In latin in-vitro means “in glass” while in-vivo means “in the body.” In-vitro fertilization (IVF) is a comprehensive term that describes reproductive technology which allows for fertilization outside of the body. IVF typically involves 5 stages: preparation and priming, stimulation and monitoring, egg retrieval and fertilization, recovery +/- embryo transfer, and pregnancy testing.
Depending on your unique care plan, preparing for IVF takes a variable amount of time per person. Patients need to emotionally, socially, and physically prepare to start stimulation. Some protocols require medications during preparation (priming) and some patients may choose to optimize or adjust their lifestyle during this time.
During ovarian stimulation, patients take medications that stimulate the simultaneous production of multiple eggs in the ovaries. This often involves 2-3 injections each day, using very small needles, or a combination of oral medications and injections for approximately 9-14 days depending on the stimulation protocol. During this time, the growth of your eggs is monitored by multiple vaginal ultrasounds and hormonal blood tests.
An egg retrieval is a minor surgical procedure under anesthesia where the eggs are retrieved from the ovaries using a long thin aspiration needle and suction. After anesthesia is given to avoid pain and discomfort, the needle is placed through the vagina under ultrasound guidance, directly into each ovary. Your doctor will collect all your eggs from both ovaries. This outpatient procedure typically takes 15-30 minutes. Patients typically do not need to stay in the hospital overnight.
The recovery after an egg retrieval is different for everyone. Most patients experience vaginal spotting, mild cramping, bloating, and constipation for a few days after the procedure. Pain medication and over the counter stool softener/laxatives may be needed to avoid discomfort. Typically, the more eggs, the more substantial the side effects, however most patients are able to return to daily activities within 1-2 days and full activity within 2 weeks.
Once eggs are retrieved they can be inseminated in the lab with sperm. There are two ways that insemination occurs in the lab: conventional IVF and intracytoplasmic sperm injection (ICSI). In conventional IVF, a cluster of sperm are placed around each egg with hopes the sperm will fertilize the egg. In ICSI, the eggs are prepared by taking off the surrounding cells and a single normal appearing, motile sperm is selected and injected into each egg. In some labs, ICSI has been shown to optimize for successful fertilization. All mate clinics include ICSI in our packages and we perform ICSI on every egg to guarantee high fertilization rate.
An egg and sperm that successfully undergo fertilization is called an embryo. Embryo(s) can be biopsied, in which a few cells removed and sent off to the genetic lab. Those embryos can then be frozen and transferred at a later date, for a delayed frozen embryo transfer or transferred without genetic testing, which is called a fresh embryo transfer. We will freeze your extra embryos a few days after retrieval. Regardless of whether a fresh embryo transfer or frozen embryo transfer is performed, remaining embryos can be kept frozen for possible future use.
An embryo transfer is a simple procedure where one embryo (we can transfer two in unique cases with written permission) is placed gently into the uterus. Patients are asked to come to the clinic with a partially full bladder to allow the uterus to be seen on abdominal ultrasound imaging. A vaginal speculum is placed to allow for visualization of the cervix. The embryo is placed into the catheter and the catheter is guided through the cervix and into the uterus. The embryo is then gently placed into the uterus and the catheter is slowly withdrawn.
After approximately 2 weeks, if the embryo has successfully implanted, a pregnancy test (blood or urine test of HCG) will be positive. At that point, we can determine if your IVF cycle has been successful or not. If you’re pregnant we will monitor you closely for 8 weeks until you will begin seeing your regular ObGyn again. If your cycle was unsuccessful, we can always try again. If you have additional frozen embryos, we can use one of those. On average it takes 2-3 cycles to achieve a successful pregnancy, so don’t get discouraged.
Exactly what you experience throughout the IVF process can be very different from what someone else has experienced. There may be some level of physical discomfort throughout the process. The ovulation drug injections should not be very painful, the needles are very small. There may be a slight stinging sensation but nothing to worry about. During the egg retrieval process you will not experience any discomfort because you will be under anesthesia, however after the procedure it is common to experience some level of cramping. The embryo transfer procedure is done with the assistance of a small catheter. If you have come this far with treatment, there is nothing to worry about during the embryo transfer, the procedure is relatively painless.
Ovarian reserve refers to a person’s remaining egg supply that can produce babies. Your fertility depends on the quality and quantity of eggs that exist within your ovaries, as well as how well the ovarian follicles are responding to hormonal signals from the brain. Ovarian reserve is one of the most important predictors of your pregnancy potential.
An average fresh IVF cycle takes about 6-8 weeks from consultation to transfer. The few weeks before your IVF cycle begins will be used for testing. If you’re using a gestational carrier or surrogate, this time may increase. An average fresh cycle timeline (not including pre-testing) looks something like this:
Day 1: Ultrasound and bloodwork (ovarian stimulation)
Day 2: (Ovarian stimulation)
Day 3: (Ovarian stimulation)
Day 4: Ultrasound and bloodwork (ovarian stimulation)
Day 5: (Ovarian stimulation)
Day 6: Ultrasound and bloodwork (ovarian stimulation)
Day 7: (Ovarian stimulation)
Day 8: Ultrasound and bloodwork (ovarian stimulation)
Day 9: (Ovarian stimulation)
Day 10: Ultrasound and bloodwork (ovarian stimulation)
Day 11: Trigger shot
Day 12: Wait
Day 13: Fertilization & egg retrieval
Day 14: Embryos culture in the lab for 5-6 days
Day 15: Embryos culture in the lab for 5-6 days
Day 16: Embryos culture in the lab for 5-6 days
Day 17: Embryos culture in the lab for 5-6 days
Day 18: Transfer or PGT-A on frozen embryo
Day 19-33: Two week wait
Day 33: Pregnancy test
If you’re doing a frozen transfer, which we will recommend in most cases, the time between your egg retrieval and embryo transfer can be a few weeks, months, or even years. Regardless, it’s better to give your body some time to rest after your retrieval before getting ready to receive an embryo.