Thank you for your interest in Northwest Fertility Center’s (NWFC) in vitro fertilization (IVF) and embryo transfer (ET) program.
IVF is a high-tech method of assisted reproduction which requires the teamwork of professional physicians, embryologists and nurses. Eggs are removed from the female partner and are combined with sperm from the male partner in a special laboratory where fertilization occurs. Several days later the resulting embryo(s) are transferred to the uterus. Other embryos might be cryopreserved (frozen) for future use. Essentially IVF bypasses the Fallopian tubes where fertilization normally takes place.
Our center was established in 1986 under the direction of Dr. Stoelk. The NWFC and Dr. Stoelk are well recognized in the Pacific Northwest for excellence in all types of fertility care, especially for our success with in vitro fertilization (IVF.) The NWFC has consistently achieved pregnancy rates higher than the national average. What makes one fertility center have higher success rates than another? The answers are varied. We believe our high success rates can be directly attributed to the fact that Dr. Stoelk is the only physician making decisions regarding your care, thus providing consistent, yet individualized, medical management. He will be the one performing the egg retrieval and embryo transfer. It is a very significant advantage to have only one highly skilled IVF physician manage your fertility treatment.
Our philosophy is to treat each patient as an individual. We do not believe in recipe-type protocols that are used for all patients. No two people have the same set of circumstances that led to their difficulty to conceive. Our goal is to assist in building families through a quality infertility investigation and appropriate treatment. We recognize the financial and emotional strains that infertility treatment may cause and make every effort to keep emotional and financial cost to a minimum. Along the way, we try to educate you so you can participate in the decisions that must be made.
Indications for IVF Participation:
- Absent, blocked, or damaged Fallopian tubes. If the egg and sperm can not meet, IVF is the most successful and least invasive option. Prior to the availability of IVF, many major surgeries were performed with poor chances of pregnancy.
- Sperm abnormalities. Men with low sperm counts, low motility, high abnormal sperm forms, sperm antibodies, and vasectomy can now opt for IVF. We have the capability to isolate one sperm and inject it directly into the egg if necessary, thereby making it possible to solve infertility due to almost any sperm problem.
- Endometriosis. Endometriosis is an abnormal condition where the normal lining of the uterus, called the endometrium, is also found in other various areas in the pelvic cavity. This tissue should not grow outside the uterus. The endometrial implants outside of the uterus create a toxic environment for the egg, decreasing chances of fertilization. IVF takes the eggs out of this hostile environment and into the laboratory for fertilization to take place.
- Unexplained infertility. This is where no exact cause for infertility has been found and pregnancy has not occurred using other fertility treatments. It is not known why some couples that appear normal do not conceive naturally or with basic fertility treatments. This can be successfully treated with IVF.
We look forward to meeting you and hope that this information will answer some of your questions regarding our IVF program. If you have any questions, call our office. We have informed health care professionals available to assist you.
The IVF Process
Dr. Stoelk will evaluate your unique situation by performing a complete history and review your previous medical records. The basic preliminary testing completed on all patients includes an exam, pelvic ultrasound, semen analysis and some blood tests. If recent testing has been preformed, he will usually not have you repeat them.
Unfortunately, many other IVF programs have a long checklist of required tests. This greatly increases your costs before you ever begin IVF and is seldom included in the cost estimate. Rarely do these “extras” result in added success. Since we wish to keep your financial costs to a minimum, we will only order additional testing if your history or medical diagnosis indicates a need, rather than having a long list of routine tests performed on everyone. You will be given a thorough review of the IVF process, explanation of the medications and procedures prior to signing informed consents.
Usually women only mature one egg a month. For IVF to have a good chance of success, multiple eggs must be obtained. Based on your age, diagnosis and history Dr. Stoelk will select a specific individualized protocol and dosage for you. There are three different medications (hormones) that help properly stimulate the ovaries. As strange as it may sound, the first one is Birth Control Pills. Birth Control Pills are often given for two reasons. First, they help regulate your cycle and secondly they decrease your risk of cyst formation that could delay your IVF start date. The second medication used is Leuprolide (Lupron.) Leuprolide inhibits the natural release of the eggs. This permits us to properly time the egg retrieval. Leuprolide is administered by subcutaneous injection and continues daily for approximately 2-3 weeks. Another IVF protocol uses either Cetrotide or Ganerelix instead of Leuprolide.
The third drug (hormone) used are the gonadotropins (Bravelle, Follistim, or Gonal F). These injections stimulate the ovaries to produce multiple mature eggs. Some of the common side effects to these hormones are mood swings, pelvic bloating and sometimes headaches, but there are never any lasting health problems. The usual duration of fertility drug administration is 8-11 days. Fertility drugs are administered subcutaneously (under the skin.)
These fertility drugs all contain follicle stimulating hormone (FSH) the same hormone that is produced by the pituitary each month to stimulate egg growth and development. These injections provide levels of FSH much higher than what the pituitary would ordinarily release, thus stimulating many eggs. Initial response will be monitored every 2-3 days by blood Estradiol testing. As the follicle/eggs get closer to maturity, transvaginal ultrasounds will be performed as well. When these studies indicate optimal follicular development, the patient is administered an injection of HCG (Ovidrel, Pregnyl or Novarel) which triggers the eggs to undergo the final stages of maturation. Egg retrieval is scheduled approximately 36 hours after the HCG injection. Two days after the egg retrieval, you will start progesterone supplementation. Progesterone is the hormone that is produced by the ovary after ovulation occurs and maintains the uterine lining. It promotes a good environment for the embryo to implant and grow.
Egg retrievals are performed in our clinic procedure suite by transvaginal ultrasound aspiration. You will be given IV sedation and pain medication. A vaginal ultrasound probe is inserted into the vagina and a needle is passed through the wall of the vagina to each ovary. The follicular fluid and eggs are then aspirated from each follicle. The number of eggs retrieved varies greatly depending on your age and medical diagnosis; usually anywhere between 5 and 40 eggs are retrieved with the average being between 10-15. The procedure usually lasts about 30-45 minutes. Most women return to work the next day following the IVF retrieval.
The follicular fluid removed from the ovary is immediately examined in the IVF embryology laboratory for the presence of eggs. The eggs are isolated and placed in petri dishes with special culture media. On the same day of the egg retrieval, a sperm sample is obtained from the male partner. The semen is processed, then placed with the eggs in the petri dish. Approximately 60-80% of the eggs will fertilize and become embryos. Dr. Stoelk will call you the day after egg retrieval to review how many eggs were fertilized.
A special IVF laboratory technique called ICSI (Intracytoplasmic sperm injection) is used when men have a very low sperm count or previously had a vasectomy. ICSI is a technique where a single sperm is picked up under a microscope using a microsurgical instrument and directly injected into the egg by our embryologist. This procedure has completely revolutionized the treatment of severe sperm problems. Many men who have had a vasectomy can now select this method instead of doing a vasectomy reversal.
Once the egg has fertilized, it is called an embryo. The embryo progresses through various stages of development. First it begins to divide into multiple cells. Once the embryo has divided into so many cells that you can no longer count them, it is called a morula (day 4.). Next these cells begin to compact creating a hollow looking appearance in the middle of the embryo and is now called a blastocyst (day 5.) We prefer to transfer at the blastocyst stage for several reasons:
- To place the embryos back into the uterus at approximately the same day they would arrive in the natural setting.
- To allow a natural self-selection to take place. By waiting the five days, the less healthy embryos will become more apparent and usually stop developing. Thus we can transfer the embryos with the best potential for implantation.
- Fewer of these “select” embryos need to be transferred, therefore giving higher pregnancy rates with less risk of multiple babies.
The IVF embryo transfer procedure is not painful or difficult. Usually two or three embryos will be selected to be transferred. Other embryos that make it to the blastocyst stage will be vitrified (frozen) for future thaw and transfer. The embryos are placed into the uterus by passing a thin, flexible catheter through the cervical opening. This is always performed under ultrasound guidance and you need pain medication for this procedure. Many of our patients elect to have acupuncture performed at the time of transfer by our licensed acupuncturist or by their already established acupuncturist. You will be asked to remain resting for approximately 30 minutes after the embryo transfer. You can then home with minimal activity for the remainder of that day.
When multiple embryos proceed to the blastocyst stage, the remaining blastocysts will be cryopreserved by vitrification for future thaw and transfer. We have been freezing embryos since the mid 1980’s and the embryos can be maintained in the cryopreserved state for many years. Vitrification is the best method to successfully freeze and store embryos and eggs.
During the follow-up phase of IVF, women will receive daily doses of progesterone to support the uterine lining. Approximately eight to ten days after embryo transfer, we will do a blood pregnancy test. If you are pregnant, the progesterone supplementation continues to approximately 7-8 weeks of pregnancy. Additional pregnancy tests and blood progesterone levels may be drawn to monitor the pregnancy’s progress and change the dose of progesterone if necessary. An ultrasound is usually done 2-3 weeks after the initial pregnancy test to determine the number of embryos that implanted and the attachment site. Most often a fetal heartbeat can be detected during this initial pregnancy ultrasound. Fetal cardiac activity seen at this point is a very good indicator that the IVF pregnancy is viable and will progress to delivery of a baby. Another ultrasound may be done 2-3 weeks after the first one to confirm normal growth and development. Usually it is at this time you will stop progesterone supplementation and see your OB/GYN physician for continued prenatal care.
There have been over four million IVF babies born world-wide and some 58,000 American IVF babies are born each year. IVF techniques do not seem to increase birth defects over “naturally” conceived pregnancies.