What to Expect During IVF
By Meg Lundstrom
Step by step, here's what you'll typically experience while trying to conceive a child with in vitro fertilization.
1. The intake interview.
If initial fertility treatments such as fertility drugs or surgery fail and you decide to move forward with IVF, your ob/gyn will refer you to a reproductive endocrinologist. During your initial meeting with the doctor, you'll discuss your medical and fertility history, and that of your partner, to determine which treatment protocols will work best for you, as well as what you can do to improve the odds of a healthy birth.
2. Preliminary tests and talks.
You'll undergo ultrasound and blood tests to determine the number and quality of your eggs. You'll also meet with a nurse to learn how to self administer fertility drugs, a financial counselor to work out payment, and a psychologist to discuss coping with any stress that might arise.
3. Drugs to induce egg growth.
To stimulate your follicles to grow as many eggs as possible during your cycle, for about two weeks you'll give yourself one to three daily injections of fertility medications (such as GonalF, a folliclestimulating hormone, and Repronex, a luteinizing hormone) in your thigh or stomach. Either before your cycle or midway through, you'll also inject a gonadotropinreleasing hormone (GnRH) drug such as Lupron, which prevents you from ovulating too early. Around day 12, you'll inject the drug human chorionic gonadotropin (hCG) to stimulate ovulation and precisely time the final burst of egg growth. During these two weeks, you'll visit the clinic about five times for blood and ultrasound tests to monitor your progress.
4. Egg harvesting.
In a carefully targeted window of time — shortly before doctors calculate that your eggs will be released through the fallopian tubes during ovulation — you'll be heavily sedated and, using ultrasound as a guide, your doctor will pull eggs out of your ovaries with a hollow needle inserted through the wall of the vagina. In the meantime, your partner, in a nearby room, will ejaculate into a cup to obtain sperm, which the lab will then quickly process to extract the most robust ones. The sperm and eggs are then mixed together in an incubator so insemination can occur. If necessary — for instance, when sperm count is low or the sperm are having difficulty penetrating the egg — the lab embryologist might also perform intracytoplasmic sperm injection (ICSI), a procedure in which sperm are injected directly into an egg. If you are over 40 or a previous IVF attempt failed, he might also puncture the outer shell of a resulting embryo shortly before transferring it into the uterus so it can implant itself more easily, a process called assisted hatching.