IVF Treatment

You’ve probably read the acronym “IVF” hundreds of times in magazines and newspapers, heard it on the news, and maybe even had a friend or relative who was able to get pregnant using this technology. You probably know the initials stand for “in vitro fertilization” and that the media sometimes calls the children born after IVF “test tube babies.” But how many people, apart from medical doctors (and women who’ve tried IVF), know what’s involved in this fertility technology?

What is IVF?

IVF, or “in vitro fertilization,” involves several steps. First, a woman is given fertility drugs that stimulate her ovaries to produce as many mature eggs as possible (instead of the usual one per monthly cycle). Second, the eggs are retrieved using a suction needle inserted into the ovary. Third, the eggs are fertilized by combining them with sperm in a culture dish. Finally, the best-quality embryos are transferred into a woman’s uterus. If all goes well, a normal pregnancy is the result.

Who is IVF for?

IVF can be used to help couples with a variety of fertility challenges—male and female—to get pregnant. As with natural conception, success rates are higher in younger women (generally meaning under 40). There are many criteria for determining who might benefit from IVF, and couples need to consult with a fertility specialist before determining whether IVF can help them get pregnant and achieve their families. Rather than looking at IVF as a last resort, think of it as “the ultimate treatment,” suggests Arthur L. Wisot, M.D., executive director of Reproductive Partners Medical Group in Southern California and co-author of Conceptions and Misconceptions (Hartley & Marks, 2004).

What is the First Step in IVF?

After an examination, a doctor will devise a fertility “protocol” (a plan for the course of medical treatment) for a woman, highlighting all of her recommended fertility “to-dos,” such as medications and blood tests. It’s important that a woman follow this protocol carefully, even if the directions don’t seem to make sense. For instance, many doctors will prescribe birth control pills for the first two months, since the hormones in oral contraceptives can help the ovaries to produce quality eggs when they’re needed later. The Pill can also help regulate the menstrual cycle, so the doctor knows what’s happening at what time, and when would be the best time to begin the IVF cycle.

What Happens in a Typical IVF Cycle?

Since in vitro fertilization has to be coordinated with a woman,s menstrual cycle, a typical IVF cycle is about 30 days long. About three weeks after the start of menstruation (or two weeks after taking a low-dose birth control pill) a patient starts injections of a drug (usually Lupron, but sometimes a newer drug such as Antagon or Cetrotide) to suppress the ovaries. After 10 days of Lupron, the patient returns for an ultrasound scan and estrogen test level. If the results show that the suppression was successful, the cycle begins. The following schedule, adapted from Dr. Wisot’s book, is approximate, since fertility doctors and clinics have their own preferred protocols.

Day 1

• Patient begins injections of gonadotropin drugs (follistim, gonal-f, bravelle, and/or pergonal or Repronex) to stimulate the ovaries. Lupron injections continue.

Day 6

• After five days of stimulation, the doctor checks to see whether there are enough follicles developing to continue the IVF cycle. If so. . .

Day 10 (depending on the patient’s progress, this stage can occur anywhere from day 7 to 12)

• The woman receives an injection of human chorionic gonadotropin (hCG) to trigger ovulation.

Day 11 (or one day after hCG)

• The patient returns to the clinic for an ultrasound to check on the status of the follicles.

Day 12 (35 hours after hCG)

• With the patient lightly sedated, the doctor retrieves the eggs by guiding a needle into the ovary through a tube inserted into the vagina. Around the same time, a sperm specimen is collected. The eggs and sperm are combined in a culture dish.

Day 13

• Doctors check to see how many eggs have been fertilized and what their quality is. If there are more good-quality embryos than can be transferred, some may be frozen.

Day 15 or 17 (depending on the clinic, day 3 to 5 after fertilization)

• The cells – now called embryos rather than fertilized eggs – are transferred to a woman’s uterus, using a thin catheter. Two days of bed rest follow, after which normal activity is allowed.

Days 28-30

• The final step: the pregnancy test!