Overview

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
  • Pretreatment Preparation
  • Ovulation Induction / Cycle Start
  • Oocyte Retrieval and Sperm Collection
  • Fertilization and Development in the Laboratory
  • Embryo Transfer

Pregnancy Test and Pregnancy Follow-Up

Your First Visit for IVF Treatment

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

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Pretreatment Preparation

At the time of your visit, you will be given a list of items to complete before starting your cycle. Our nurses will assist you in scheduling these. Our nurses will also create a calendar for your entire cycle. The calendar is created to outline your individual stimulation protocol developed by your doctor 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 will be performing your ultrasounds and egg retrieval. Your primary physician may be different from the doctor you saw for your IVF consultation.

A second doctor will perform your embryo transfer. Our doctors 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 treatment calendar. 

From the time you begin ovarian stimulation to the day of your egg retrieval, our lab technicians and embryologists are involved in many diagnostic and preparatory procedures. We will draw your blood to determine how much estradiol is in your body. Estradiol indicates whether your oocytes are mature.

As a precautionary measure, we will also have your partner schedule an appointment about one to two months before to your procedure to leave a semen sample. We will freeze your partner’s semen sample. It will serve as a backup sample in case of an emergency.

Ovulation Induction/Cycle Start

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 any possible follicles or cysts. If the ultrasound is normal, a nurse will review your individual calendar and confirm when you can start medications to stimulate egg development. Your nurse will also give you additional instructions.

As you continue your IVF cycle, you will have morning appointments starting day 8 of FSH injections. You may also need to have blood work. 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 will work best if we can reach you directly or at least be sure that you have an identifiable voice mail.

Oocyte Retrieval & Sperm Collection

An oocyte is an immature egg cell. Once your doctor determines that your eggs are ready to be retrieved, you will be given another medication (HCG) exactly 36 hours before your eggs are retrieved. This medication will bring your eggs to final maturity.

During your sonographic egg retrieval, your doctor will use an ultrasound guided needle to gently remove your eggs from your ovaries. You will be sedated with an IV during the procedure and should experience little or no discomfort.

During this time, your doctor will aspirate your ovarian follicular fluid, which contains oocytes. 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. The follicular fluid will then then transferred into the embryo lab where one of our embryologists will transfer the oocytes into a dish with specialized media. We will then incubate your oocytes at body temperature until they’re fertilized.

During this incubation time, we will ask your partner to give us a semen sample. 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 left 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.

Fertilizing & Developing Embryos in the Laboratory

After your eggs are retrieved, your embryologist will prepare your eggs in our lab with sperm. After the incubation period is over, your oocytes will be fertilized with sperm using one of two methods:

  1. microdroplet or
  2. ICSI (intracytoloplasmic sperm injection).

During microdroplet fertilization, a lab technician add sperms to the dish containing the oocyte.

ICSI is a technique where a single sperm is injected into an egg. In general, this procedure is used in cases where the man has severe infertility. After either type of fertilization, the oocytes are incubated overnight.

Embryo Growth

Days 1–4 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 fertilizing. The embryos will then be cultured and looked at again on days 2 and 3.

Depending on the quantity and quality of the embryos, our embryologists will transfer your embryos on either day 3 or day 5. The embryos will be left in the incubator on day 4. We 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 transfer (implant) the embryos on day 5.  

Day 3 Embryo Transfer

On the third day after fertilization, some of your embryos should have multiplied into six or eight cells. We will give you and your physician an assessment of the embryo’s quality. We’ll also give you a picture of the embryos that will be transferred. You and the physician will carefully discuss and determine the number of embryos that should be transferred (one to three), and how to dispose any remaining embryos. 

Most couples choose two embryos for transfer. During your embryo transfer, our embryologists will place these embryos in a catheter. Your doctor will then implant the embryos in 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 your doctor with an assessment of the embryos’ quality and a picture of the embryos that are going to be implanted.

You and your doctor will carefully discuss and determine the number of embryos that will be implanted as well as whether you’d like the remaining embryos to be cryopreserved or disposed. Most couples choose to implant (transfer) two embryos.

During your embryo transfer, our embryologists will place the embryos in a catheter. Your doctor will then implant the embryos in your uterus.

Embryo Transfer

The embryo transfer will take place three to five days after your doctor has retrieved eggs from your ovaries. On the day of your embryo transfer, your UCRM physician will discuss the final embryology report and will recommend transferring either one or two embryos. The embryos are then transferred through your cervix into your uterus using a small catheter.

We recommend you schedule two to three days of bed rest after your transfer. If there are any good quality embryos left for cryopreservation, we will review this option with you at the time of the embryo 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 implanted in your uterus: 

  • You can choose to freeze (cryopreserve) the embryos for a future IVF embryo transfer.
  • You can choose to continue an embryo culture to see if the embryos develop to the blastocyst stage and then have them cryopreserved.
  • You can choose to stop the cultures for the embryos, which will stop them from developing into blastocysts .

Cryopreservation 

IVF patients have the option of freezing any unused embryos, also known as cryopreservation. If you choose to have a second round of IVF, cryopreservation will prevent you from needing to retrieve additional oocytes. 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 the agreement is terminated.

Pregnancy Test & Pregnancy Follow-Up

Seventeen days after the egg retrieval, you will return to UCRM for a blood pregnancy test (quantitative HCG). If you are 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. You will need to continue hormone therapy until 10 weeks of your pregnancy.