IVF 101

IVF isn’t something we learned about in school when learning about the birds and the bees. You’ve heard the acronym “IVF” hundreds of times in the media and it seems like many of your friends needed IVF to get pregnant but aside from leading to “test tube babies,” most don’t really know what IVF involves. IVF is a type of treatment that involves taking eggs from a woman’s body, creating embryos with sperm and putting embryos into a woman’s uterus. That sounds kind of complicated, I know. I’m going to break it down in the simplest terms possible.

Every woman has a set number of eggs that she can potentially ovulate every month. We ovulate 1 and we lose the rest. You can never use them again. Every woman’s “potential” number of eggs that she can ovulate declines as she ages. This number is different from woman to woman. For example a woman going through IVF at the age of 25 could have 30 eggs retrieved whereas a woman going through IVF at the age of 42 could have 4 eggs retrieved. How do you know what your potential number of eggs could possibly be? The way we can assess your potential number is by looking at your ovaries and counting the number of antral follicles you have.

Antral follicles look like small black circles on your ovaries. Each black circle represents a fluid filled sac that contains 1 egg. Eggs are microscopic. We can’t see eggs on ultrasound. When you take medications during an IVF cycle you are taking medications that will make the follicle size grow and the egg mature. The follicle size is a reflection of the maturity of the egg inside. We know that eggs tend to be mature when the follicle reaches close to 20 mm in size. Why do we care if an egg is mature or not? Only mature eggs can be fertilized by sperm.

The way I explain IVF to patients is this: IVF is a 6 week event in your life – from start to when you find out you’re pregnant. You take medications to quiet your ovaries, followed by medications to stimulate your ovaries followed by medications to support a pregnancy. Your doctor calculates a dose of medication that she thinks is right for you based on your age, antral follicle count and how you’ve responded to previous fertility treatments.

During the time of stimulation, expect to see your doctor for frequent ultrasound and blood draws to monitor how you’re doing on the medications. After about 10 days of stimulating medications, you will take a shot to trigger ovulation. Since you are taking a medication to prevent ovulation, the eggs will not leave the ovary. The shot that we use to trigger ovulation is actually pregnancy hormone. The egg retrieval is performed 36 hours after this shot is given.

The egg retrieval is a procedure that can be done in usually under 30 minutes. Most clinics do egg retrievals with an anesthesiologist present. Medications to help you fall asleep and treat pain will be given through an IV line placed in your arm. When you wake up after the procedure you won’t have any memory of the procedure. While asleep, you will be placed in stirrups much like the stirrups used during your pelvic ultrasounds. Your egg retrieval is just a pelvic ultrasound but during the ultrasound, your doctor will place a needle alongside the probe and under ultrasound guidance, will place the needle in the follicles of the ovary. The fluid in each of the follicles is then aspirated and goes directly into a test tube. Test tubes filled with follicular fluid are then handed to the embryologist who then examines the fluid for eggs.

The eggs are then placed in culture dishes and either injected with sperm (called ICSI=intracytoplasmic sperm injection) or inseminated with sperm (just placing a small droplet of sperm over the egg). The culture dishes are then placed in an incubator. The embryos are then transferred 3-5 days after the egg retrieval. Your doctor will discuss with you whether you should have a transfer done – either 3 days or 5 days after the retrieval.

An embryo transfer is done like a PAP smear except a catheter loaded with your precious embryos will be passed through your cervix into your uterus. Most clinics will ask you to have a full bladder so that an ultrasound probe can be placed on your belly to allow the doctor to see exactly where the embryos are being transferred. You will then lie down to let the embryos nuzzle into place.

I consider myself an egg rescuer and a chef. I rescue the eggs of my patients and create the absolute best recipe possible to make the best situation for all my patients’ fertility situations. So while Diego is the animal rescuer, Dr. Aimee is the egg rescuer!

Dr. Aimee Eyvazzadeh is a native of the Bay Area. She is a graduate of UCLA School of Medicine. After completing her residency in Obstetrics & Gynecology at Beth Israel Deaconess Medical Center and Harvard Medical School, she completed a fellowship in Reproductive Endocrinology & Infertility at University of Michigan. She also completed a Masters in Public Health in Health Management and Policy at University of Michigan.Dr. Aimee is board certified by the American Board of Obstetrics and Gynecology and continues to contribute to research in the field of reproductive endocrinology and infertility. You can learn more on her website:www.draimee.org.