Preparing for In Vitro Fertilization (IVF)
- How Long Should It Take To Become Pregnant?
- How Long Should I Wait To See A Fertility Specialist?
- What is Included in the Medical Evaluation for Fertility?
- What is the IVF Procedure?
- What is the Cost and Insurance Coverage for IVF?
- How do you Choose an IVF Clinic?
How Long Should It Take To Become Pregnant?
The following chart gives the average time to conception given age:
How Long Should I Wait To See A Fertility Specialist?
When you see a fertility specialist is dependent on age and history of reproductive problems. If there is no conception after unprotected intercourse, the following length of time to see a specialist is recommended:
History of Reproductive Problems
What is Included in the Medical Evaluation for Fertility?
Tests for men include: medical history, semen analysis, possible additional sperm, blood, and cultures tests, plus consultations to assess structural problems or blockages. Tests for women include: medical history, egg quality analysis, testing of ovulation, examining fallopian tubes and uterus, checking cervical mucus.
What is the IVF Procedure?
(Refer to Fertility Language for definition of terms)
You take GnRH agonist medications (birth control pills, lupron) to suppress FSH and LH to control your cycle. You then take follicle stimulating hormones to stimulate the ovaries to produce several eggs in one cycle. You and your partner typically attend a class at your fertility clinic to learn how to administer injections. You have blood tests to check that hormone levels rise as expected, and ultrasounds to monitor the ovaries’ response to the medication. Your dose is based on a prediction of how your ovaries will respond given age, your FSH and estradiol levels, and previous experience with follicle stimulating hormones. Your partner’s sperm is often obtained, frozen, and stored as a “back-up specimen” available the day of egg retrieval.
After approximately 7-10 days on stimulating hormones, your follicles have often matured enough to be retrieved. Ovary response varies, and ranges from 2-3 follicles to as many as 20-30. When it is determined that the majority of follicles have matured, you give yourself an HCG injection. This secures the time of egg retrieval, which is scheduled 34-36 hours later. You then use progesterone by injection and/or vaginal suppository gel to help prepare the uterus for implantation.
During the retrieval, your physician uses a vaginal ultrasound to locate the follicles and guide the needle for egg retrieval. You are sedated enough for the 20-30 minute procedure that you awake without memory of the retrieval.Your partner comes with you for the procedure to contribute sperm for fertilization. The back-up sperm is on hand, in the event your partner is not able to produce sperm “on demand”. If you are using donor sperm, vials were previously shipped to your clinic, and are readily available. You are encouraged to go home and rest the remainder of the day, as you may feel some pelvic heaviness, soreness, and/or cramping.
Fertilization and Embryo Culture
Eggs and sperm are prepared and mixed in the lab by the embryologist. The embryologist incubates fertilized eggs and monitors their development. If there is a problem with the sperm, the embryologist may do Intracytoplasmic Sperm Injection (ICSI), whereby one sperm is injected directly into each egg.
Embryo or Blastocyst Transfer
3 days after your egg retrieval, embryos that have divided into 4-8 cells are transferred to your uterus. Some clinics may wait 5 days after retrieval and transfer at the blastocyst stage. A physician inserts a small catheter holding the embryos through your cervix into the uterine cavity. This procedure requires no anesthesia, as it is brief and fairly painless. For some, assisted hatching is recommended. This procedure helps the embryo hatch out of its outer layer and implants itself in the lining of the uterus. After transfer, you are encouraged to go home and take it easy for 1-2 days, followed by non-vigorous activity until your pregnancy blood test.
Approximately 10 days after your transfer, a pregnancy blood test determines if the embryo(s) have implanted.
The Pregnancy Result Call
If the blood test is positive, you are asked to continue the medication and take a repeat blood test in 2 days to assure that the hormone level is rising as it should. This repeat test measures the expected rise in hormones. If your second blood test is positive with the expected rise in hormone level, you are advised to continue progesterone for 8-10 weeks, and have ultrasounds 4 weeks and 6 weeks after retrieval. You are then transferred to an OB/GYN.
Sometimes the test result is positive but the hormone level atypically low. The nurse asks you to stay on the medication and return for a repeat pregnancy test in two days to see if the hormone level is rising, as it should.
If the test is negative, you are advised to discontinue the medication and seek a Next Step Consult with your physician to discuss treatment outcome and recommendations. It is helpful to take some time for emotional healing, so you are able to process the information from your consultation. At the same time, it is best to not wait so long that you lose your momentum and “fall through the cracks”.
What is the Cost and Insurance Coverage for IVF?
The cost of an IVF procedure ranges from $15,000-$20,000. Extra procedures raise the cost, such as PGD, ICSI, and Assisted Hatching. Insurance plans in most states do not cover IVF; however, always check to determine if you have coverage or partial coverage. Some clinics offer IVF insurance. Advanced Reproductive Care or ARC offers IVF packages at affordable rates, which include financing options, and shared risk packages that partially reimburse patients if a pregnancy does not occur.
How do you Choose an IVF Clinic?
Always choose a reputable clinic, in good standing with American Society of Reproductive Medicine (ASRM) and a long track record doing assisted reproductive technology. Clinic IVF statistics are available on the web. However, these statistics can be misleading. While some clinics accept all patients into their patient population regardless of diagnosis or prognosis, other clinics accept only patients with a good chance of success. This skews statistics. Some clinics offer free educational seminars on IVF and related medical issues and a free phone consult as well. Take advantage of these offerings, so you can be best informed and make the best choices possible.