Sometimes described as the "test tube baby procedure," IVF gets its name from the fact that fertilization occurs outside of the body, in a laboratory dish. This procedure has been performed successfully thousands of times throughout the world for nearly 2 decades. The indications for IVF include damaged fallopian tubes, endometriosis, abnormal sperm, unexplained infertility and failure to respond to other treatments.

The IVF procedure is best understood as a series of steps that lead up to a successful pregnancy.  They involve

(1) Pre-procedure evaluation includes day 3 hormone testing, evaluation of the uterus with HSG or hysteroscopy, semen analysis, measurement of the uterine cavity and counseling

(2) Suppressing the ovaries with birth control pills and a medication called GnRH agonists such as Lupron® in order to prevent the eggs from releasing prematurely.  Some women will use a GnRH antagonist such as Cetrotide® or Ganirelix which starts later in the cycle.

(3) Stimulating the ovaries with fertility drugs such as Gonal-F®, Follistim® , Bravelle®, Menopur® or Repronex® in order to obtain as many eggs as possible for the procedure. This process is monitored with early morning transvaginal ultrasound exams and blood tests about every other day, and then daily as the eggs mature.

(4) Stimulating the eggs to release with hCG (Pregnyl®,Pregnyl®, Ovidrel®)

(5) 34-36 hours after the hCG injection (just before the eggs are released), the Egg Retrieval is performed using a needle guided by a transvaginal ultrasound. This can be done with intravenous sedation, local anesthesia or general anesthesia.

(6) The eggs are handed off to the Embryologist who places the eggs in a dish with the husband's sperm. Fertilization occurs in a laboratory dish and can usually be appreciated under the microscope by the following morning.

(7) After 3 days in the laboratory, the embryos have usually divided to the 6 or 8 cell stage and are ready for transfer. Embryo transfer is accomplished by passing a small plastic transfer catheter into the uterus. The embryos may be grown an extra 2-3 days and transferred at the blastocyst stage.  Anesthesia is usually not required.

(8) Progesterone supplements which were begun the day after retrieval continue until the pregnancy test is negative or throughout the first trimester of pregnancy. Pregnancy test results are available just over 1 1/2 weeks after transfer.