, weight lifting, etc., is prohibited during ovarian stimulation and until the pregnancy test results are known.
- Acupuncture is permitted prior to, during, and after your IVF cycle but herbal supplements are absolutely prohibited.
An IVF cycle can be an emotional and stressful time for you and your partner. It may be helpful to have supportive personnel to speak to, such as friends and family, a clergy member, or a psychologist/therapist.
Sperm quality on the day of egg retrieval is often related to what happened in the male’s body 3 months ago. This is because sperm development takes about 3 months. Listed below are guidelines to help ensure the semen specimen used in an IVF cycle is of the best possible quality:
- A fever of 101 degrees Fahrenheit or higher within 3 months prior to ART treatment may adversely affect sperm quality. Sperm count and motility may appear normal, but fertilization may not occur. If you become sick during the ART cycle, please notify the ART nurse, and take Tylenol to keep your temperature below 101 degrees Fahrenheit.
- Discontinue alcohol and cigarette use before and during ART treatment. Do not use any recreational/illegal drugs.
- If any prescription medication has been taken during the last 3 months, notify the ART nurse.
- Do not sit in hot tubs, spas, Jacuzzis, or saunas during or 3 months prior to the ART cycle.
- Do not begin any new form of endurance exercise during or 3 months prior to the ART cycle. Physical activity at a moderate level is acceptable and encouraged.
- Avoid all testosterone, DHEA, and Androstenedione/Androstanediol hormone-containing supplements. NO GYM SUPPLEMENTS!
- Tell your infertility physician if you have ever had genital herpes, or suspect you may have been exposed to genital herpes in the past. Also, tell your physician if you have pre-lesion symptoms, develop a lesion, or have healing lesions before or during the ART cycle.
- Refrain from ejaculation for 2-3 days, but not more than 5 prior to collecting the semen sample for the ART cycle. The ART nurse will have your specific instructions from the andrologist.
Start Your IVF Journey in Florida
The Reproductive Medicine Group has many years of experience performing IVF and other fertility care procedures in Florida. With locations in North Tampa, South Tampa, Brandon, Clearwater, and Wesley Chapel, our expert team of fertility specialists is ready to answer all your questions and provide personalized fertility care. Schedule a consultation with The Reproductive Medicine Group.