What is IVF?

I realize that most of you have probably heard of IVF and vaguely know what it is, but I thought I would devote this post to explaining it with a little more detail.  IVF stands for in vitro fertilization.  In Latin, this means within the glass.  Babies conceived through IVF used to be called test tube babies.  There are many phases to IVF.  I will speak about IVF as it applies to my treatment plan.  

The first phase of IVF is ovulation stimulation.  I am given a couple of different hormones, a gonadotropin-releasing hormone (GnRH) and follicle-stimulating hormone (FSH) to induce ovulation.  Ovulation is the formation of eggs in my ovaries.  In a normal woman my age, one egg is usually produced each month.  During ovulation stimulation, I will produce many eggs, hopefully at least twelve.  Twelve is my own personal goal.

During the maturation of the eggs in the follicles of my ovaries, daily or semi-daily blood work and ultrasounds will be completed to monitor my estradiol levels and the maturation of the eggs.  Once the majority of the eggs measure a certain size on the ultrasounds, I will be given a single injection of human chorionic gonadotropin (hCG).  It stimulates the precise timing of the release of the eggs from the follicles in my ovaries.

Next, I will be sedated for the egg retrieval.  My doctor will insert an ultrasound-guided needle vaginally to gain access to the ovaries just prior to my eggs being released from the ovaries.  The follicles are then aspirated and the fluid is delivered to the lab.  The lab then retrieves the eggs from the fluid.

At this point, one of Dave's sperm will be injected into each egg through a procedure called intracytoplasmic sperm injection (ICSI).  The fertilization process occurs in a culture medium in the lab.  The fertilized eggs are allowed about 3 days to mature.  At this point they are 6 or 8 celled embryos.  They will look something like this:



On day 3, the embryos are evaluated closely to determine if they will be transferred to my uterus. If there are many wonderful looking embryos that appear to be of high quality, the embryos will not be transferred on day 3. They will remain in the lab and transferred on day 5 as a blastocyst.  If there are very few day 3 embryos or they do not appear to be of high quality, they will be transferred to my uterus on day 3. This is because they are probably not likely to survive in the lab much longer. If the embryos develop in the lab until day 5, they will form a 60-100 cell blastocyst that looks something like this:


There are many advantages to transferring the blastocyst on day 5 as opposed to transferring the embryo on day 3. The day 5 blastocysts have a much greater chance of producing a pregnancy.  For this reason, fewer blastocysts are usually transferred, thereby minimizing the risk of high order multiple pregnancies - no OCTUPLETS for us!  Dr. Ahlering explained to me that he usually transfers two blastocysts, but many factors are taken into consideration when this is decided. 

 The embryo or blastocyst is transferred to my uterus using a tiny catheter.  It is usually only slightly painful (similar to a pap smear).  I am an expert at this procedure as it was completed each time Dave and I did IUI treatment cycles.  I think I will be on bed rest for 24 hours following the transfer.  

Just to give you a better idea on our timeline,  I start my daily injected hormones on Wednesday, March 4.  I told the wonderful ladies at my office to hold on to their hats.  The hormones can have a profound effect, stimulating mood swings.  No matter how hard I try, I will not be able to control it.  

My appointments in St. Louis for regular ultrasound and estradiol monitoring begin on Monday, March 23.  I also have an IV infusion of Intralipid  on this day.  The egg retrieval will occur between March 27 and March 29.  The transfer will happen for us somewhere between March 30 and April 4.  I think I can take a pregnancy test somewhere around April 11, hopefully sooner.  According to my estimations, if I do get pregnant during this cycle, I will have an estimated due date around December 15.  Jeff is excited about this.  He said he would like to share his birth month with his new niece or nephew.  

I hope that helps to clarify the process a little.  Thanks for reading!