This is a lengthy, stressful, expensive journey without guarantee for success. This is also a quest for the most precious reward that a couple may ever seek- a baby. My role as a physician is to guide you confidently and competently from start to finish, trying to reduce unwarranted stress and apprehension. Good preparation is very important, as with any important journey. Once the physician determines that IVF is medically appropriate, the couple must then determine if IVF is the appropriate procedure for them from their own ethical, spiritual, physical, and financial standpoint. An extensive consultation with a qualified physician is therefore warranted.
Preliminary evaluation for IVF must include evaluation of the uterus and fallopian tubes, preferably by hysterosalpingogram (HSG, x-ray of the uterus and tubes) or sono-hysterogram (ultrasound with fluid). Abnormalities of the uterus such as fibroids, polyps, scar tissue, or distortions from birth must be repaired before the IVF procedure. If the female partner is older than age 35, evaluation of her ovarian reserve should be performed, usually by a blood test for the hormones AMH and FSH and assessment of antral follicles by ultrasound. Poor or marginal ovarian function merits serious consideration for alternatives to IVF with the female partner’s eggs, such as egg donation or adoption. A special semen analysis performed under the same conditions as during the IVF process (the semen “IVF screen”) should help in determining whether conventional IVF, or IVF with intracytoplasmic sperm injection (ICSI), is appropriate.
At our institution, the couple is asked to attend an IVF class, where one of our nurses and one of our embryologists explain the “nuts and bolts” of the IVF process in detail. This is a 1-2 hour class, usually attended by several couples, that our patients have found extremely helpful in clarifying the process. Each couple will then individually communicate with one of our nurses about their own start time, approximate egg retrieval and embryo transfer dates, and the specific ovarian stimulation protocol for them. Financial arrangements must be made prior to starting the process. A bank loan program is available for couples. They should contact Bennett Fertility Institute (405-949-6060) if interested.
The IVF process usually lasts 7 weeks. The female partner will be seen only twice during the first 5 weeks. These 5 weeks are the “ovarian suppression” period, where usually birth control pills (3 weeks) and Lupron daily injections (2 weeks) are taken. In the first few days of the designated menstrual period for cycle start, the patient is seen for an ultrasound and transfer catheter trial. This is called “mapping and mock cannulation“, a “dress rehearsal” to the actual embryo transfer on week 7. Four to five weeks later, another ultrasound is performed (“suppression check“) to ascertain that the ovaries are now at a state of rest prior to stimulation with fertility injections.
Week 6 is a busy one. The patient will take several injections per day to stimulate the formation of several eggs in the ovaries. She is usually seen 4 times for brief visits consisting of an ultrasound and blood work. On week 7, egg retrieval and embryo transfer will take place. The egg retrieval procedure is performed under IV sedation and lasts 20-40 minutes. Under ultrasound guidance, while the patient is asleep, a needle will be inserted twice in the vagina and ovarian follicles containing eggs will be emptied. After approximately one hour of recovery, the patient will go home, usually resting for several hours before resuming activities. Three to five days later, embryo transfer will be performed while the patient is awake. This simple procedure, similar to the “mock cannulation” earlier, lasts 10 minutes. The patient will then rest at home for 2 days. The pregnancy test is performed 14 days following the egg retrieval procedure.
