IVF Cycle Overview

Preparation:

• Following your consultation with the physician and reviewing your option of care if IVF cycle was chosen you will undergo preparation toward your treatment.

• You will have a nurse educational session where the IVF cycle will be reviewed with you step-by-step from preparation to cycle treatment, egg retrieval, and embryo transfer.

• You will be educated about the medication used and how to administrate them.  There will be medications that involve injection this will be reinforced on cycle start date as well as during the cycle.

• You will have a financial consultation.  Your insurance coverage will be reviewed with you as well as your financial responsibility.   If any services are not covered other options of financial help and infertility insurance will be offered if needed.

• Based on your individual condition you may need some testing to prepare you for the treatment.  Some of the testing includes, testing of your hormones, evaluation of your uterine cavity, and your partners sperm or donor sperm if applicable.

• When you are all completed with your preparation you will be ready to start your cycle.  Scheduling of this can be done with your nurse.  The use of fertility medications sometimes gives us flexibility as far as your cycle start date which will effect the time of your retrieval and embryo transfer.  If you or your partner may be away or have any other concerns at the time of your cycle start please share this with your nurse so we can accommodate as needed.

IVF Start Cycle:

• Naturally your body releases one egg every month.  During the cycle we will use fertility medications to help you produce more of your eggs to be available for egg retrieval.

• Achieving more eggs enables us to have more embryos.  This enables us to transfer the better quality embryo and increase your success rate.  The extra embryos can be frozen.  In case pregnancy is not achieved this will allow you to undergo a simple Frozen Embryo Transfer cycle which involves less medication and is equally as successful.

• In many cycles prior to start of fertility medications the patient maybe on birth control pills that helps us to retrieval more eggs of the same quality during the cycle.

• In order to retrieve more eggs we will use a combination of fertility drugs that stimulate the ovaries as well as decrease the risk of spontaneous ovulation.

• For patients that have concerns on the storage of the multiple embryos we have other solutions available such as egg freezing as part of an IVF cycle.

• Fertility medications will be ordered through your insurance preferred specialty pharmacy.  If your insurance does not cover medication we will encourage you to compare a few specialty pharmacy proposals and choose the one that can offer you the medications in a less expensive way.  Your nurse can help with this.

• On a designated day you will be seen in the office for blood work and ultrasound to see that your body is ready to start the cycle.  At this time, we will re-review your medication and injection instructions and based on your test results your cycle will be started accordingly.

Cycle Monitoring:

• You will be seen in the office periodically based on your treatment protocol and your ovarian response.

• In the office you may have hormonal testing and/or pelvic ultrasounds to monitor your follicular development in your ovary.  This monitoring helps determine when your body is ready for egg retrieval.

• Every time you are seen in the office you will receive communication from a nurse in the afternoon with instructions on how to continue your treatment and when to return back to the offices.

• We have a nurse and physician on call after office hours for any of your needs during your cycle.

Due to Insurance protocol it may take a few days between ordering and delivery of medications.  Always make sure you have enough medications and not wait for the last minute.

• When your body indicated your eggs are ready to be retrieved you will be instructed about taking your “trigger” shot HCG at a specific time.  This will determine when your egg retrieval will take place.

• This usually happens two days prior to your Egg retrieval.   The day after your “trigger” shot you will be seen in the office to ensure your body is ready for egg retrieval.  For most patients on this appointment you will undergo cervical trial.

• Cervical Trial is a minor non painful procedure performed in the exam room.  Trial catheters similar to the embryo transfer will be attempted to reassure everything is ok for your embryo transfer.  Whenever difficulty is diagnosed at this stage this will be re-tried during your egg retrieval under anesthesia.

Egg Retrieval:

• On the day of your egg retrieval you will come to the facility at your scheduled time.  You will need to be fasting from midnight the day prior.

• Some patients still need to take their medications for example blood pressure even on the day of your retrieval.  Please verify with your nurse the day prior.

• The egg retrieval is an ultrasound-guided, out patient procedure done in our Operating Room under sedative called twilight, given intravenously.

• There is a needle guided attached to the vaginal probe that visualizes the ovaries and the other pelvic structures.  The needle is guided through the vaginal wall into each ovary where the fluid containing the eggs is aspirated.

• The procedure takes about 15-30 minutes.  You will stay in the recovery room for up to 2 hours.  Some of the side effects of the procedure may include pelvic cramping, spotting or slight bleeding.  Generally, patients resume normal activity the following day.

• You will need transportation home after the procedure as you are not allowed to drive 24 hours after anesthesia.

Embryo Transfer:

• The embryo transfer is an uncomplicated procedure that usually does not require a sedative or anesthesia.

• The embryo transfer is an abdominal ultrasound guided procedure.  It is important that the patient’s bladder is full during time of transfer to help visualize the pelvic structures by ultrasound.

• The physician first inserts a speculum to visualize the cervix, and then cleans the cervix with sterile water.

• Next, the embryo(s) are loaded into the catheter and then the catheter is inserted into the vaginal canal.  When the tip of the catheter is in the uterus, the embryo(s) are released into the cavity.

• Once the catheter is removed, the embryologist verifies that there are no embryo(s) remaining.

• The patient remains resting for 30 minutes and then is discharged home.

• Following embryo transfer you can resume normal activities.

Following Embryo Transfer:

• A few days following your embryo transfer you may need a blood test to check your Progesterone.

• Based on the date of your embryo transfer you will have a pregnancy test performed twice to confirm conception.

• With a positive pregnancy test, the patient will come every 2 days for a Beta and Progesterone serum level.

• Based on your bodies response an ultrasound will be scheduled to evaluate the pregnancy.

• The patient comes to the office about every 2 weeks for bloodwork and vaginal ultrasound.

• We discharge our patients to the care of their OBGYN between 8-12 weeks, based on the patient’s insurance.