When you begin your infertility research, you’ll find several acronyms to fertility treatment including IUI, CCS, SET, AMH and of course IVF. IVF, short for in vitro fertilization, is one of the most common fertility treatments and has been known to be one of the most effective treatment options for many people with reproductive complications. According to research from the Society for Assisted Reproductive Technology, US fertility clinic completed over 200,000 successful IVF cycles in 2015 alone.
Despite its tremendous track record of success, IVF is not a viable option for every infertility case. Several factors may necessitate proceeding to IVF, such as genetic diseases, medical history, issues with sperm or egg quality or quantity, recurrent miscarriage, and various other possibilities. The team at Reproductive Medicine Associates of Florida (RMA-FL) will closely monitor your IVF cycle to increase the chance of success. An IVF cycle includes several important steps.
IVF Stages at a Glance
Ovarian Stimulation Over eight to twelve days, an IVF patient will undergo daily injections of several medications that stimulate multiple eggs. Once the eggs reach the proper size, a final injection of hCG (human chorionic gonadotropin) spurs the eggs to the final maturation stage. Your provider will harvest the eggs 36 hours after the final injection.
Egg Retrieval During retrieval, you will be placed under anesthesia and your doctor will use ultrasound to guide the retrieval process. Once your eggs are extracted, they are sent to the IVF lab for the fertilization process. The retrieval process is minimally invasive and only takes about 15 minutes to complete. Patients can go home the same day, usually only after a few hours.
Extended Embryo Culture Once your eggs reach the IVF lab, they grow there for five to six days until reaching the blastocyst stage of embryonic development, at which time they are comprised of about 200 cells. RMA-FL uses an exclusive blastocyst stage culture IVF laboratory, and various scientific studies report that implantation rates are higher when implanting extended embryo cultures.
Embryo Transfer (ET)/ Frozen Embryo Transfer (FET) After another five or six days after reaching the blastocyst stage, the embryo is transferred back into the patient’s uterus. If all goes well, the embryo will implant on the uterine wall and a healthy pregnancy will result. However, RMA-FL’s standard of care for all IVF patients involve FET. This process preserves the embryo for about 30 days until the patient’s hormone levels return to normal levels and the body is most ready to receive the embryo.
FETs are scientifically proven to have higher implantation rates than typical ET procedures and lead to higher birth weights and lower risk of premature birth.
Select CCS/ Comprehensive Chromosome Screening (CCS)This is a more robust approach to embryo selection for IVF patients. Once your embryo cultures are made, RMA-FL staff will analyze them to determine which have the best chromosomal balance. Imbalanced embryos often lead to miscarriages or failed IVF cycles, and RMA-FL only uses The Foundation for Embryonic Competence, a non-profit reference lab, for embryonic screening.
Embryonic Biopsy Patients can opt-in for genetic screening. A small sample of genetic material is biopsied for analysis. Published scientific data reports that blastocyst stage biopsy at the trophectoderm layer of the embryo is safer than cleavage stage embryonic biopsy, and since 2012, RMA has only performed blastocyst stage embryo biopsies.
IVF Process Overview
Consultation and Workup
Your RMA-FL team will design a fully customized treatment plan in Florida that addresses the various factors of your infertility issues. Once we complete this workup of your physical examination and hormone levels, we’ll start your IVF cycle.
The next stage can last for seven to ten days, during which time patients will receive daily subcutaneous gonadotropin injections that stimulate the production of multiple eggs instead of a single egg normally produced each month. RMA-FL will closely monitor the treatment progress using blood work and ultrasound. Once the eggs reach the appropriate size, a final, critically timed injection of hCG (human chorionic gonadotropin) spurs the eggs to the final maturation stage and starts ovulation.
36 hours after the final injection, your RMA-FL team will remove the eggs from the ovaries during a 30 minute in-office procedure. Mild anesthesia reduces discomfort and doctors will use an ultrasound probe to guide the needle into the follicles of the ovary to collect the eggs. Most women can return home after an hour or two following the procedure. Following retrieval, the patient starts injections or vaginal delivery of progesterone to prepare for the implantation of the embryo five or six days later.
During this stage, eggs are mixed with sperm from the male partner or donor to start fertilization. If male infertility is the issue, single sperm may be injected into each egg using Intra-Cytoplasmic Sperm Injection (ICSI). Your RMA-FL team will keep you updated as the embryos develop.
During this phase, genetic testing can help determine the most viable embryos using the Select CCS platform. At the blastocyst stage, it is safe to biopsy the embryo to collect the genetic material required for testing. RMA-FL only uses blastocyst biopsy for the best possible results. After the development process is complete, patients return for the embryo transfer five to six days after the retrieval procedure.
Using a catheter inserted through the cervix, your RMA-FL team will transfer no more than two of your embryos to the uterus using ultrasound for guidance. Thanks to effective embryo screening technologies, RMA-FL performs an increasing number of SET procedures today. Progesterone therapy continues for another 14 days following egg retrieval. We’ll confirm the pregnancy with a test, and if confirmed, you will continue progesterone treatment for another three to four weeks until your placenta produces enough progesterone on its own to sustain the pregnancy.