Question 1

Step 1: Pre-cycle Preparation

Accepted Answer

IVF pre-cycle preparation involves patients meeting with their physician to develop a treatment plan and undergo necessary tests and medications. Medications may include:

Birth control to regulate the patient’s cycle, prevent ovarian cysts, and allow the ovaries to rest
Leuprolide (Lupron) to suppresses ovulation
Cetrotide or oral estrogen to balance hormone

Pre-IVF tests include blood tests, mid-cycle ultrasound, hysterosalpingogram, hysterosonogram, and hysteroscopy. Male partners undergo semen analysis and infectious disease testing as required by California law.

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Question 2

Step 2: Medications and Monitoring

Accepted Answer

The stimulation phase of the In Vitro Fertilization cycle begins with daily injections of fertility medications. These medications (Follistim, Gonal-F) contain Follicle Stimulating Hormone (FSH). Often medications containing Luteinizing Hormone (LH) or low-dose hCG are added to help mature the eggs. Menopur contains both FSH and LH. Antagonist medications (Cetrotide, Ganirelix) are prescribed to stop ovulation prior to the egg retrieval.

During this time, monitoring visits occur every 2-3 days. Patients undergo ultrasounds and estrogen level tests to monitor progress and assess readiness for treatment. When follicles reach the optimal size, human chorionic gonadotropin (hCG) injection triggers egg maturation and detachment from the follicle. Egg retrieval follows approximately 36 hours later.

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Learn More About Clomiphene Citrate

Question 3

Step 3: Egg Retrieval

Accepted Answer

IVF egg retrieval involves mild sedation as eggs are retrieved using a needle guided by ultrasound. A sperm sample is provided on the same day, with frozen sperm thawed if necessary. Afterward, patients rest for about two hours in the clinic before being discharged. They must have someone to drive them home due to sedation.

Recovery typically involves minimal discomfort, such as pelvic heaviness or cramping, which can be managed with rest, heating pads, and mild pain medication if needed. Patients are advised to avoid heavy lifting, vigorous exercise, alcohol, and caffeine. Patients may be given progesterone to support the uterine lining in preparation for embryo implantation. Ongoing communication with the clinic ensures optimal recovery and support.

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Question 4

Step 4: Insemination, Fertilization, and Embryo Development

Accepted Answer

After egg and sperm retrieval, IVF progresses in the embryology laboratory. Eggs mature in culture media, essential for embryo development, and are inseminated with sperm. Fertilization occurs when a sperm penetrates the egg, leading to embryo formation.

Procedures such as assisted hatching, intracytoplasmic sperm injection (ICSI), and/or preimplantation genetic testing (PGT) may be performed to support healthy embryonic formation and development. PGT in particular is crucial for identifying genetic and chromosomal abnormalities early before embryo transfer.

Patients also have the option to freeze their eggs, sperm, or embryos for future use, offering flexibility and preserving fertility. These steps are tailored to individual needs for successful IVF outcomes.

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Question 5

Step 5: Embryo Transfer

Accepted Answer

IVF embryo transfer involves placing embryos into the uterus through the cervix using a thin catheter, either with fresh or previously frozen embryos that have been thawed (also known as frozen embryo transfer). This minimally invasive procedure takes about 15 minutes, with the actual transfer lasting only 30 seconds. Patients are advised to rest afterward, avoiding vigorous activity and certain intimate care products.

At PFC, we primarily perform elective single embryo transfer (eSET), a technique that prioritizes safety and success by transferring one high-quality embryo at a time, reducing the risk of complications associated with multiple pregnancies. Advanced technologies like time-lapse photography and preimplantation genetic testing further enhance embryo selection for optimal outcomes.

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Question 6

Step 6: Luteal Phase

Accepted Answer

In a natural menstrual cycle, the luteal phase involves the production of progesterone, which prepares the uterine lining for potential embryo implantation. In IVF, following the egg retrieval and embryo procedure, patients are commonly prescribed progesterone supplementation, which is administered intravaginally or via injection. Estrogen patches are also prescribed to help maintain balance during the luteal phase, as estrogen levels can drop following egg retrieval. Two weeks post-transfer, a blood pregnancy test is taken to confirm early pregnancy, with follow-up ultrasounds at two and four weeks to verify clinical pregnancy.

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Question 7

Step 7: Pregnancy

Accepted Answer

After a positive pregnancy has been confirmed, monitoring at our clinic continues for about 10 weeks, when patients transition to their obstetrician's care. It is with both joy and a touch of sadness as we bid farewell to the aspiring patients, as they graduate from our care to continue their pregnancy under the care of an obstetrician.

In the case of a negative test, emotional support and follow-up appointments are provided to discuss future plans and continued care, whenever the patient feels ready. Ongoing support is a crucial aspect of our patient care throughout the IVF journey.

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The IVF Process

Understanding the IVF Journey