For this reason, we prescribe a precise time for you to take the trigger injection and we schedule your egg retrieval 35 hours later. During the egg retrieval you are sedated and sleeping comfortably while the doctor withdraws the fluid contents of each follicle, using an ultrasound-guided needle. The fluid is passed in a syringe to the embryologist, who then examines the liquid to see if an egg is present.
By the time you leave the clinic that day, you will know how many total eggs were retrieved. The next day you will know how many of the mature eggs fertilized into embryos. In the days that follow we will monitor those embryos to see if they continue to divide and grow. It is important to remember that a follicle is not the same as an egg. When you are monitored during your IVF cycle, we use ultrasound technology to measure and count how many follicles are in the ovary; however, we cannot see the eggs inside.
Although we hope that each follicle contains an egg, we know that this is not the case. Not every follicle has an egg, not every egg is alive, not every live egg is mature, not every mature egg fertilizes and not every fertilized egg embryo continues to develop until the day of embryo transfer.
Therefore, the more follicles one starts with, the better chance for overall success but in the end, it can just take one good embryo to make a baby. Typically, three to five days after egg retrieval, embryos are put back into the uterus in a procedure called embryo transfer. This procedure feels similar to a PAP smear exam without the uncomfortable brush. It is not painful; therefore, patients typically are not sedated.
The final decision regarding how many embryos to transfer and what to do with any remaining embryos is made on the day of transfer.
Sometimes, the follicles are empty. You could have a good number of follicles, but not retrieve any eggs from them. The cycle would end here. Progesterone is a hormone that rises after ovulation.
It helps prepare the endometrial lining , where the embryo will hopefully implant, and it helps maintain a pregnancy. However, some women will experience increasing progesterone levels on the day of egg retrieval. If this happens to you, your doctor may recommend cryopreservation of any embryos and scheduling at a later date a frozen embryo transfer. Waiting can be difficult, but it may improve the odds of treatment success.
This means there will be no embryos to transfer. As mentioned above, ovarian hyperstimulation syndrome can be very serious if left untreated. If your symptoms, ultrasound, or blood work indicates a high risk of OHSS, your cycle may be canceled or postponed.
This may occur before egg retrieval or after retrieval but before embryo transfer. If either partner comes down with a serious illness in the midst of treatment, the cycle may be canceled or delayed. High fever can negatively impact sperm counts. Be honest with your doctor if you have a high fever or are coming down with something during your treatment month.
It can be disappointing to cancel or delay treatment, but some illnesses can decrease your odds of success and may even put your overall health at risk. The very first IVF baby was conceived with just one aspirated egg. So, why not just go ahead with the egg retrieval during conventional IVF even if you only have a few follicles developing?
This is a controversial issue. There are some doctors who are willing and may even encourage you to go ahead with egg retrieval. In some situations, this is a best-case scenario for that particular woman. The fact that high dosages of hormones were not enough to significantly stimulate the ovaries may indicate that egg quality is poor.
Not every doctor will give you an option to go ahead with egg retrieval if your follicle numbers are too low. Others will give you their opinion on what to do but leave the final decision in your hands.
The actual number of eggs retrieved matters, with fewer eggs leading to lower pregnancy rates. Here's an overview of what was discovered. This, of course, would only be if your ovaries did not respond as favorably as hoped. You would not want to switch to an IUI cycle if your ovaries hyper-responded. Whether this is a good choice for you will depend on cost, your reasons for infertility, and what male factor issues are at play. For example, if you have blocked fallopian tubes , IUI is not going to be an option.
Superovulation might not be successful in women over age 40 and women diagnosed with primary ovarian insufficiency also known as POI or premature ovarian failure. You might need to see a specialist with specific experience or consider using an egg donor. In fact, IVF success rates with an egg donor are good.
Ideally, your doctor won't want to put you through IVF or superovulation if they don't think it will work for you. This is why ovarian reserve testing is done. Ovarian reserve testing is intended to predict how you will respond to fertility drugs during IVF.
Another test called the Clomid challenge test CCT is also used at times to predict potential superovulation success. Be sure to talk to your doctor about whether or not they think this will be a successful route. Get diet and wellness tips to help your kids stay healthy and happy. History and challenges surrounding ovarian stimulation in the treatment of infertility. Fertil Steril. Treatment outcome of ovulation-inducing agents in patients with anovulatory infertility: A prospective, observational study.
J Pharmacol Pharmacother. Live birth rates following natural cycle IVF in women with poor ovarian response according to the Bologna criteria. Hum Reprod. Optimum oocyte retrieved and transfer strategy in young women with normal ovarian reserve undergoing a long treatment protocol: A retrospective cohort study.
J Assist Reprod Genet. Is in vitro fertilisation more effective than stimulated intrauterine insemination as a first-line therapy for subfertility?
A cohort analysis. Trends and outcomes for donor oocyte cycles in the United States, American Society for Reproductive Medicine. Medications for Inducing Ovulation. Brindha Bavan, Amin A. In addition to the potential for multiple pregnancy, spontaneous conception during in vitro fertilization IVF can lead to undesired genetic outcomes.
We present a case of a patient undergoing IVF with the intention of subsequent frozen embryo transfer after preimplantation genetic testing PGT.
Unprotected intercourse 6 days prior to egg retrieval resulted in a spontaneous pregnancy before the opportunity for embryo transfer.
This case report highlights that spontaneous conception during IVF compromises the ability to transfer embryos that are euploid, unaffected by single gene disorders, or intended for gender balancing within a family when desired. However, the probability of spontaneous conception occurring during any given IVF cycle is very small [ 2 — 4 ].
In a previous case report from , we described the first known incidence of simultaneous spontaneous and IVF conception, which resulted in a quadruplet pregnancy [ 5 ]. As reviewed in this publication, intercourse during IVF treatment traditionally had been discouraged for the purpose of avoiding trauma to hyperstimulated ovaries and optimizing semen parameters. Here we describe a case report where spontaneous conception occurred during IVF treatment, prior to embryo transfer and without the opportunity for PGT.
A year-old Chinese-Vietnamese nulliparous female presented to our clinic after trying to conceive for 1 year and 9 months without success. Her cycle length varied from 30 to 39 days. Body mass index was Previous workup showed normal hormone levels and hysterosalpingogram. Antral follicle count was Post-coital testing was reassuring with regard to mucous and presence of motile sperm. The patient had previously undergone 3 cycles of letrozole and timed intercourse at an outside institution.
She proceeded to undergo 4 cycles of letrozole and intrauterine insemination in our clinic, which were unsuccessful. The decision was then made to move forward with IVF with embryo freezing after biopsy for aneuploidy screening. For her stimulation protocol, she began with 75 units of human menopausal gonadotropin and units of recombinant follicle stimulating hormone, which was subsequently increased to units.
An antagonist was started on stimulation day 8.
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