Whether you’re just starting to research fertility treatments or are already a patient planning to begin IVF, knowing more about the process can reduce any anxiety and help you feel more prepared for treatment. You are not alone on your fertility journey. We are here to help you have a baby.
After making an appointment with our office, we will send your username and password for the patient portal. Please complete the History Form (Patient Evaluation) on the patient portal. If you have copies of relevant medical records, please emailed to [email protected]. The medical records release form can be found on patient welcome kit page 2. This enables our doctors to assess your personal case history as well as evaluate your medical information before your visit.
* You must complete the patient history forms on the Patient Portal before you can see the physician. Please be advised that we designate ALLcare’s waiting room as a child-free area. Out of respect for our current patients and with concern regarding influenza transmission, we request that you do not bring children to your appointments.
The first consultation includes a 45-minute comprehensive evaluation with our doctor. He will discuss with you your personal health history, medical records and possible diagnostic and treatment options.
You will then have the opportunity to address any questions or concerns regarding these options. After the prescribed tests have been completed, a follow-up is scheduled to review the results and formulate the treatment plan best suited to your needs.
You will also have time to talk with our billing department. Our experienced staff will help you to check if your insurance covers your treatments. If not, you may choose our affordable self-pay price or packages.
During the ovarian stimulation phase, you will come into the office approximately seven to eight times for morning monitoring. Monitoring includes a sonogram and bloodwork. A sonogram measures each follicle that contains an egg and the thickness of the uterine lining, both of which should be increasing as you take the medications. Blood is drawn and tested to measure your hormone level.
After each monitoring, you will receive a phone call or an email from our nurse, usually in the afternoon. During the update, the nurse will explain to you the progress of your cycle, any medication modifications, and when you should return for the next monitoring appointment.
The stimulation phase ends with a trigger shot. The trigger shot provides final maturation to the developing follicles and sets ovulation in motion. Timing is crucial in this phase because the egg retrieval must be performed prior to the expected time of ovulation. The doctor decides when you are ready to trigger.
Egg retrieval occurs approximately 36 hours after the trigger shot. Your partner’s (or donor) sperm is either collected the day of the retrieval or previously frozen sperm will be thawed and used.
Usually we offer local anesthesia. If you choose to use general anesthesia, you will meet with an anesthetist who will review your medical history and start an intravenous (IV) that will deliver the anesthesia medication.
The egg retrieval itself typically takes about 20 to 30 minutes. During the procedure, an ultrasound is used to guide a needle into each ovary to remove the follicular fluid and egg.
Prior to embryo development, fertilization must occur. There are two methods used for fertilization:
Conventional fertilization is a standard method used during the IVF process. The embryologist starts by “washing the semen,” allowing him/her to isolate the healthy sperm, which are placed around each egg so fertilization can occur.
ICSI is used in cases where the quantity or quality of sperm is poor and therefore unable to effectively penetrate the egg on its own. The embryologist selects a single sperm and injects it directly into the center of each egg.
The decision about which method to use is based on the quality of the sperm. To test sperm, a semen analysis and diagnosis is completed as part of the initial basic fertility work-up. We ask our patient’s partner to finish semen analysis in-house. We also recommended that once you get the semen analysis report, you consult with your doctor regarding the kind of insemination method (natural or ICSI) to use in your cycle.
Embryo development begins when the fertilized eggs are placed in an incubator overnight. Then, every morning for the following 3 to 5 days, an embryologist examines each patient’s developing embryos. The embryologist records any changes that have occurred since the previous day and adds them to the patient’s electronic record.
The goal is to see the slow and steady development of a 4-cell embryo, on the second day of development, into an 8-cell embryo on the third day. After the 8-cell stage, cell lines begin to blur and the embryo enters what is called the blastocyst stage at day 5 or 6. The blastocyst has a protective jelly-like shell called a zona pellucida and defined areas of cells within. The organization of what is called “the inner cell mass” is a key indicator of how likely the embryo is to implant.
The embryo transfer is a simple procedure that takes about 5 minutes to complete. There are two kinds of transfers, fresh transfer or frozen transfer (you may need to choose one or the other at the beginning of the cycle). When your embryo transfer is scheduled, your nurse will notify you and provide specific instructions on when to arrive and how to prepare. Our transfer procedure is guided visually on a monitor with a vaginal sonogram. That means you don’t have to keep a full bladder.
Typically, there’s no anesthesia or recovery time needed following an embryo transfer. You’ll be given instructions for the next 7 days and come back to do a pregnancy test.
About 9 days after a day-3 embryo transfer, and 7 days after a blastocyst transfer, a patient should have a quantitative beta hCG blood pregnancy test performed. When a positive pregnancy is determined, you’ll be asked to repeat the test in 2 days. If at the second pregnancy test the hCG level doubles, another beta may be ordered between the 5th and 6th week of gestation. If all four pregnancy tests indicate a pregnancy, then a vaginal sonogram will be scheduled between the 7th and 9th week of gestation. At that time, your doctor will be looking for a gestational sac and heartbeat to confirm the pregnancy. Around the 9th week of gestation, patients “graduate” from Legacy IVF and are referred back to their OB/GYN for continuing obstetric care.
If the cycle results in a negative pregnancy test, it is, of course, very disappointing. It’s important to remember – you have a treatment plan with options for trying again. Our medical team will instruct you to stop your medications and offer to schedule a consultation with your doctor. During this meeting with your physician, you’ll discuss the cycle, any changes that can or should be made to your protocol and ultimately determine how you want proceed.