Before the IVF process can officially begin, a variety of testing will be completed at the fertility clinic. The requirements will vary depending on whether a woman is cycling for her own retrieval and transfer, or if she is a gestational carrier or egg donor.
Once all the financial details, insurance issues, and medical requirements are complete (as well as a legal contract, if it’s a third party match), the team will establish a treatment plan and medical protocol. They will create a calendar that is detailed and specific to her situation. Remember, each clinic and each IVF cycle can be different, but this is an example of what an IVF calendar may look like:
Step 1: For the first three weeks, many women take birth control to regulate hormone levels and to synchronize her period so that the timing is right with medication.
Step 2: The day the woman gets her period is the first true step of the IVF process. She will continue to take birth control pills to maintain the regulation of hormones.
Step 3: On day 21, she may begin taking Lupron as a stimulation medication. Lupron stimulates the ovaries, but it also suppresses the ovaries from ovulating and controls some female hormone levels. The goal is for the ovaries to mature multiple follicles, instead of the one that typically matures during a natural cycle. Depending on the clinic’s protocol, other medications may be used instead of or in addition to Lupron.
Step 4: After taking Lupron for 10 days, she will have an appointment to ensure ovulation has been suppressed.
Step 5: She will begin taking follicle stimulation medication that may include Gonal-F, Menopur, Follistim, Bravelle or Repronex. These are taken once a day for approximately 10 days. Lupron is slowed and eventually stopped during this period. Regular monitoring appointments, typically every other day but as often as every morning, are important to check how the ovaries are responding to the medication. When the follicles measure 18-22 millimeters in diameter, they are ready to mature and harvest.
Step 6: Once instructed by the doctor or nurse coordinator, she will take the hCG (Human Chorionic Gonadotropin) or “trigger shot.” hCG is the name of the pregnancy hormone produced by the placenta. It matures the eggs before they are retrieved so that they are usable for IVF.
Step 7: The egg retrieval! For such an important step in the IVF process, this outpatient procedure only takes about 30 minutes. Because timing is critical, the eggs must be retrieved 36 hours after the trigger shot and the sperm must be available for fertilization.
Step 8: Once the eggs have been retrieved, they are graded and tested so that the lab knows how many eggs are viable. They will either be frozen or fertilized in a dish of sperm, or fertilized using Intracytoplasmic Sperm Injection (ICSI). In situations of low sperm count or motility issues, ICSI increases the chances of fertilization.
Step 9: After the eggs are fertilized, they are allowed to grow for three to five days. Some intended parents choose to have the embryos undergo a process known as Preimplantation Genetic Testing (PGT), which screens for general chromosomal issues.
Step 10: The transfer! The highest quality embryo is transferred to the intended mother or gestational carrier to attempt a pregnancy. Depending on the circumstances two embryos may be transferred, but typically any remaining embryos will be frozen for future use or donated. A pregnancy test can be attempted about two weeks after the transfer.
While it may seem that there are many moving parts, typically an IVF cycle is completed in about four to six weeks. There can be unforeseen circumstances in which the stimulation process takes a bit longer, or may even need to be canceled and restarted the next month if the ovaries are over or under responding to the medication.
While your clinic can estimate a general timeframe and will create a calendar for you to follow, it’s important to maintain flexibility, follow instructions precisely, and remember that each match is unique. To learn more about IVF with a surrogate or egg donor, contact our team!
All Things Conceivable is a blog dedicated to sharing the knowledge and expert opinions of the dedicated team at ConceiveAbilities, a Chicago-based egg donation and surrogacy agency.