The IVF process is very complex and can be overwhelming as you start to learn more about it. To help provide information about infertility, what it means to be infertile, and what to do if you think you may be infertile, Circle Surrogacy partnered with Dr. Vicken Sepilian, infertility specialist and reproductive endocrinologist, at Pacific Fertility Center Los Angeles for the content of this post.
Circle Surrogacy works closely with the wonderful staff at PFC-LA on surrogacy and egg donation parenthood journeys through our Boston, San Francisco, and New York offices.
What is the IVF process step by step?
Our team recommends you set your fertility goals and evaluate any barriers and opportunities in achieving those goals. Your REI (specialist in reproductive endocrinology and infertility) will help you navigate the IVF process. Your REI will recommend testing for hidden issues and evaluate your medical health to create a treatment plan.
Step 1: Menstrual Cycle Monitoring & Egg Development
Treatment usually starts with your menstrual cycle and a baseline ultrasound to make sure the ovaries are ready for stimulation. Daily injections of stimulation hormones develop multiple eggs. Egg development is monitored on ultrasound every few days over the next ten days. A typical schedule for ultrasound is on days 0, 5, 8, 10. Plan to be in our office for about 45 minutes on those days.
Step 2: Egg Retrieval
Retrieving the eggs is a simple process done under a mild anesthetic. A retrieval is much like having your blood drawn. A needle is placed into the ovary under ultrasound guidance and fluid is removed from the follicles. Since the ovaries are fairly sensitive, a mild anesthetic makes the process easy. Egg retrieval takes about 15 minutes. With prep and recovery, you’ll be in the procedure center for 2 to 3 hours.
Step 3: Egg Fertilization
In the lab, eggs are inseminated with sperm and cultured. The first signs of fertilization appear the next morning. Embryos are then cultured for 5 to 7 days.
Most of our patients elect to have their embryos screened for chromosome errors, using a technique called pre-genetic testing for aneuploidy (PGT-A). We use a laser to open the zona, a sort of a shell covering the egg, and a few embryo cells hatch out. Those cells are sent to a genetics lab and the embryo is cryopreserved. Test results return about 10 days later and we talk about the embryo quality and chromosome tests.
Step 4: Embryo Transfer
The next step is the transfer. The uterine lining looks its best after a menstrual cycle at about cycle day(s) 12 to 14. The ultrasound should show a trilaminar pattern of at least 8mm. If the lining looks good then the transfer is scheduled for a week later, about day(s) 20 to 21 of the cycle. Progesterone is typically used to help support the pregnancy.
A pregnancy test is taken 9 days after the transfer; if positive (which, more often than not, they are) you are on your way!
How long should you try to get pregnant before IVF?
You can seek a fertility assessment at any time. Your REI can help you sort out your personal fertility plan and help you achieve those goals. One of the best times to see your REI is before you are trying to get pregnant to get ahead of any underlying issues. The guidance on trying to conceive for 6 months or a year before seeking help is no longer valid.
When should I consider using an egg donor?
There are several reasons to work with an egg donor. When eggs no longer work or are not available, an egg donor is the easy solution. A woman may consider using an egg donor at an older age, particularly in her mid-40s. In younger age groups, if the IVF process is not successful or due to diagnoses such as premature ovarian failure, egg donation is helpful. A single man or gay couple will require an egg donor to complete their family. (Circle Surrogacy discusses exploring egg donation in a related blog post.)
When should I consider using a surrogate?
A gestational carrier is helpful when the uterus is unable to support a pregnancy. Sometimes the uterus can be damaged, for instance medical conditions like scar tissue (Asherman Syndrome) or significant fibroids where surgery is not an option. Some women are born with ovaries but no uterus and benefit from gestational carriers. Some medical conditions, like pulmonary hypertension or aortic stenosis result in a medically risky pregnancy, and working with a gestational carrier is safer. A single man or gay couple will require a gestational surrogate carrier to complete their family.
What drugs are used for IVF?
IVF medications are hormone medications, FSH and hCG. These hormones are naturally produced by the body and the medications are versions of these hormones. The hormones are injected in the belly on a daily basis for 10 to 12 days. A tiny needle is used, and almost all of our patients self-administer. Most patients feel fine on these medications, after they get used to using the needles. The discomfort that you feel depends on the number of eggs developing in the ovaries.
What type of support is available for me if I’m struggling with infertility?
You may contact the offices at Pacific Fertility Center Los Angeles at any time, and we will be more than happy to guide you along your journey toward becoming a parent.
While infertility is often a difficulty and anxiety-provoking condition, the overwhelming majority of couples and individuals will be able to overcome it with the proper evaluation and treatment. You can reach out to Brittany at PFCLA by email or by calling (310) 209-7700.
What Is the IVF Process was written by Dr. Vicken Sepilian
Reproductive Endocrinology and Infertility