More Information on In Vitro Fertilization (IVF)
Before the Cycle
A patient beginning an IVF cycle reviews her cycle schedule with her IVF coordinator. The cycle start date depends on where the patient is in her menstrual cycle and the IVF cycle protocol (course of medication) prescribed by her physician.
IVF Orientation Class
CRM offers an IVF orientation class. Taught by an IVF nurse, the class includes:
- Staff introduction
- Treatment timeline
- Medication protocols
- How to mix and administer medications
- Injection techniques
- Post-treatment follow-up
- Support services
- Billing and insurance questions
After orientation, the patient meets with her IVF nurse to review her specific medication protocol.
IVF orientation classes are generally held Monday through Thursday at 9:30 AM at CRM's Upper East Side office and at other locations by request.
CRM's staff psychologists specialize in the emotional and psychosocial aspects of infertility, and are available to patients for ongoing individual and couples therapy.
Psychological services at CRM are an integral part of the infertility treatment team, and our psychologists, who understand the highly stressful nature of infertility treatment, make every effort to be available to patients at any point during the process. Contact the Psychological Services Program Coordinator at (646) 962-3447 for more information, or to make an appointment.
Some patients may require hormone suppression before entering the stimulation phase (see below). This is intended to promote a coordinated ovarian response during the stimulation phase. Medications such as birth control pills, estrogen patches, GnRH antagonists (Ganirelix or Cetrorelix) or Lupron are used to suppress the patient’s natural production of FSH and LH.
Ovarian stimulation promotes the growth of multiple mature (i.e., ready for fertilization) eggs. Most IVF cycles include a stimulation phase.
During the stimulation phase of an IVF cycle, patients self-administer hormones by subcutaneous (under-the-skin) and/or intramuscular injections. Follicle-stimulating hormone (FSH) and luteinizing (LH) hormone are the two most commonly used medications. FSH and LH stimulate the ovaries to "recruit" multiple follicles, the fluid-filled sacs which contain eggs.
The length of the stimulation phase depends on the response to the medication regimen. Monitoring via blood tests and ultrasound of the ovaries is performed to track this response.
Monitoring During Ovarian Stimulation
Monitoring occurs at one of CRM's offices. Ultrasound imaging allows the physician to count and measure the follicles. Blood tests tracking hormone levels are another indicator of progress. After each visit for monitoring, the patient receives a call from her IVF nurse with instructions from her physician on medication dosage based on her test results, as well as the next date she will need to come to the office for monitoring.
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When the patient’s follicles are of optimal size, a hormone, human chorionic gonadotropin or hCG, is administered to initiate the final maturation process of the eggs.
The patient undergoes an egg retrieval approximately 36 hours after the hCG injection. As timing is critical to the success of this procedure, the patient (and partner, if applicable) should arrive at the IVF suite on the 8th floor of NewYork-Presbyterian Hospital two hours before the scheduled retrieval.
Egg retrieval is a transvaginal surgical procedure. Using ultrasound to visualize the ovaries, the physician gently suctions eggs from the follicles using an aspiration needle, as illustrated below.
Patients are lightly sedated during retrieval, and the post-operative recovery period usually lasts one to two hours. Mild cramping is the most common side effect of egg retrieval.
Patients will be contacted on the day following retrieval with their fertilization results. The number of eggs varies substantially depending on a number of factors, including the patient’s age and response to the stimulation medications. The number of eggs retrieved does not directly correlate to IVF success because egg quality can vary.
The male partner generally produces a fresh semen specimen at the Embryology Laboratory, where retrievals are performed, on the day of the retrieval procedure. Embryology Laboratory staff process the specimen before using it to fertilize the retrieved eggs.
Patients may also use frozen sperm specimens, either partner or donor, to fertilize retrieved eggs. The thawing and preparation of frozen partner or donor specimens is scheduled prior to the retrieval by the patient coordinator and the Andrology Laboratory staff.
Retrieved eggs are fertilized either by conventional insemination, the placement of eggs and sperm in a culture-containing dish, or by intracytoplasmic sperm injection (ICSI) by the embryologists and andrologists in CRM’s Embryology Laboratory. For more information about ICSI, visit the technique’s page.
Embryos (successfully fertilized eggs) are closely watched by the embryologists as their cells begin to divide. If applicable, before transfer or cryopreservation, assisted embryo hatching, endometrial co-culture or preimplantation genetic diagnosis (PGD) procedures may be performed at this time. Please refer to these procedures’ pages for more information.
Above: Images of embryo development.
Day 3 vs. Day 5 (Blastocyst) Transfer
Embryologists monitor the embryos’ growth and viability to determine whether a day 3 or day 5 transfer is appropriate. Embryo transfers three days after retrieval (referred to as “day 3 transfers,” when the embryo contains four-to-eight cells) have resulted in tens of thousands of successful pregnancies. Alternately, embryos are often transferred five days after retrieval and fertilization (“day 5 or blastocyst transfer"), with excellent pregnancy rates.
After the embryo(s) suitable for transfer to the patient have been transferred, the embryologist evaluates any remaining embryos for cryopreservation (freezing). Embryo cryopreservation gives patients who wish to have another child the option to have an embryo transferred at a later date without having to complete another IVF cycle.
Progesterone is a hormone that supports the growth of the endometrium, the lining of the uterus, in order to create a healthy environment for a transferred embryo to implant. IVF patients begin progesterone supplementation the day after egg retrieval. Progesterone stimulates the receptivity of the lining of the uterus for embryo implantation.
Embryo transfer is an outpatient procedure that typically does not require anesthesia and is performed at NewYork-Presbyterian Hospital. Using a catheter, a physician places the embryo(s) selected for transfer into the woman’s uterus via the cervix. The number of embryos transferred is decided by the physician and patient prior to the procedure based on the patient's specific clinical history.
Two weeks after retrieval, a pregnancy blood test is performed. If this test is positive, the patient is considered four weeks pregnant.
Patients with successful cycles see their CRM physician around week seven of their pregnancy for an ultrasound to detect the fetal heartbeat, after which they transition to an obstetrician’s care.