IVF Cycles

The in vitro fertilization approach to assisted reproduction has proven to be effective for patients with the absence or blockage of fallopian tubes that can't be repaired surgically. Couples with infertility related to severe male factor issues also may benefit from IVF. Those who have other causes of infertility such as endometriosis or who have unexplained infertility may be candidates for IVF cycles as well. There is no specific age limit for couples who may be participate in an IVF cycle at the Fertility Center; however, patients over age 40 have decreased chances for success without donor eggs.

Each month, two consecutive weeks are designated by the Fertility Center as a retrieval week 
and a transfer week. Patients who have been screened, approved and prepped to participate in that month's IVF Cycle are divided into two groups. This coordination allows appointments to be staggered and ensures that adequate space is available in the embryology lab's incubators. 
An average of a dozen couples are involved in each cycle.

Prior to an IVF cycle, most female patients use birth control to delay the start of their menstrual cycles.  Women also are encouraged to take one baby aspirin a day along with prenatal vitamins. Both men and women undergo a round of prescribed oral antibiotics. Full-body massages are recommended for women to help increase blood circulation and relaxation and chances for success. Ideally, one massage should be scheduled just before starting stimulation medications with a second massage between egg retrieval and embryo transfer.

Patients are instructed when to stop taking birth control pills. Spotting or breakthrough bleeding may occur for several days and is normal as the pills are discontinued. Each patient schedules a baseline vaginal probe ultrasound scan and lab appointment to ensure the ovaries are quiet and estrogen levels are low. At the onset of an IVF cycle (which is about 10 days prior to retrieval week), one group of patients begins stimulation medication injections on Saturday; the remainder start injections on Sunday.

Three days after starting stimulation meds to help egg follices grow and mature, each patient is scheduled to have blood drawn in the lab at the Fertility Center to check hormone levels. Each patient also will have an ultrasound scan to measure and evaluate the growing ovarian follicles. These scans and labs continue every other day and possibly daily closer to the day of retrieval. Other medications may be added to the daily medication regime based on hormone levels and the size of follicles.

Each time a patient visits the office for a scan and labs, she will receive a voicemail message after 6 p.m. that day with instructions about her results and directions for altering her medication, if necessary.  Sometimes a patient will continue taking the same dose of medication; other times the dose may be increased or decreased. To access the Fertility Center’s voicemail system from any phone at any time, just dial 423.899.0500, press 4, then press 1 and enter your seven-digit home telephone number (without area code). Your phone number is your identification code. Listen to the message, which will include your lab results along with instructions about what to do next, then hang up.

Most patients require an average of 7 to 10 days of stimulation before their follicles are adequately sized. At that point, a “trigger” injection is given to signal the eggs within the follicles to mature and eventually release. The goal is to allow for the maturation of the eggs, and then capture those eggs before they are released through natural ovulation. Each patient is instructed to take her "trigger" injection at a specific time, and her egg retrieval procedure is scheduled 36 hours later.

The eggs are retrieved while a patient is under anesthesia, then fertilized with sperm in the lab to create embryos. After about five days of growth and division, a transfer procedure returns the best one or two viable embryos to the patient's uterus, which has been supplemented with progesterone. Each patient returns to the Fertility Center for a progesterone level check a few days later and then for a pregnancy test nine days after transfer.

Patients who participate in a cycle using cryogenically preserved or "frozen" eggs or embryos bypass the stimulation, trigger and retrieval stages of the IVF process. In addition to repeating any out-of-date labs, female patients use adhesive estrogen patches to prepare the uterus. Scans and labs help determine the best time for the doctor to schedule the transfer of "thawed," fertilized and prepared eggs or thawed and prepared embryos. As with "fresh" embryo cycles, a frozen transfer is followed by progesterone supplementation. Male patients are encouraged to lend emotional support and typically choose to be in the room when their wives become pregnant during a frozen embryo transfer, but nothing clinical is required from men during a frozen cycle.

* NOTE: Women taking stimulation medications may experience symptoms of Ovarian Hyperstimulation Syndrome, a condition that causes swollen and painful ovaries. In rare cases, fluid may accumulate in the abdominal cavity and chest, causing bloating, nausea, vomiting or lack of appetite. Patients are required to be frequently monitored by ultrasounds and blood tests to minimize risks of hyperstimulation and resulting complications while taking these medications. About 10 to 20 percent of patients undergoing ovulation enhancement will have a mild case of hyperstimulation syndrome. In these cases, all embryos from the retrieval of the cycle are frozen until hyperstimulation is resolved. Then the embryos can be thawed and transferred into the uterus. Odds for achieving pregnancy are about with same with either fresh or frozen embryos. Less than one percent of all patients that experience ovarian hyperstimulation have a case severe enough to require hospitalization. The condition tends to resolve itself within a couple of weeks, unless pregnancy occurs. If pregnancy does occur, the condition is usually aggravated by the increase in pregnancy hormones. Ironically, Ovarian Hyperstimulation Syndrome is less common in IVF pregnancies than in unassisted conceptions, most likely because the follicles are emptied of fluid and cells during the egg retrieval.