IVF Phases

Phase 1: Fertility evaluation and stimulation of the woman's ovaries with fertility drugs

The fertility health of both the woman and man is assessed through testing. The woman's egg production is then increased through the injection of hormones and her "cycle" is monitored.

Before beginning an IVF cycle at Sacramento, San Francisco Bay Area or Fremont reproductive health center, your personal infertility physician will conduct tests to evaluate several variables critical to the procedure's success. The first variable in the success of IVF is your ability to respond to fertility drugs. Your personal infertility physician will measure the level of follicle stimulating hormone (FSH) during the first three days of the menstrual cycle, which helps estimate your ability to produce eggs in response to fertility drugs.

The second variable is your uterine environment. Just prior to ovulation, your personal infertility physician will look at your uterine lining by ultrasound (sonogram). Ureaplasma, chlamydia, and gonorrhea cervical cultures will also be taken in certain cases to ensure significant infection is not present.

The third variable is the male's fertility. A physician will analyze your partner's semen at your local Kaiser Permanente medical center in conjunction with your Reproductive Endocrinology and Infertility (REI) specialist.

Women with normal ovarian function usually produce one egg per month. To increase the number of mature eggs available for fertilization, your ovaries will be stimulated with carefully regulated hormone doses, administered by injection. Your infertility physician will monitor your response to these hormonal preparations and track egg development through ultrasound scans and blood tests. Ovulation is then triggered by hormone injections.

During this phase patients will also attend an IVF 101 and Egg class that will provide comprehensive information on the process, expectations, and timing. Each patient will receive a personalized calendar and IVF packet prior to these classes.

Phase 2: Egg retrieval, fertilization, and embryo transfer

Phase 2 typically involves two visits to The Center for Reproductive Health. First, your eggs are retrieved directly from your ovaries and then placed with the sperm in special cultures to fertilize. The embryos develop over several days. You then return to The Center where a physician will transfer the resulting embryos into your uterus.

Egg retrieval is accomplished using a vaginal ultrasound probe to guide a needle into the ovaries. Retrieval usually takes no more than 20 or 30 minutes and patients receive sedation for the procedure.

The egg and fluid from each follicle are collected and carefully examined in the IVF laboratory. The eggs are isolated and placed inside an incubator. Eggs are combined with sperm and left to incubate together in the carefully controlled environment.

Approximately three days after the egg retrieval, the best embryos contain around eight cells each. At Kaiser Permanente, embryos for some patients may be allowed to develop for an additional two days, known as the blastocyst stage. These embryos contain approximately 60 to 100 cells and represent the embryos with the highest potential for establishing a pregnancy. This means fewer embryos may need to be transferred, lowering chances for multiple births, but not lowering the chances for implantation and pregnancy.

The embryo is transferred using a small catheter. Using ultrasound-guidance, the embryos are then placed in the uterine cavity. There is generally very little discomfort. Following the embryo transfer, no extra rest is needed and you can resume your normal daily activities. Hatching and implantation will occur in the next two days.

Phase 3: Follow-up care

After the IVF procedure, you'll return to your local infertility doctor to determine if pregnancy has occurred and talk with him or her to determine the next steps.

You'll receive supplemental progesterone and estrogen to maintain the integrity of your uterine lining. Six to 10 days after the transfer, blood tests are taken. Rising blood levels of the pregnancy hormone hCG indicate that implantation has occurred. Other blood tests follow to confirm normal gestational progression. Clinical pregnancy is tested by ultrasound examination four weeks after the transfer.