In Vitro Fertilization

About IVF

There are several acronyms to fertility treatment including IUI, CCS, SET, AMH and of course IVF. In vitro fertilization or IVF is the procedure most people commonly associate with fertility treatment. While not every patient is right or ready for IVF, it has been demonstrated to be a highly effective option for many with over 200,000 IVF cycles performed by US fertility clinics alone in 2015.¹

Patients are often graduated to IVF based on a number of factors including age, genetic disease, recurrent miscarriage, medical history, or issues related to sperm and egg quantity and or quality.  Your IVF cycle is closely monitored by your expert RMANJ care team and consists of several key steps.

IVF At-A-Glance

  • Ovarian Stimulation – patient will undergo daily injections of various medications over 8-12 days to stimulate multiple eggs in the ovaries. Once the egg(s) reach the proper size, the patient receives a final injection of hCG (human chorionic gonadotropin) to spur final maturation of the eggs. Patient’s eggs are retrieved 36 hours later.

  • Egg Retrieval  under anesthesia and using ultrasound guidance, the patient’s eggs are retrieved and sent to the IVF lab for fertilization. The egg retrieval process generally takes 15 minutes to complete and the patient is able to go home same-day and usually within a matter of hours.
  • Extended Embryo Culture – developing embryos are allowed to grow in the IVF laboratory for 5-6 days until they reach the blastocyst stage of development – growing to about 200 cells. RMANJ is an exclusive blastocyst stage culture IVF laboratory. Published data supports improved implantation rates and outcomes with extended embryo culture.

  • Embryo Transfer (ET) / Frozen Embryo Transfer (FET) – about 5-6 days after the embryo has grown the the blastocyst stage of development, it is transferred back to the uterus to implant and hopefully become a healthy pregnancy and delivery. However, at RMANJ frozen embryo transfer is the standard of care for all IVF patients. FET’s allow a more natural transfer experience by safely cryopreserving or “freezing” the embryo and waiting until the patient’s hormone levels return to a more natural state and ready to receive the embryo, usually on their next cycle – usually 30 days later.

    Not only have FET’s shown to increase implantation rates but support improved obstetrical outcomes including higher birth weight deliveries and lower risk of prematurity vs. fresh embryo transfer cycles.

  • SelectCCS / Comprehensive Chromosome Screening (CCS) – as an option for IVF patients, it allows are more evidence-based approach to select which embryos to transfer during IVF. CCS your care team to evaluate which embryos have the right balance of chromosomes and which are imbalanced. Embryos which are imbalanced, too few or too many chromosomes, will likely lead to a failed IVF cycle or miscarriage. RMANJ only uses The Foundation for Embryonic Competence, a non-profit reference laboratory for embryonic screening.

  • Embryonic Biopsy – if patients opt-in for genetic screening a sample of genetic material must be biopsied from the embryo for analysis  Embryonic biopsy is a highly technical process and requires a skillful embryologist to  perform the biopsy. Since 2010 RMANJ only performs blastocyst stage embryo biopsy. Published data supports that blastocyst stage biopsy at the trophectoderm layer of the embryo is a safer method than cleavage stage embryonic biopsy.

¹. Source: www.sart.org

IVF Process Overview

Consultation and Work Up

Your RMANJ care team will work with you to design a customized IVF treatment plan in NJ that addresses the clinical and/or physical factors and barriers to achieving a successful pregnancy and delivery. Once a comprehensive work-up of your hormone levels and physical examination have been conducted, your care team will start your IVF cycle.

Stimulation

Daily subcutaneous gonadotropin injections are given to stimulate production of multiple oocytes (or eggs) rather than the single egg normally produced by the body each month. The stimulation process may continue for 7-10 days, during which your RMANJ care team monitors your fertility treatment progress personally with ultrasound examinations and blood work over several days. Once the follicles containing eggs have reached an appropriate size, typically around 18mm, a single and critically timed injection of hCG (human chorionic gonadotropin) is used to help final maturation of the eggs and spur ovulation.

Egg Retrieval

Thirty-six hours after the hCG injection, the eggs are removed from the ovaries. The process of egg retrieval is a short 30 minute procedure performed in our office. Anesthesia is administered to ensure patient comfort during this process. Doctors direct a needle into the follicles of the ovary, guided by an ultrasound probe, to retrieve the eggs. Most women are able to return home an hour or so after the procedure.

The patient starts injections or vaginal delivery of progesterone following retrieval to prepare the uterus for implantation of the embryo about 5-6 days later.

Development

At this point eggs are mixed with sperm provided by the partner or donor to initiate fertilization of the egg and embryo development.  In cases where male factor has been identified, a single sperm can be injected into each egg by a process called Intra-Cytoplasmic Sperm Injection (ICSI). Over the next few days, your RMANJ team will keep you updated as embryos develop.

Where fertilization has been successful and an embryo(s) have developed, genetic testing and biopsy of embryos may be indicated using the SelectCCS platform. Only at Day 5 or blastocyst stage is it safe to biopsy the embryo to collect genetic material for any testing. Based on scientific evidence, RMANJ only performs blastocyst biopsy.

Once the embryo development process is complete and viable embryos have been selected, you will come back to the office for your embryo transfer 5-6 days after retrieval.

Learn more about Select CCS.

Transfer

RMANJ will transfer no more than two embryos into your uterus using a catheter, which is inserted through the cervix. Doctors use ultrasound to help guide the catheter to ensure appropriate placement.  Single Embryo Transfer (SET) is increasing at RMANJ based on effective embryo screening technologies.

After the embryo transfer, you will continue progesterone therapy until about 14 days after egg retrieval, when a pregnancy test is done. If a pregnancy is confirmed, you will continue progesterone for another three to four weeks until your placenta begins to produce enough progesterone to support the pregnancy on its own.

Learn more about Single Embryo Transfer (SET).

For more information on In Vitro Fertilization (IVF), please contact us today.