Many patients ask us how the IVF process works. The process for IVF treatment is divided into a series of steps. It is important to keep in mind that our staff will assist you along the way in completing the required steps. It may seem overwhelming at first but once you start IVF treatment it goes very quickly and Dr. Shaykh and the staff will be with you every step of the way if you have any questions.
Before starting the process, it is important to complete any of the required testing beforehand. This required testing consists of basic laboratory blood work to check for any potential diseases as required by the FDA. We will also require either a hysterosalpingogram (HSG) or sonohysterography (sonohyst) to ensure there are no abnormalities present within the uterus before treatment begins. Once we have the results of the testing, the IVF treatment can then begin.
Step 1: The first step in the IVF treatment process is to call or email our IVF nurse within the first 1-2 days of the start of your menstrual period. You will be given a prescription for birth control pills and will be instructed to start these immediately within 3 days of starting your period. The purpose of the birth control pill is to suppress your ovaries before the stimulation is started and so that we may gain control of your cycle. You will take the birth control pills for only a short time and then they are stopped right before you start your medication injections. The birth control pills are used to “reset” your natural cycle so that when we start the stimulation medications, your eggs will develop at around the same rate.
Step 2: Secondly, an IVF calendar or schedule will be created for you. This calendar will have all you your IVF medication instructions, IVF treatment instructions and monitoring appointments as well as the tentative day of egg retrieval. The staff will either give you a copy of this calendar in person, or they may email it to you. It is extremely important to your treatment to follow the instructions and medication instructions on the calendar very carefully.
Step 3: Next you will need to order the required IVF medications. Our staff will provide you with a prescription of all the medications you will need for the duration of your IVF cycle. You will be responsible for ordering/purchasing these medications through a fertility pharmacy. We do have a discount medication program and can order some of the medications for a lower price than a regular pharmacy can. This can save our patients thousands of dollars. Once you receive your medications, the staff will schedule you for a medication teaching appointment and show you how to use all of the medications and answer any questions you may have regarding the medications. Some people may be nervous about the injections however the injections are fairly easy to mix and administer.
Step 4: The birth control pills are stopped a few days later and then you are scheduled for an ultrasound/medication teaching appointment with our IVF nurse. At this appointment, your uterine lining and ovaries will be checked to make sure they are where they are supposed to be before starting the medication injections. You will bring all of the medications you purchased from the pharmacy with you to this appointment. If you ordered medication from us, we will have these medications for you.
Our IVF nurse will then go over the Follicle stimulating hormone (FSH) medications with you and teach you how to do the injections. She will explain some of the other medications as well.
Step 5: Next you will start your medications as instructed on your IVF calendar. Once you start the medications, you will have 3-4 ultrasound/blood work appointments during the next 10 days. These are usually scheduled for first thing in the morning so we receive the results back in time before the end of the business day. This also allows our patients to minimize time away from work.
The blood work level measures your estradiol (estrogen) level which is what is being produced by your growing eggs. The ultrasound will measure your follicle growth until they reach a mature size( follciles are the structure which should contain your eggs). Our staff will call you each day after you’re your appointment to discuss any changes to your medication instructions. During this time you may start another medication, either ganirelix or cetrotide which will prevent you from ovulating prematurely until your follicles have reached the appropriate size.
Step 6: Once your follicle sizes reach the appropriate size, usually 18-22mm and your estradiol levels are stable and on target with your follicle growth, you will be shown how to give yourself an injection of human chorionic gonadotropin (HCG). The HCG injection will cause you to ovulate approximately 36 hours after it is given. Your egg retrieval procedure will then be scheduled for this exact time. You will be given instructions not to eat or drink anything after midnight the night before your procedure.
Step 7: The day of your egg retrieval you will need to arrive on time and bring your partner with you to your procedure so they may provide a semen specimen. The procedure will take place in the office and you will be given an IV sedative so you will not be awake or feel anything during the procedure. Your eggs will then be retrieved with a very thin aspiration needle which is inserted through the vagina and into each ovary.
The procedure usually lasts 10-20 minutes and then you will relax afterwards while the sedative wears off. Some women experience mild to moderate cramping and some spotting after the procedure. Your partner will then provide the sperm specimen and the eggs will be fertilized. You will be given a new medication calendar and instructions following the procedure. You will then be allowed to go home and are advised to rest for the remainder of the day. Our staff will call you with updates over the next several days to inform you of how your embryos are growing in the lab and to schedule you for your embryo transfer appointment.
Step 8: The next step in the IVF process is your embryo transfer appointment. This is the exciting day that one or more embryos will be placed back inside your uterus. The amount of embryos placed back into your uterus is based on your request and well as the doctor’s recommendations for your age group. If you desire assisted hatching, this will be performed just before the transfer. Assisted hatching is sometimes recommended in order to assist the embryo with hatching out of its shell so it can use more if its precious energy for implanting in the uterus.
The embryos are placed back into your uterus typically either on the 3rd or 5th day following the egg retrieval depending on the quality of the embryos and how well they are developing. The embryo
transfer procedure takes only about 10 minutes and is described as being similar to having a pap smear performed. You will be able to watch the screen as the embryos are inserted under ultrasound. It is then up to the embryos to implant and start growing within your uterus.
After the transfer, you will rest for another 10-15 minutes and then you will be allowed to go home. You will also be given a new medication schedule/instructions as well as a laboratory slip to have a pregnancy test performed in around 12 days.
Step 9: The last step in the process is going for a laboratory blood test (Beta HCG) on around day 12 to confirm if you are pregnant or not. Once we receive the results from the test, our staff will call you and notify you of the result. We hope to have good news for you and will give you additional medication instructions if you are pregnant. If you are not, Dr. Shaykh will meet with you to discuss your cycle and answer all your questions.
Dr. Shaykh and the staff are here to assist you along the way with reminders and to answer any questions you may have.