Getting Started With IVF
As a patient at the Utah Center for Reproductive Medicine, you can expect to receive the highest quality of care for your IVF treatment. Before you begin IVF, you will go through a fertility assessment process. Once you’ve completed that and you and your specialist have determined that IVF is the next step in your fertility journey, you will go through the following steps:
- Pretreatment preparation
- IVF injections
- Egg retrieval process
- Sperm collection
- Embryo growth
- Cryopreservation
- Pregnancy test and pregnancy follow-up
Pretreatment Preparation
Cycle Calendar & Schedule
At the time of your first treatment visit, we will need you to complete these items:
- Preconception screening labs
- Uterine cavity evaluation
- Consideration of preconception genetic carrier screening
- Semen analysis (if not previously done)
Our nurses will assist you in scheduling these. Our nurses will also create a calendar for your entire cycle.
IVF Injections
Preparing for Egg Retrieval with IVF Injections
The IVF egg retrieval process starts with your doctor prescribing you a series of medications (usually shots) that aid your ovaries in producing multiple mature eggs at once. Retrieving multiple eggs will increase your chances of success because not all eggs will fertilize or develop normally after fertilization.
Before you start medications to stimulate your ovaries to produce eggs, you will have an appointment to measure your uterine lining and check your ovaries for follicles or possible cysts. If the ultrasound is normal, a nurse will review your individual calendar and confirm when you can start medications to stimulate egg development.
Injection Instructions
Depending on the type of injection, you may have to mix and prepare your medicine before injection. Injection sites may also vary on the type of injection you are giving yourself.
Your nurse will provide you with specific instructions for the injections you need to take, but you can also view these helpful videos with injection instructions.
As you continue your IVF cycle, you will have morning appointments starting day 5 of your injections. You will also have blood work done at these visits. Your doctor will order more ultrasounds and blood tests as needed each day. Your doctor may also need to change the dose of your medication.
You will need to be available by phone during your IVF cycle. Your nurse may need to contact you with important information about your medications and appointments. It is imperative that you have an identifiable voicemail, as we will need to reach patients during the process, and cannot leave a message without an identified voicemail.
On average, it takes about eight days to two weeks from when you begin taking the hormone medication until your eggs are mature and ready for retrieval.
What Can You Do to Make Your Egg Quality Better?
To improve the health of your eggs, we recommend a healthy balanced diet that limits the amount of highly processed foods. We also recommend moderate exercise and an overall healthy lifestyle.
However, once you begin your IVF injections, it’s important not to exercise vigorously as the medication will enlarge your ovaries and too vigorous exercise can cause the ovary to twist and cut off the blood supply.
IVF Egg Retrieval Process
Once your doctor determines that your eggs are ready for retrieval, you will be given another medication (HCG or Lupron) 36 hours before the egg retrieval procedure. This medication will bring your eggs to final maturity.
The retrieval process is a short 15 to 30-minute procedure that will take place in your doctor’s office. During your sonographic egg retrieval, your doctor will use an ultrasound-guided needle to gently remove your eggs from your ovaries. You doctor will sedate you with an IV during the procedure and you should experience little or no discomfort.
Due to the use of anesthesia, you will need to remain at the clinic for one hour for observation before going home, and you’ll also need someone to drive you home after the procedure. You will need to take a full day off of work to rest and recover.
Is IVF Egg Retrieval Painful?
There is no need to worry that you will feel severe pain after egg retrieval. Most patients experience minimal discomfort only. The most pain you will likely feel will be cramping similar to menstrual cramping. A feeling of fullness or pressure on the bladder is also possible because your ovaries are enlarged.
What to Wear to Your Egg Retrieval Procedure
The most important factor when selecting what to wear is your comfort and well-being. Here’s what we recommend:
- Warm and cozy pair of socks
- Comfortable, loose-fitting top
- Sweatpants, comfy bottoms, or a skirt
- Comfortable underwear
You will be asked to change into a gown for the procedure, but you can keep your socks on. So, wearing a pair of warm, fuzzy socks will help keep your feet warm (and the rest of you) during the procedure. We also provide non-slip socks if you’d prefer. You may also feel bloated, so having loose fitting clothes will be more comfortable.
Recovery After Egg Retrieval
While the procedure is relatively simple, you may feel some slight pain after IVF egg retrieval, including cramping and feelings of fullness or pressure. You should also give your body time to rest and recover from the procedure. We recommend that you avoid vigorous physical activity and sexual intercourse for approximately two weeks.
Egg Retrieval Side Effects
Side effects after egg retrieval can include:
- Mild cramping
- Mild bloating
- Constipation
- Breast tenderness
These are all common side effects after egg retrieval and not cause for worry. More severe symptoms include:
- Pelvic pain
- Blood in the urine or heavy vaginal bleeding
- Painful urination
- A fever over 100.5F
If any of these symptoms occur, please call your doctor immediately.
Will Egg Retrieval Harm Your Remaining Eggs?
No, not at all. The process is well-monitored and non-invasive. After your egg retrieval procedure, your doctor will also conduct a vaginal exam to ensure there are no issues or uterine bleeding.
After Your Egg Retrieval
During your egg retrieval, your doctor will extract follicular fluid from your ovaries. The eggs come out of your ovaries with the follicular fluid. One of our technicians will be at your doctor’s side to assist during the procedure.
We will collect the follicular fluid in a test-tube. We will then transfer the follicular fluid into the embryo lab where one of our embryologists will extract the eggs into a dish with specialized media. We will then incubate your eggs in specialized media so that they can fertilize and start developing into embryos.
Sperm Collection
Usually, we will ask your partner to give us a semen sample the morning of your egg retrieval. Sometimes we use previously collected sperm that has been frozen. Our technicians will prepare your partner’s semen for the fertilization process.
We will give you a preliminary report about how many eggs your doctor was able to retrieve before you leave our center that day. Two days after your egg retrieval, an embryologist will call you to tell you about the number and quality of the embryos that have started to develop.
Embryo Growth
Days 1–7 of Embryo Growth
The morning after your eggs have been fertilized, our embryologists will transfer your embryos to a special growth dish and see how well they are developing. The embryos will then be cultured and looked at again on days 2 and 3.
We will plan to transfer an embryo when it reaches the blastocyst stage of development, which is typically five days after fertilization. Sometimes, however, the embryos may be more slowly developing, such that they reach this stage on day 6 or even day 7 after fertilization.
You will discuss with your doctor whether to proceed with a fresh embryo transfer (the embryo is transferred in the same cycle in which it was created), or if you’ll freeze your embryos and then do a transfer later (delayed primary transfer).
We understand that you want to know as much about your embryos during their time in the embryology lab. Our embryologists optimize conditions in the incubator to maximize your embryos’ growth and development, and they will call you with updates as this process progresses.
Typically, our embryologists will call you on day 2 with an update then again on day 4 with a second update. We will also let you know what time we will plan to transfer (implant) the embryos.
Embryo Transfer
Fresh Blastocyst Embryo Transfer
Depending on how quickly your embryos mature, by day 3 some of your embryos should have multiplied into six or eight cells. The day before the embryo transfer (typically day 2), our embryologists will give you and your physician an assessment of the embryos’ quality. The next day, when you come in for your embryo transfer, we’ll give you a picture of the embryo(s) that we will be transferring.
You and your doctor will carefully discuss and determine the number of embryos to implant as well as how many embryos you would like frozen for later use. Our clinic prides itself on providing the best possible care for you and your future children, and often, the best way to achieve optimal success and outcomes is by transferring one embryo at a time. This decision is important and one that you should discuss with your doctor before your IVF cycle and also again at the time of your embryo transfer.
During your embryo transfer, our embryologists will carefully load the embryo you’ve chosen to transfer into a catheter. Your doctor will then transfer your embryo into your uterus under ultrasound guidance. We don’t recommend bed rest after your transfer, but we do recommend that you take it easy and avoid vigorous activity in the days following your transfer.
What Happens to the Remaining Embryos?
At the time of transfer, we will give you choices about what you’d like to do with any viable embryos that are left that won’t be transferred into your uterus:
- You can choose to freeze (cryopreserve) the embryos for a future IVF embryo transfer. We only offer this option for any excess embryos that have already developed to the blastocyst stage. If they have not, we offer continued culture.
- You can choose to continue an embryo culture to see if the embryos develop to the blastocyst stage (early stage of embryonic development) and then have them cryopreserved. We recommend this option for embryos that are still alive but haven’t quite developed to the blastocyst stage.
- You can choose to discard the embryos. We don’t recommend this option, as cryopreserved embryos can be transferred in another cycle and typically result in similar implantation rates compared to fresh transfers.
Cryopreservation
IVF patients have the option of freezing any embryos you don't use. This is also known as cryopreservation. If you choose to have a second round of IVF, cryopreservation will prevent you from needing to retrieve additional eggs. This means your doctor won't need to extract eggs from your ovaries if you'd like to try to get pregnant through IVF again.
You will need to sign an embryo storage agreement before your embryos are cryopreserved. Payment includes the first year of storage. After the first year of storage, payment for the current storage period must be paid in advance.
A patient 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 University of Utah Health employee or a notary public must witness your signature. The original written notice must be received and acknowledged by the University before terminating the agreement.
Pregnancy Test & Pregnancy Follow-Up
Twelve days after your embryo transfer, you will return to UCRM for a blood pregnancy test (quantitative HCG). If you are pregnant, we will ask for you to return in two days for a repeat blood pregnancy test. If those levels look reassuring, we will schedule you 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. You will need to continue hormone therapy until 10 weeks of your pregnancy.
