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IVF Procedures and In Vitro Fertilization Procedures
Oocyte retrieval

When the size of the leading follicles reaches 18 to 20 mm in average diameter and the estradiol hormone level is appropriately elevated, then it is time for the eggs to be "harvested". The HCG injection (described in the previous section) will be administered in the evening usually between 7 PM and 11 PM. The egg retrieval will be scheduled 36 hours after the HCG injection. For instance, if the HCG is given on a Monday at 8:45 PM, then the egg retrieval will be performed on Wednesday at 8:45 AM.

The couple needs to be at PFCLA at least 30 minutes prior to the scheduled time of Egg Retrieval (ER). The patient should not eat or drink anything after midnight, the night before the ER day.

The ER is performed under “general anesthesia” but without intubation. The patient will not feel any discomfort during the procedure and will wake up within 10 to 15 minutes of the end of the ER. Depending on the number of follicles present, the ER will usually last 10 to 30 minutes.

The procedure is performed under ultrasound guidance similar to the vaginal ultrasound examination that the patient has during follicular monitoring. A needle guide is attached to the ultrasound probe, a long needle is introduced through the guide, and under direct visualization each follicle is punctured and the fluid (along with the egg floating in it) is aspirated. The fluid is then immediately sent to the laboratory where the embryologists search for the eggs, isolate them and place them incubators. At the completion of the ER, the patient is taken to the recovery area where she will stay for about an hour. Pain medications might be administered at this time as needed. Some discomfort is expected for a few hours following ER and Tylenol can be taken by the patient at home as needed every 4 hours. Occasionally, some nausea might also occur which usually dissipates within a few hours.

After about an hour when the patient is fully awake and relatively pain-free, instructions are given by the recovery nurse and the patient is discharged home. The patient must be accompanied by someone who can drive them home and should not be left alone for the rest of the day.

While the patient is undergoing the ER, the partner is asked to provide us with a semen sample. The semen is then washed and prepared to inseminate the eggs 3-4 hours later. If ICSI is to be performed, the partner might be asked to give another semen sample if the first sample does not have an adequate number of viable sperm.

In cases where the male partner has to undergo the testicular biopsy (TESE or MESA) procedure, he will be taken to an adjacent operating room and the urologist will perform the needle biopsy under local anesthesia. This procedure will usually last 15-30 minutes and the patient will be discharged home with an ice pack placed over the testicles to prevent swelling. Read our IVF Procedures Blog for more information!

The risks of retrieval involve bleeding, infection and possible damage to adjacent organs.  Intravenous anesthesia is usually used during retrievals.

Fertilization

Once the eggs are harvested and cleaned in the laboratory, they are incubated with sperm overnight to fertilize the eggs. Roughly 16 hours after insemination, the embryologist will check on the status of the fertilized eggs.

A fertilized egg is called an embryo. An embryo goes through stages of development until it is ready for transfer to the uterus. The following represent a schematic view of the growth of an embryo from the 2-cell stage to Blastocyst.

In these pictures actual photographs of an embryo is shown under magnification:

Embryo transfer

Three to five days following the Egg Retrieval the patient will have the Embryo Transfer (ET). During this time the fertilized eggs (embryos) have been allowed to grow and divide in the incubator. The patient would have also been started on Progesterone injections and/or suppositories the day of HCG injection to prepare the uterine lining for implantation.

The day before ET the patient will be contacted and given a specific time to come to PFC-LA for ET the next day. About 15 minutes before the transfer, the physician will meet the couple and discuss the number and quality of the embryos at hand. A decision will be made by the couple and their physician as to the number of embryos that will be transferred and the number to be frozen or discarded. The patient will then take a sedative pill if needed. The embryos will be separated into a separate dish and then transferred to the transfer catheter. Meanwhile the physician will prepare the patient for the ET. This is very similar to an artificial insemination procedure except that embryos are transferred to the uterus instead of sperm. A speculum is inserted in the vagina; the cervix is washed and cleansed. An ultrasound is used in most cases as guidance to the transfer. The embryologist will then deliver the catheter to the physician who introduces it through the cervical canal into the uterine cavity where the embryos are released. The embryologist will then check the catheter to make sure none of the embryos are in the catheter.>

The whole procedure takes approximately 5 minutes. The patient will remain in a supine position for about an hour. She will then be discharged home. It is recommended that the patient rests at home for 1 or 2 days following the transfer.

A blood pregnancy test is done 10 days after the embryo transfer. Depending on the level of hCG hormone in the blood, another test might be requested in 2-4 days or an obstetrical ultrasound scheduled 2 weeks later to check on the health of the pregnancy. It is during this examination that we can determine the number of fetuses (i.e. twins or triplets..).

We will follow our patients until the 10th week of gestation, after which, they will be discharged to their own obstetrician.

Most often, embryos are transferred 5 days after fertilization at the blastocyst stage.

IVF success is also dependent on the quality of the uterine lining. Both the thickness and texture are important parameters we check. The following figure shows an ideal thick and triple layered endometrial lining:

Intracytoplasmic sperm injection (ICSI)

ICSI is the process where one motile sperm is selected and injected into an egg under a special microscope. This procedure is indicated in cases of severe male infertility, surgically retrieved sperm, and unexplained infertility, history of poor fertilization or in cases where PGD is performed for single gene disorders.

In some male infertility cases, the patient does not produce any sperm because of a blockage of the ducts transporting the sperm (vas deferens) or a vasectomy (for contraception). In these patients, sperm is retrieved directly from a “storage pouch” in the testicles called Epididimys. This procedure is called MESA or PESA and the ICSI is necessary to use sperm recovered through this method.

Assisted hatching (AH)

AH is a procedure where the a small hole is created in the shell (zona)of the embryo. It is thought that this procedure may aid in implantation especially in eggs from women greater than 37 years. It is most commonly performed under the microscope by using a special laser or a specially prepared acid mixture.

Preimplantation Genetic Diagnosis (PGD)

PGD is the process in which a blastomere (cell) is removed from an embryo three days after the retrieval (usually at the 8-cell embryo stage) and is analyzed for several genetic tests. The non-affected embryos may then be transferred. It is very useful in certain diseases that have strong inheritance patterns and can prevent affected offspring. It is also sometimes used in cases of recurrent pregnancy loss, advanced maternal age and sex selection.

Gamete Intrafallopian Tube Transfer (GIFT)

GIFT is a procedure that involves an oocyte retrieval followed by immediate laparoscopy where several sperm cells and eggs (gametes) are then placed into the fallopian tube with a special catheter, thereby allowing fertilization to occur inside the fallopian tubes.  It is rarely used today since it is more invasive than IVF.

Zygote Intrafallopian Tube Transfer (ZIFT)

ZIFT is a procedure that involves an oocyte retrieval followed by in vitro fertilization.  Once fertilization is confirmed day 2 embryos (zygotes) are then placed laparoscopically into the fallopian tube. 

It is rarely used today since it is more invasive than IVF.

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What Is the Cost of In Vitro Fertilization?

In vitro fertilization is not an inexpensive endeavor, but the cost of in vitro fertilization pales in comparison to the joy a child brings to a couple who has been unable to get pregnant in traditional ways.

As with any medical procedure, it’s important to do your research before making any decisions about treatment. Make sure you understand and are comfortable with the procedures, and compare the cost of in vitro fertilization between several fertility clinics. While the cost may only vary slightly, you may find that some clinics suit your needs better than others.

The Cost of In Vitro Fertilization

The average cost of in vitro fertilization is between $10,000 and $15,000 per treatment cycle. However, additional procedures and reproductive assistance can increase the cost of in vitro fertilization. The following costs are approximate and can vary based on location, clinic, and other factors:

• Preimplantation genetic diagnosis (PGD), which is also known as embryo screening: $3,000-$5000
• Cryopreservation, which is also known as embryo freezing: $1,000
• Intracytoplasmic sperm injection (ICSI), which involves injecting an individual sperm directly into an egg: $1,800
• Using an egg donor: $15,000-$20,000 for one cycle
• Using a sperm donor: $1,000
• Embryo donation: $5,000

Will My Insurance Cover the Cost of In Vitro Fertilization?

Part of your research should include reviewing your insurance policy to see if it covers the cost of in vitro fertilization. Although most insurance companies don’t cover it, some policies include infertility treatment options and may pay for part of the cost of in vitro fertilization.

Fortunately, you don’t have to only rely on insurance. Most fertility clinics offer several financing options and payment plans, so you don’t have to worry about a large lump sum upfront. Many even offer refund programs, where the clinic shares some of the financial risk of the cost of in vitro fertilization. With a refund program you pay a set fee and the clinic refunds a percentage of the cost if you don’t get pregnant after a predetermined number of in vitro fertilization treatment cycles.

Make sure you understand the terms of a clinic’s refund program. One clinic may define a successful cycle as a positive pregnancy test, while another may define it as a successful birth. This is obviously an important distinction because a miscarriage will negate the refund if the clinic considers a positive pregnancy test as a success under the terms of the refund program agreement.

What’s the most important part of assessing the cost of in vitro fertilization? Fully understand your options and the ways in which your chosen fertility clinic will work with you financially to ensure a successful birth.

Start Your Research Now!

We know there’s more to the question of, “What is cost of In Vitro Fertilization?” It’s a complicated issue and you should speak with an expert before making any decisions. If you want to learn more about in vitro fertilization or if you have questions, simply fill in this Contact Form and we will respond to you quickly. All inquires will be responded to in a timely manner. For more informaiotn on in vitro fertilization browse our website.

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10 In Vitro Fertilization Frequently Asked Questions

There are many questions, fallacies, and realities to in vitro fertilization. Here are ten common in vitro fertilization frequently asked questions to help you and your partner understand the facts and procedures involved.

10 In Vitro Fertilization Frequently Asked Questions:

1. How prevalent is infertility worldwide?

About 10 to 15% of couples have infertility problems according to the World Health Organization (WHO). That’s approximately 70-80 million people across the world. You’re not alone!

2. Is infertility primarily a female problem?

This is at the top of many couples’ in vitro fertilization frequently asked questions. The answer is a resounding “no.” As a matter of fact, infertility in women and men is nearly identical. Infertility is exclusively a female problem approximately 30 to 50% of the time, and is exclusively attributed to males in about 30 to 50% of the cases.

3. Is infertility hereditary?

Genetics can be a factor in determining fertility. There are many conditions, such as endometriosis that affects approximately ten percent of women, which can be passed from mother to daughter to potentially cause tubal infertility. On the male side, DNA abnormalities of the Y chromosome can lead to problems with infertility.

4. What causes infertility?

This is another common in vitro fertilization frequently asked questions. Couples ask, “Why are we here? Why are we infertile?” We can break it down into female infertility and male infertility. Common female infertility is caused by anatomical abnormalities and problems with the ovaries. Male infertility includes problems with the quantity and quality of sperm production, immunological disorders, and anatomical issues.

5. What are the treatment options?

In a word: Drugs. It’s not a bad word, though. Most female patients have great success conceiving with oral fertility hormones such as clomiphene citrate. Some will need injectable ones. The treatment of male infertility on the other hand, often requires IVF with intracytoplasmic sperm injection (ICSI) .

6. Does infertility treatment have a high success rate?

This is one of the most popular in vitro fertilization frequently asked questions. The answer is a resounding “yes.” The success of treatment has a direct correlation with the woman’s age. The younger the better! Overall, 70-80% of women under the age of 40 should expect a successful outcome.

7. What influences the success of treatment?

The most important factor is a woman’s age. As her age increases, especially after 40, fecundity decreases and her chances of conceiving are diminished. Of course, if her partner also has infertility problems, such as a low sperm count, the probability of infertility also increases.

8. Can painful periods cause infertility?

No. However, many women with painful periods and pain with intercourse might harbor endometriosis, which is indeed associated with infertility. Therefore, an evaluation is warranted in these cases.

9. What are the health risks for women?

Another one of the in vitro fertilization frequently asked questions is a woman’s health risks. Although the procedure itself isn’t dangerous, the drugs used to treat infertility can have side effects. Regular monitoring of follicular growth in ovulation induction will determine whether the treatment is successful, and will also prevent ovarian hyperstimulation syndrome (OHSS) and reduce the risk of a multiple pregnancy.

10. Are there health risks for kids born with infertility treatment?

Of all of the in vitro fertilization frequently asked questions we get from hopeful parents, the health of their children is often at the top of the list. There are conflicting reports that suggest a slight increase in the congenital anomalies with IVF. The risks are minimal but the benefits are breathtaking!

We know there’s more to the question of, “What is in vitro fertilization?” It’s a complicated issue and you should speak with an expert before making any decisions. If you want to learn more about in vitro fertilization or if you have questions, simply fill in this Contact Form and we will respond to you quickly. All inquires will be responded to in a timely manner. For more informaiotn on in vitro fertilization browse our website.

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What Is In Vitro Fertilization?

In vitro fertilization was first successfully used in the U.S. in 1981 and, since then, over 250,000 babies have been born. The technique has given more than hope to couples worldwide. It’s given them a real chance to share in the miracle of childbirth and have a family when it once seemed impossible.

What Is In Vitro Fertilization?

Put simply, in vitro fertilization is a procedure used to help infertile couples become pregnant. It involves removing an egg from a woman's ovary and fertilizing the egg with sperm. Once the egg is fertilized, the embryo is implanted in the woman's uterus. In vitro fertilization gives infertile couples the opportunity to have a child who is biologically related to them.

What Is In Vitro Fertilization?: Egg and Sperm Donation

Egg and sperm donor candidates often start with the question: “What is in vitro fertilization?” The next question is usually, “Ok, so how does it work?”

• Egg donation: When a woman has impaired ovaries or a genetic disease, in vitro fertilization is often the best option. The egg donor is typically between 21-30 years of age, and may be either a relative or an anonymous donor. Considering the seriousness of the procedure, it is recommended that both the recipient and the donor consult with a fertility counselor, as well as sign a consent form to cover the legal issues of the donation.
• Sperm donation: In instances where male partners have low sperm counts or impaired sperm, a sperm donation, whether an anonymous sperm donor or “banked” from the partner at an earlier time due to chemotherapy or other damaging conditions, can be highly effective.

What Is In Vitro Fertilization?: Success Rates

The success rate of in vitro fertilization is surprising. Based on age, it’s actually similar to the pregnancy rate of typical pregnancies:

• Younger than 35 years old: >50%
• 36-39 years old: 35-45%
• 40-43 years old: 10-20%
• Egg donation: >70%

If you or your partner is infertile, in vitro fertilization is a safe and viable alternative to normally conceived pregnancies.

What Is In Vitro Fertilization?: Ask the Experts

We know there’s more to the question of, “What is in vitro fertilization?” It’s a complicated issue and you should speak with an expert before making any decisions. If you want to learn more about in vitro fertilization or if you have questions, simply fill in this Contact Form and we will respond to you quickly. All inquires will be responded to in a timely manner. For more informaiotn on in vitro fertilization browse our website.

Follow us on Twitter and Facebook

Like This Article? Share it on your favorite Social Network!