In Vitro Fertilization, IVF - the Process and Procedures
Let’s get you pregnant.
IVF doesn’t have to be intimidating. If you’re considering IVF, you may have already experienced a physically and emotionally taxing fertility journey. We understand that, which is why you can expect highly personalized, compassionate care, with easy access to your doctors and care team whenever you need them.
The AFCC Difference
Not all fertility clinics are equal. Here’s what you can expect from the team at Advanced Fertility Center of Chicago:
IVF stands for in vitro fertilization. It’s one type of assisted reproductive technology (ART). In simplest terms, IVF involves retrieving mature eggs from a woman and fertilizing them with sperm in a laboratory, then transferring the fertilized eggs — embryos — into the uterus.
Depending on your individual circumstances, you may perform IVF with your own eggs and your partner’s sperm, or with donor eggs, sperm or embryos. You may also consider using a gestational carrier (surrogate), who will carry the pregnancy if the female partner is unable to do so.
Generally, we’ll use IVF for couples who have failed to conceive after at least one year of trying, who also fall into one or more of the following categories.
Blocked fallopian tubes
Pelvic adhesions with distorted pelvic anatomy
2-4 failed cycles of ovarian stimulation with intrauterine insemination (IUI)
Advanced female age (over about 38 years of age)
Men that are considering vasectomy reversal surgery
Men with male factor infertility
The IVF Process
The IVF process is just that: a process. While it can seem overwhelming at the outset, the doctors and nurses at AFCC have guided thousands of patients through IVF, one step at a time — and we’re ready to do the same for you.
Keep in mind: no two patients are alike, and no two IVF treatment plans are exactly the same, but here’s what most patients can expect.
Basic screening tests are performed on both partners. Some of the required testing may already have been performed if you’ve undergone previous infertility testing and procedures.
We use medications to produce multiple follicles and eggs. Keep in mind: while only one follicle with one egg inside develops in a natural menstrual cycle, IVF success rates are higher when multiple follicles and eggs are produced.
We’ll use ultrasound to monitor follicle development. When they’re ready, we’ll retrieve the eggs from the ovaries. It’s a 10-minute procedure that’s typically done under anesthesia.
Next, we’ll fertilize the mature eggs we retrieved in our state-of-the-art laboratory. In IVF without ICSI, the eggs and sperm are placed in petri dish to fertilize on their own; for patients using ICSI, sperm are injected directly into the eggs — more on that below.
This is the final procedure in the IVF process. The embryo is placed in a catheter, which is inserted into the uterus; when the catheter reaches the right location, it is transferred — i.e., squirted out of the catheter — to the uterine lining. For women, the embryo transfer should be painless, and no sedation or other drugs are required.
It’s critical that a highly experienced doctor performs the transfer; the entire IVF cycle depends on delicate placement of the embryos at the proper location near the middle of the endometrial cavity — with minimal trauma and manipulation.
ICSI is an acronym for intracytoplasmic sperm injection. Whereas IVF involves placement of sperm and eggs in a petri dish, allowing them to fertilize on their own, ICSI injects sperm directly into the egg.
ICSI is a very effective fertilization method. Traditionally, its main use has been for significant male infertility cases, or when previous IVF resulted in no or low rates of fertilization.
However, our thinking about ICSI has changed over time, and we’re now doing more ICSI (as a percentage of total cases) than we were 10-12 years ago. As we learn more about methods to help couples conceive, our thinking will continue to evolve.
Using donor sperm is an option for individuals or couples when a male partner isn’t present, or where male factor infertility is an issue. At AFCC, we partner with fully licensed, highly accredited sperm banks, whose screening steps meet well-established standards. Sperm donors are heavily screened for medical conditions and other physical, emotional and psychological risk factors.
As embryos develop, they have a protective shell, which they break out of as they grow. Sometimes, we choose to “assist” the hatching process by weakening the shell in the laboratory. The goal is to help the embryo continue to grow and expand.
We might consider assisted hatching when:
- The female partner is older than 37
- Egg quantity or quality are low
- Embryo quality is poor
- Embryos have a thick outer shell, called zona factor
- Previous IVF attempts have failed
A fresh embryo transfer refers to an embryo transfer that is performed during the same IVF cycle that fertilization occurs. With a three-day embryo transfer, an embryo is transferred three days after fertilization; with a five-day embryo transfer, an embryo is transferred five days after fertilization. Often, additional embryos are frozen and preserved for future transfers
As opposed to a fresh embryo transfer — when an embryo is transferred several days after the egg retrieval — a frozen embryo transfer involves freezing an embryo after it’s fertilized, then thawing and transferring it in a later cycle.
There may be medical or personal reasons to freeze all embryos and perform a transfer in a subsequent cycle, versus performing a fresh transfer. Or we may perform a fresh transfer and freeze all remaining embryos for future transfers. Embryos can be preserved indefinitely.
The term PGD, preimplantation genetic diagnosis, is often loosely used to refer to any testing performed on an embryo prior to it being transferred to the uterus. However, there is a difference between the terms PGD and PGT-A.
PGD (preimplantation genetic diagnosis) is the process of removing a cell from an IVF embryo for genetic testing before transferring the embryo to the uterus.
PGT-A (preimplantation genetic testing – aneuploidy) is the term for testing for overall chromosomal normalcy in embryos. PGT-A isn’t looking for a specific disease diagnosis; it’s screening the embryo for normal chromosome copy number.
We may recommend embryo testing for IVF patients who:
- are 38 or older (female partner)
- have had multiple failed IVF attempts
- have had recurrent miscarriages
- have a reason/desire to screen for inherited genetic diseases
- are carriers of chromosomal translocations
In general, the best clinics for PGD or PGT-A will be the clinics with the best IVF success rates: the skills and technology that lead to successful IVF are the same ones that facilitate successful embryo testing.