The First Steps of IVF

In vitro fertilization is a complex sequence of procedures used to assist with fertilization and conception of a child. While experts say it is the most effective form of assisted reproductive technology, it's still a big decision that can come with some trepidation.

If you’re considering IVF (either with a partner or solo) read on for a better understanding of the first few steps you’ll encounter in the process. (There’s a lot to take in, so it can be helpful to break it up into smaller bits.) Desireé McCarthy-Keith, MD, MPH, medical director of Shady Grove Fertility Atlanta board certified in Obstetrics and Gynecology, Reproductive Endocrinology and Infertility, shares her expertise on what to know and what to expect when beginning the IVF journey.

Who is a Good Candidate for the IVF Cycle?

A good candidate for IVF success has healthy egg quality and reserve and normal sperm from a partner or donor. Egg reserve is assessed by ultrasound of the ovaries and blood testing for anti-Mullerian hormone (AMH) and follicle stimulating hormone (FSH) levels. Sperm function is measured by microscopic semen analysis. Ultrasound is also performed to evaluate the shape and size of the uterus and development of the uterine lining where an embryo will implant.

What Should Someone Look for in a Fertility Coordinator and Facility?

You should seek a fertility clinic with well trained and experienced healthcare physicians and embryologists. You can review the facility’s treatment success rates and clinic reviews online, and also ask for referrals from your trusted gynecologist.

Before Moving Forward with the IVF Process, What Should be Considered?

You should consider the qualifications of the clinic that you choose to work with and look for a clinic which is supportive and patient focused. While many patients focus primarily on the financial preparations for IVF treatment, it is equally important to ensure that you are physically, emotionally, and psychologically prepared. Going through fertility testing and fertility treatment (as well as the side effects) can be stressful and emotional, so ensuring that you have a good support group and effective ways to cope with the ups and downs of treatment is key.

Are There Ways to Prepare Physically and Emotionally Before Starting Treatment?

I always encourage patients to optimize their overall health before starting treatment. I recommend following a healthy diet with prenatal vitamins and folic acid supplements, plenty of fresh fruits and vegetables, and less processed foods and animal products. Starting treatment at a healthy weight increases the chances of success. Patients should quit smoking or avoid tobacco products and excessive alcohol as they prepare their body for a healthy pregnancy. Psychological counseling is an effective way for patients to foster their mental health and receive support before, during and after treatment.

What Happens in the Treatment Stage with Pituitary Suppression?

During IVF stimulation, hormone injections are administered to prevent ovulation. These injections must be given daily, along with injections to stimulate the ovaries. Once egg retrieval is planned, these medications are discontinued and another injection is administered to “trigger” the final preparation of follicles for retrieval.

It is typical to experience hormonal symptoms during IVF, which may include headache, breast tenderness, abdominal bloating and mood changes.

Once Ovarian Stimulation has Started, How is the Response Measured?

Hormonal injections are administered daily to stimulate follicles/eggs to develop. Typically, 10-14 days of daily injections are required in order for eggs to fully develop and mature. During the 10-14 days of injections, the ovarian response is measured with pelvic ultrasounds to measure the sizes of growing follicles, and with blood testing of estrogen levels. Treatment response may be measured for additional days and some cycles may be cancelled if response is very low.

What Happens During the Trigger Injection?

The trigger injection is given when follicles are the appropriate size, typically 18-20 millimeters each. Typically, follicles reach this size after 10-14 days of ovarian stimulation.

The trigger injection must be administered 36 hours before the egg retrieval is performed. In the interval from trigger shot to egg retrieval, the final maturation of the follicle occurs, and the egg is released into the fluid environment of the follicle. The trigger shot is time sensitive and is a critical step in the IVF process.

Are There Patient Prep Protocols for the Future Egg Retrieval Process?

Patients should be rested and well hydrated prior to the egg retrieval. They will be instructed to have nothing to eat or drink after midnight the evening prior to the procedure. They should adjust their personal and work schedules to allow for 1-2 days of light activity and recovery after the procedure.

I encourage patients to visit www.fertilityoutloud.com where they can seek help from a fertility specialist, find out information about cost and insurance coverage, and get advice from a community of others who are struggling with infertility. Just in time for the holiday season, Fertility Out Loud is also launching new resources for patients and their loved ones on how to deal with insensitive comments from well-meaning friends and family surrounding infertility.

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