Over one million children have been conceived through in vitro fertilization (IVF), a term that literally means "fertilization outside the body." IVF may be recommended for couples that have not been or cannot be helped with other fertility treatments. After the patient's menstrual cycle has been regulated with the aid of oral contraceptives and hormone medications, eggs are harvested from the ovaries and fertilized in the laboratory with the male partner's or a donor's sperm. The embryos are allowed to develop for a few days, at which time the best one(s) are placed in the uterus in the hope that one or more will result in a full-term pregnancy.

Egg retrievals are done under IV sedation administered by Board Certified anesthesiologists.

IVF is a complex process with many steps that must be successful in order to maximize the chance of conceiving. The steps are as follows:

• Pre-treatment
• Ovulation Induction
• Egg Harvesting
• Insemination & Fertilization
• Embryo Development
• Embryo Transfer
• Pregnancy

Pre-treatment

Before any treatment is begun, you will meet with the reproductive endocrinologist and complete a thorough screening. The initial examination will include a full medical history and prescriptions for a variety of tests, which may consist of some or all of the following:

• Blood Test. A blood sample is taken on the third day of the menstrual cycle to determine blood type, detect any infectious diseases, and measure performance of the pituitary gland and ovaries.
• Ultrasound. An ultrasound exam is performed midway through the menstrual cycle at the time of ovulation to measure the uterus, endometrium (lining of the uterus), ovaries and cervical canal. A physical exam and gonorrhea/Chlamydia culture may be performed at the same visit or at the time of another uterine image if one is necessary.
• Uterine Imaging:
  • Hysterosalpingogram (HSG). A small amount of fluid is injected into the uterus and an X-ray is taken to assess the fallopian tubes and uterus.
  • Saline Sonogram . A small amount of fluid is injected into the cervix and uterus and then an ultrasound is performed to detect abnormalities.
• Semen Analysis and Semen Cultures for Men. This assesses the male partner's sperm count and health and indicates whether further testing is necessary.
• Infectious Disease Tests. Required by law, this includes screening for hepatitis, HTLV-I, and HIV I and II.

Dr. Denker will also tell you about ways to increase your chance of conceiving during the initial IVF stages. This includes instructions about diet, nutritional supplements, exercise and weight loss, and sexual behavior as well as a recommendation to avoid tobacco, alcohol, caffeine, and certain medications.

You may be referred to our counselor who is specially trained to help you through the emotional roller coaster that often accompanies a diagnosis of infertility as well as treatment.

When these tests have been completed and the results examined, you and your partner will meet with the Dr. Denker and the IVF nurse. At this time, the details of the treatment plan will be explained and scheduled, and any questions and concerns you have will be addressed. You will be asked to sign all necessary consent forms.

Ovulation Induction

The first step in IVF is the retrieval of eggs, or oocytes, from the ovaries. The body normally produces one egg per ovulation cycle. Ideally, the more eggs that are collected and fertilized, the more viable embryos there will be to select from, and the greater the chance of conception. For this reason, prior to harvesting, the ovaries are carefully stimulated to produce more eggs than usual. This process is known as superovulation.

Superovulation is achieved through the injection of special medications that regulate the menstrual cycle by adjusting the levels of certain chemicals in the body. These include:

• GnRH agonists, or gonadotropin-releasing hormone agonists - Stimulate high-quality egg production and help prevent mid-cycle increases in estrogen levels. (Lupron)
• GnRH antagonists - Prevent premature ovulation. (Antagon, Cetrotide)
• FSH, or follicle stimulating hormones - Stimulate egg-producing follicles in the ovaries. (Follistim, Bravelle, Gonal-F)
• FSH and LH, or luteinizing hormones - Stimulate egg-producing follicles in the ovaries. (Repronex, Menopur)
• hCG, or human chorionic gonadotropins - Prepare eggs for harvesting. (Pregnyl, Profasi, Novarel)

There are some risks associated with these treatments, including side effects from the injection itself (bruising, swelling, tenderness or infection), allergic reaction, and excessive or insufficient response from the ovaries. Increased estrogen levels may cause fluid retention, weight gain, nausea, diarrhea, breast tenderness, moodiness, headache or fatigue. A rare but possible complication is ovarian hyperstimulation syndrome (OHSS), in which estrogen levels rise sharply and the ovaries produce too many eggs, potentially causing excessive fluid retention, thrombosis and enlarged ovaries. OHSS is a serious condition that requires hospitalization. Severe reactions to the medications may result in the cancellation of the treatment cycle.

In the ovaries, eggs develop within fluid-filled sacs called follicles. Follicle growth is monitored through a series of ultrasound exams (sonograms).

Treatment Timeline

Every patient is different. Accordingly, IVF treatment plans are tailored to each individual. With this in mind, below is an outline of what to expect during a typical IVF cycle. The average time from the start of pre-cycle testing to the embryo transfer is 6 to 10 weeks.

For more information on the IVF cycle, click here.