IVF: In-Vitro Fertilization

Pricing Guidelines

In-vitro fertilization (IVF) is one of the most effective techniques available for improving your chances for a pregnancy and treating infertility issues. At UCRM, our boarded certified endocrinologists and reproductive medicine specialists work closely with our patients to guide them through their journey and provide the best outcomes possible. IVF treatment is detailed and involved, but our physicians, nurses and staff are here to help explain the process and answer any questions you may have.

The Utah Center for Reproductive Medicine is conveniently located in Salt Lake City, UT. We treat patients from Utah, Wyoming, Montana, Idaho, Colorado and beyond. For patients traveling out of state, please visit our travel section for information on hotels and airlines.

Preimplantation Genetic Diagnosis

For couples considering IVF who are concerned about passing on an inherited genetic disease to their children, preimplanation genetic diagnosis (PGD) is an excellent treatment option available to UCRM.

Preimplantation genetic diagnosis (PGD) refers specifically to when one or both genetic parents has a known genetic abnormality, and testing is performed on an embryo to see if it also carries a genetic abnormality. This allows couples choosing IVF to avoid passing on an inherited genetic disease to their children. The process is detailed, but our infertility experts will guide you through each step of the process and answer any questions you may have.

Most couples seeking PGD are aware of the genetic disorder and have already undergone testing to verify it. If testing is necessary to identify a genetic disorder, we will work with you to set up an appointment with a genetic counselor and schedule the appropriate testing. In either case, once we have received the test results we will assist you in setting up an IVF/PGD consultation appointment with one of our fertility specialists to describe the process and discuss your options.

In-vitro fertilization is based on a simple principle: if eggs are obtained and fertilized in the laboratory, most will produce embryos, and some of these will be healthy and will very often produce a pregnancy if placed in the uterus during the third to fifth day of life. Obtaining the eggs requires a sequence of medications that result in the maturation of many eggs at once, which can be retrieved with an ultrasound guided needle under light anesthesia. Fresh sperm are used to fertilize the eggs the same day. The resulting fertilized eggs are maintained in sophisticated and carefully controlled laboratory conditions while they undergo repeated cell divisions. After a few days, a some of these will be clearly the healthiest, and generally two are returned to the uterus in a simple procedure using a fine catheter.

Normally two embryos are placed to increase the chance of pregnancy overall, but this practice comes at a cost of producing twins in about one-third of resulting pregnancies. Sometimes one pregnancy will fade away while the other succeeds so that only a single baby arrives at term. Sometimes both embryos will succeed, and one will split so that triplets will occur. This will happen in about one of fifty in-vitro fertilization pregnancies in the center. The center rarely places more than two embryos, and sometimes only one is placed. It is important to reduce the incidence of triplets as much as possible as these pregnancies are often high risk for the mother and babies and can result in babies with lasting handicaps. Placing too many embryos can do more harm than good. The decision about how many embryos to place is always determined between physician and couple after careful discussion at the time of the embryo transfer.

In-vitro fertilization is equally effective for almost all infertility conditions. Pregnancy is detectable after two weeks, and close to three quarters of women undergoing this procedure will have a positive pregnancy test. Some of these pregnancies will fade after a few days, but most will persist and thrive. Pregnancy rates in successful clinics, such as the Utah Center for Reproductive Medicine, will exceed 50% per try. The success rate is dependent on a woman’s age with rates of pregnancy slightly lower after 35 and much lower after 40.

As a patient at the Utah Center for Reproductive Medicine, you can expect to receive the highest quality of care for your IVF treatment. IVF treatment includes the following steps:

Your Initial Visit

Every couple has a unique situation; no initial visit is the same. At your first visit, you will meet with one of our physicians and one of our nurses, and after carefully review of your medical records, we will establish an IVF treatment plan to meet your individual needs.

Pretreatment Preparation

At the time of your consultation, you will be given a list of items to complete prior to starting your cycle. Our nurses will assist you in scheduling these. Our nurses also will calendar out your entire cycle. The calendar is created to outline your individual stimulation protocol developed by your physician and includes a schedule of medications and appointments for your IVF cycle. You will receive a formal calendar at the time of your injection class. During your cycle, your primary physician (may be different from the physician you saw for your IVF consultation) will be performing your ultrasounds and egg retrieval. A second physician will be performing your embryo transfer. Our physicians are assisted by fellows who may perform your ultrasounds and participate in your treatment. A nurse will be available at any point during the cycle to answer questions related to your calendar.

Ovulation Induction/Cycle Start

Before you start medications to stimulate the production of eggs, you will have an appointment to measure your uterine lining and check your ovaries for any possible follicles or cysts. If the ultrasound is normal, a nurse will review your individual calendar, confirm the day to start medications to stimulate egg development with additional instructions. As your IVF cycle proceeds, you will have morning appointments starting day 8 of FSH injections, which may include blood work. Further ultrasounds and blood tests are ordered as needed each day and may require changes in your medication dosage. You will need to be available by phone during your IVF cycle as a nurse may need to contact you with important information related to your medications and necessary appointments. It is best we be able to reach you directly or at least be sure that you have an identifiable voice mail.

Oocyte Retrieval and Sperm Collection

Once you are ready for egg retrieval as determined by your UCRM physician, you will be given another medication (HCG) exactly 36 hours prior to the egg retrieval. This medication will bring the eggs to final maturity. The sonographic egg retrieval involves the use of an ultrasound guided needle to gently remove the eggs from the ovaries. You will receive IV sedation during the procedure and should experience little or no discomfort. Your partner’s sperm is collected on the day of egg retrieval for fertilization of the eggs.

Fertilization and Development in the Laboratory

After the egg retrieval, the embryologist prepares the eggs in the laboratory with sperm. You will receive a preliminary report regarding the number of eggs retrieved by the physician prior to leaving the center that day. Two days after your egg retrieval, an embryologist will call you with the number and quality of the embryos that have started to develop.

Embryo Transfer

The embryo transfer will take place three to five days after your egg retrieval. On the day of your embryo transfer, your UCRM physician will discuss the final embryology report and will recommend transferring one or two embryos. The embryos are then transferred through the cervix into the uterus via a small catheter. It is recommended you have two to three days of bed rest after your transfer. If there are good quality embryos remaining for cryopreservation, the option will be reviewed with you at the time of the embryo transfer.

Pregnancy Test and Pregnancy Follow-Up

Seventeen days after the egg retrieval, you will return to UCRM for a blood pregnancy test (quantitative HCG). If pregnant, you will be scheduled for a viability ultrasound between six-and-a-half and seven-and-a-half weeks of pregnancy. In general, it is important to contact your OB to set up your first prenatal visit. It will be necessary for you to continue hormone therapy until 10 weeks of pregnancy.

Preparation for the Procedure

From the time you begin ovarian stimulation to the day of your egg retrieval, our laboratory technicians and embryologists are involved in many diagnostic and preparatory procedures. In particular, we will be drawing your blood to determine the concentration of estradiol (an indicator of oocyte maturation). As a precautionary measure, we will also have the partner schedule an appointment (approximately one to two months prior to your procedure) to leave a semen sample, which will be frozen and serve as a backup sample in case of an emergency.

The Day of Your Oocyte Retrieval

The day of the retrieval your physician will aspirate your ovarian follicular fluid containing the oocytes. One of our technicians will be at the side of your physician assisting during the procedure. During this time the follicular fluid will be collected in a test-tube, which is then transferred into the embryo lab where one of our embryologists will transfer the oocytes into a dish with specialized media. The oocytes are then incubated at body temperature until fertilization. During this incubation time, the husband will collect a semen sample, which our technicians will prepare for the fertilization process. After the incubation period, your oocytes are fertilized by one of two methods: microdroplet or ICSI (intracytoloplasmic sperm injection). Microdroplet fertilization involves adding sperm to the media containing the oocyte. ICSI is a technique by which a single sperm is injected into the egg. In general, this procedure is used in cases where severe male factor infertility is involved. After either fertilization technique is employed, the oocytes are incubated overnight.

Days 1–4 of Embryo Growth

The morning after fertilization, our embryologists will transfer your embryos to a special growth media and assess them for fertilization. The embryos will then be cultured and reevaluated on days 2 and 3. Depending on the quantity and quality of the embryos, a day 3 or a day 5 transfer will be selected. The embryos are left in the incubator on day 4. You will receive a call on day 2 with an update then again on day 4 for a second update as well as a transfer time for day 5.

Day 3 Embryo Transfer

The third day after fertilization some of your embryos should ideally reach the six- or eight-cell stage. We will provide you and the physician with an assessment of the embryo quality and a picture of the embryos to be transferred. You and the physician will carefully discuss and determine the number of embryos to be transferred (one to three), and the disposition of any remaining embryos. Most couples choose two embryos for transfer. During your embryo transfer, our embryologists will place these embryos in a catheter. The catheter is given to your physician who will then transfer the embryos to your uterus.

Day 5 Embryo Transfer

On the fifth day after fertilization, some of your embryos should ideally be at the blastocyst stage. We will provide you and the physician an assessment of the embryos’ quality and a picture of the embryos to be transferred. You and the physician will carefully discuss and determine the number of embryos to be transferred as well as the cryopreservation or disposition of the remaining embryos. Most couples choose two embryos for transfer. During your embryo transfer, our embryologists will place the embryos in a catheter. The catheter is then given to your physician who will then transfer the embryos to your uterus.

What Happens to the Remaining Embryos?

At the time of transfer, you are given choices concerning the fate of your remaining viable embryos:

• The embryos may be frozen (cryopreserved) for a future IVF embryo transfer.
• An embryo culture may be continued to see if the embryos develop to the blastocyst stage and then cryopreserved.
• The culture of embryos may de discontinued.

Cryopreservation

At the completion of an embryo transfer, additional embryos may remain unused. Cryopreservation may be used to retain the embryos, alleviating the need to retrieve additional oocytes for future pregnancy attempts. An Embryo Storage Agreement must be signed prior to cryopreservation of embryos.

Payment includes the first year of storage. Thereafter, payment for the current for the current storage period must be paid in advance. A client may terminate a storage agreement at any time by requesting and completing a Consent to Discard Pre-Embryos OR a Consent to Donate Pre-Embryos to IRB Approved Research form (contact the Andrology Lab to obtain the correct form). Please carefully read and complete the entire form. Please note: a UUHSC employee or a notary public must witness your signature. The original written notice must be received and acknowledged by the University before the agreement is terminated.