In Vitro Fertilization, also known as IVF is the gold standard of fertility medicine. IVF is an Assisted Reproductive Technology (ART) whereby a physician removes one or more mature eggs from the follicles developing inside the woman’s ovaries and then fertilizes those eggs inside the embryology laboratory and later transferred back to the woman’s uterus. Because IVF treatment is the most successful fertility treatment available today, many clients choose IVF both as their first fertility treatment with a reproductive endocrinologist (RE) as well as those who have failed “first line,” fertility procedures.
IVF is used in conjunction with other protocols to successfully treat all cases of infertility including and is suitable for:
- Those with Blocked, damaged, tied, or removed fallopian tubes
- Couples with significant male factor infertility
- Couples with female ovulation disorders
- Couples with premature ovarian failure
- Couples with uterine fibroids
- Couples with genetic disorders
- Couples with metabolic syndrome and PCOS
- Those struggling with idiopathic, unexplained infertility
- women of all ages, BMI, etc.
- ANY and ALL CASES of INFERTILITY
The IVF cycle follows a normal ovulation or menstrual cycle. During a normal or natural cycle, the woman’s body develops only one egg to maturity (sometimes two and three – fraternal twins and triplets). Through the use of medications, a traditional IVF cycle generally aims to stimulate the ovaries into making many mature eggs. By making many mature eggs during the cycle for the physician to harvest, there is a higher chance of creating healthy embryos and achieving a successful treatment. IVF can generally be split into the several following steps to help understand this complex treatment.
An IVF treatment cycle begins with the onset of a menstrual period. To begin treatment, you will first undergo a baseline exam, often referred to simply as a “baseline,” on cycle day 2,3 or 4. This baseline will include blood work and a transvaginal ultrasound that helps establish a baseline reference for your blood hormone levels, ovaries, and follicles.
Ovarian Stimulation and Monitoring
Ovarian stimulation is the process whereby medications are used to help the body produce multiple mature eggs which will then be retrieved by a physician and fertilized by our team of embryologists.
During your baseline, your stimulation protocol will be outlined and reviewed in great detail. You will likely begin your ovarian stimulation the same day as your baseline appointment. The medications for your ovarian stimulation will be administered by yourself or loved ones in the comfort of your home.
To keep track of your follicular and thus egg development, you will be scheduled for monitoring appointments every 2-4 days. During your monitoring appointments, you will have labs taken and an ultrasound performed to measure your follicular development. Once your follicles grow to 13mm and/or your Estrogen level reaches a certain level, the staff will instruct you to begin your antagonist injection (Cetrotide or Ganirelix). Stimulation typically occurs for 8-10 days.
Once the follicles are of maturing size you will then take a single injection of Human Chorionic Gonadotropin (hCG), or Lupron to trigger final maturity of the eggs. The egg retrieval will be scheduled 35 hours after this injection. You should not have intercourse during the time between the trigger injection and the egg retrieval.
Egg Retrieval and Egg Preparation
Egg retrieval is an office procedure whereby a physician will gently aspirate (remove via suction) the eggs from your ovaries. The number of eggs retrieved will depend on your age, history, fertility diagnosis, medication protocol and response to medications. On average, 6-12 eggs are developed for injectable cycles.
This ambulatory procedure requires a sterile environment and mild anesthesia. For that reason, your partner will not able to be present in the room.
Using ultrasound for guidance, a thin needle is passed through the top of the vagina and into the ovarian follicles. The needle enters the follicles and aspirates or removes the follicular fluid which contains the eggs.
As soon as the eggs are retrieved they are carefully transported to our embryology lab (about 40 steps from the retrieval rooms) so that they can be identified by an embryologist and placed in a petri dish with a culture medium. The culture medium is designed to mimic your own body’s fallopian tube secretions. This medium nourishes the egg and the subsequent embryo just as your natural bodily secretions would inside your womb.
Egg retrieval can take anywhere from 5-20 minutes. During the short procedure, you will be monitored by an anesthesiologist who will insure your comfort and safety. Because of the pain medications you will receive that day, you are not able to drive after your procedure.
After the surgery you will rest in a relaxing recovery area. After you are feeling comfortable to walk, you are free to leave and resume mild daily activity (no driving, operating other machinery, or exercising). The day following your retrieval, you can resume your normal daily activity.
Sperm Collection and Preparation:
Sperm collection for IVF is usually provided the morning of the egg retrieval, but can also be collected in advance, prepared, frozen, and then later thawed the morning of the egg retrieval.
If the sperm is being provided by a male partner, it is most often collected through ejaculation into a sterile cup. If necessary, sperm can be collected using more advanced sperm retrieval procedures like a Microepididymal Sperm Aspiration (MESA) or a Testicular Sperm Extraction (TESE). If your male partner is providing the semen sample, we recommend abstaining from sexual intercourse or any means of ejaculation for at least two days.
If the sperm is being provided by a donor, we will need the sperm in our office before the day of retrieval.
Once the andrology lab receives the semen, the andrologist must clean and concentrate the sperm from the larger sample of semen. To do this, the andrologist first places the semen inside of a column which is then spun in a centrifuge. This isolates the population of sperm with normal morphology and higher motility.
After this first step of isolation, the sperm is washed and suspended in a solution that mimics the environment of the Fallopian tubes in the female reproductive tract.
Once this process is complete, the concentrated motile sperm will be transferred to the embryology lab where fertilization will take place.
After retrieving the female’s eggs, an embryologist will immediately begin to identify and sort all of the eggs from the follicular fluid.
It takes about four to six hours after the retrieval to finally mature to the point where they are ready for insemination. Around that time, the sperm will be finishing up their preparation in the andrology lab. Once both of these processes are complete the andrology lab will bring the sperm into the embryology lab for fertilization.
There are generally two methods of fertilization that you will often hear about in IVF procedures: conventional insemination and intracytoplasmic sperm injection (ICSI). Conventional insemination is a process whereby the eggs and sperm are put within close proximity inside of a dish and allowed to fertilize similar to how a sperm would penetrate and fertilize an egg following intercourse. ICSI, on the other hand, uses a microscopic needle to inject the egg with a single sperm. ICSI is responsible for 99% of the embryos we create because it offers the greatest chance of success and at no additional charge.
After fertilization, your embryo development begins. Your embryo will continue to grow in media inside an incubator mimicking the womb’s natural environment until it has been proven to be healthy and ready to be transferred or frozen. During development, an embryologist will examine each embryo individually to check its continued development.
The day of fertilization is referred to as day 0. The goal is to see a two or four celled embryo on day 2, 6 to 8 cell embryo on day 3, and a large ball of cells on day 5 known as a blastocyst.
Embryos can be transferred from day 2 through day 7, but are usually transferred as a cleavage stage embryo on day 3 or as a blastocyst (blast) stage embryo on day 5.
The embryo transfer is a simple procedure that takes only a few minutes. No anesthesia or recovery time is needed. Prior to transfer however, many things can be done to help your body prepare itself to receive the embryos.
To help your body prepare itself for the embryos, you will be given daily progesterone to supplement your own. This additional progesterone starts the day after egg retrieval and continues for at least two weeks. Progesterone is a hormone which transforms the lining of the uterus to be an ideal receptor for the embryos. Many also choose to do acupuncture and or intralipids prior to transfer.
The day of your transfer, one of our practitioners, along with the embryology team, will examine the embryos to determine the best embryo to transfer. By the time of your transfer, we will have reviewed the quantity and quality of embryos made as well as the number of embryos that you would like to have transferred.
During the transfer, the embryos are “loaded,” into the tip of a catheter along with a very small amount of transfer medium. The physician, along with a member of the embryology team and a nurse will confirm the clients identity to insure the embryos are properly matched. The catheter is then gently passed through the cervical canal and into the uterus using an abdominal ultrasound to provide visual guidance during the transfer. The embryos are slowly expelled near the top of the uterus.
After carefully removing the catheter, an embryologist will double check that the embryos indeed left the catheter using a microscope. At this time, a nurse will provide you instructions for the following “two week wait,” and when to come in for your beta pregnancy test.
We generally recommend transferring one embryo in a ESET, or two embryos. If the female is above the age of 35 with multiple failed cycles or with poor embryo quality, we may consider transferring more embryos.
As the number of embryos transferred increases, the chance for multiple pregnancies increases greatly while having very little effect on overall success outcomes. These issues will be discussed prior to your embryo transfer.
Establishing Pregnancy and the Two Week Wait:
About two weeks after transfer, a blood test will be performed to determine if you are pregnant. This can be done at any lab of your choice. Your results should be available the same day.
If the pregnancy test is positive, an ultrasound will be scheduled two weeks later to determine the implantation site and often detects a heartbeat. The heartbeat should be seen by four weeks after a positive pregnancy test. At this time, you will be given instructions regarding progesterone or other medication use.
Once a heartbeat is detected, there is a 90-95% probability that the pregnancy will continue to a live birth. IVF pregnancies are no higher a risk than natural pregnancies. At about 12 weeks into your pregnancy, you can return to your obstetrician for routine prenatal care.
If the pregnancy test comes back negative, you can stop the progesterone. Your period should start in a few days.
You can begin another IVF cycle as soon as you like.
There are several factors to consider before deciding on how many IVF cycles you may try before moving on to other treatments. These factors include your response, age, previous IVF cycles and the number of years you have been experiencing infertility. Just because you may not become pregnant after one, two or even three tries, does not automatically mean your chances of becoming pregnant are slim.
As with everything in life, persistence is key. Because CNY Fertility offers high success rates at an incredibly affordable cost, you may have a chance to pursue the multiple cycles necessary to attain a pregnancy where you may not be able to otherwise.
IVF costs $3,900. What’s included:
- ICSI fertilization
- assisted hatching
- ONE fresh embryo transfer. Frozen Embryo Transfers will be discounted to $250 per transfer within your first year. After one year, FETs are $1900.
- cryopreservation & storage of remaining embryos for up to 12 months
The monitoring for an IVF cycle is $850. If you choose to do monitoring with us, that would bring your total to $4,750.
We offer in-house financing for up to two years allowing you to make payments as low as $240/month. Our in-house payment plans are interest-free, but we charge an account maintenance fee of $250 per 6 months financed (roughly $40/month).
Medications are not included in the cost of our IVF cycles. You will purchase your medications through a pharmacy. The cost of your medications varies greatly depending on your treatment plan, but the following can be used as a general guide:
- Natural cycle: no medication costs
- Trigger only cycles: few hundred dollars
- Donor cycles & FETs: $1200
- “Mini”& low dose injectible cycle: $1500
- Injectable & fully medicated cycle: $2,000-$5,000
Below is preliminary data for 2016 which is the most recent complete year we have on record. Unfortunately, even IVF, the gold standard of fertility care, is not a sure deal. At CNY, we believe persistence is key, and with our payment plans that allow you to pay monthly fees of around $200/month and FETs only costing $250 for the first year after your retrieval, pursuing multiple embryo transfers is a real option.
The data below is constructed so that you can better see your success rates for multiple transfers.