In Vitro Fertilization (IVF)
Dallas Fertility Center is conveniently located in Dallas, Texas and we have extensive experience with all procedures, including IVF, ICSI, assisted hatching, blastocyst transfer, PGD, and other micromanipulation techniques.
IVF refers to the creation of embryos by placing sperm and eggs in a culture dish in a laboratory setting. Oocytes, or eggs, must be obtained by stimulating the ovaries with fertility drugs, as many eggs are required to produce enough good quality embryos for transfer. Once the eggs mature, they are retrieved in a procedure called transvaginal oocyte retrieval.
An oocyte retrieval is performed in an operating room under light sedation using intravenous anesthesia. The procedure involves the passage of a needle through the thin posterior wall of the vagina into the ovarian follicles, and then aspirating the oocytes.
On the day of the oocyte retrieval, sperm is processed and used to fertilize the oocytes and create embryos. These embryos are allowed to grow in the incubator for three to five days before being transferred. The embryo transfer procedure uses a small catheter inserted through the cervix using ultrasound guidance. The embryos are placed directly into the uterus with the hope that at least one will implant into the endometrium and result in a pregnancy.
IVF Cycle Pretreatment Testing
Before an IVF treatment cycle begins, patients will consult with their fertility specialist to discuss their treatment and prognosis. After a treatment plan has been decided, there will be pretreatment testing in order to optimize the chances of pregnancy. Most women will need follicle stimulating hormone (FSH) and estradiol blood tests performed on the third day of their cycles (Days 2, 3, or 4 are acceptable). These tests will be used to help determine the responsiveness of the ovary to fertility drugs and the initial drug dosage.
IVF candidates should have had a uterine evaluation within two years of the IVF procedure. This evaluation can be done by hysteroscopy, hysterosalpingogram (HSG) or sonohysterography to ensure that the endometrial cavity is normal. Most abnormalities will need to be corrected before undergoing in vitro fertilization.
IVF patients will undergo controlled ovarian hyperstimulation with gonadotropin fertility drugs. These products are administered according to treatment protocols. With the start of menses, a baseline sonogram and blood testing will be performed. The purpose of these tests is to confirm that the ovaries are at a baseline state and no cysts are present. This means the ovaries should contain no follicles that are greater than 15mm in size, and the blood estradiol level should be less than 50 pg/ml. In approximately 10 to 15 percent of patients, one or both of these two conditions are not met. In these cases, the stimulation start date may be delayed: an ovarian cyst aspiration, an in-office procedure, may be performed or other individualized plans are made.
After ovarian suppression has been achieved, ovarian stimulation using gonadotropin fertility medication may commence. This is referred to as the “cycle start.” Fertility drug dosages are individualized for each patient based upon age, weight, the number of follicles, cycle Day 3 FSH levels, estradiol levels, and the response to previous stimulation cycles. After the cycle start day, the initial dose of medication may be changed dependent upon each patient’s protocol and estrogen levels. Gonadotropins will be taken throughout the stimulation phase of the cycle, until hCG is administered.
During the stimulation, patients will usually return for follow-up sonograms and estradiol blood tests every one to three days to monitor follicular growth. In general, patients are asked to return more frequently towards the end of ovarian stimulation. Most women need eight to 12 days of ovarian stimulation, thus requiring four to six sonograms and/or estradiol tests.
Texas IVF Clinic, Dallas Fertility Associates- Treatment Protocols
Different treatment protocols are employed for different patients as every patient's treatment is individualized. Some people may require much higher doses of FSH, while others might receive only pure FSH such as Gonal-F or Follistim. Still others may have Repronex incorporated into their protocol.
IVF Cycle Initiation - Contact Us
Please call the office at 214-363-5965 between 8:30 a.m. and 3:30 p.m. on the first (or second) day of menstrual flow, and let us know that you are an IVF patient
The IVF Process in the Lab
Luteal Phase Support after Transfer
On the day after the oocyte retrieval, patients are instructed to start progesterone supplementation. This may be in the form of an injection or vaginal gel. Progesterone is a hormone produced by the ovaries only during the post-ovulation, or luteal, phase of the ovarian cycle. Progesterone develops the endometrial lining of the uterus to support and maintain pregnancy. Supplementation is required because some of the cells, which produce progesterone in the ovary, are removed during the egg retrieval and drugs like Lupron diminish the body’s progesterone production.