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04.04.2014


In order to maximize success rates with in vitro fertilization we want a good number of high quality eggs from the woman. There are several ovarian stimulation medication protocols that are used to "pump up" the ovaries to make enough follicles and eggs. The commonly used stimulation regimens include injections of follicle stimulating hormone - FSH.
The ovaries are stimulated with the injectable FSH medications for about 7-12 days until multiple mature size follicles have developed.
With ovarian stimulation for in vitro fertilization, the goal is to get approximately 8 to 15 quality eggs at the egg retrieval procedure. We do not want to have overstimulation of the ovaries which can lead to significant discomfort for the woman and in rare cases can result in ovarian hyperstimulation syndrome, OHSS.
We also do not want the ovarian stimulation to be insufficient and only give us a few eggs if we might have been able to obtain more by using higher medication doses, etc.
In vitro fertilization can be successful with a very low number of eggs retrieved, but success rates are substantially higher when more eggs are recovered. Quality control throughout the entire process is very important with in vitro fertilization. We use a GE Voluson E8 ultrasound machine with a computer built-in that can outline and accurately measure the developing follicles.
We have found that this method is more precise and reliable as compared to the traditional method - which is usually manual measurements in two dimensions. The HCG injection is given when the estrogen level and the follicle measurements look best for successful outcome. The egg retrieval is planned for 34-35 hours after HCG injection - shortly before the woman's body might start to release the eggs (ovulate). The minimum number of follicles needed to proceed with in vitro fertilization treatment depends on several factors, including their sizes, age of the woman, results of previous stimulations and the willingness of the couple (and the doctor) to proceed with egg retrieval when there will be a low number of eggs obtained.
Some doctors will say that you should have at least 5 that measure 14mm or greater while others might do the egg retrieval with only one follicle. Women that are more likely to be low responders to ovarian stimulation would be those that have low antral counts, those women who are older than about 37, women with elevated FSH levels, and women with other signs of reduced ovarian reserve.
Infertility treatment and IVF is a process that is different for everyone and is tailored for individual couple's needs.
IVF can be used as an effective treatment for infertility of all causes except for women with infertility caused by an anatomic problem with the uterus, such as severe intrauterine adhesions.


In vitro fertilization increases the efficiency of human reproduction, which is often not very efficient naturally. With IVF we remove multiple eggs - and after careful culture for 3-5 days of the eggs that fertilize, we transfer one or more of the "prettiest" embryos back to the uterus.
We culture the embryos for several days and then pick the best one (or more) for transfer to the woman - selection of the best one(s) increases success. For example, if we transfer 2 embryos to the uterus and the female becomes pregnant - if there is one fetal heartbeat seen on early ultrasound (single pregnancy) the implantation rate is 50% (1 of 2 implanted).
Implantation rates are considered by fertility doctors when talking with couples about their chances for IVF success rates and multiple births.
Implantation rates are used by in vitro fertilization labs to measure internal quality control. A weakness somewhere in the system (in the lab, or elsewhere) will cause implantation rates to drop as embryos become "weaker" - with a decreased ability to implant. Our implantation rates for 2003-2005 were 47% for women under 35 years old, 33% for age 35-39, and 18% for women 40-42. Before you choose an in vitro fertilization clinic for your treatment, make sure you know the IVF success rates of the clinics you are considering. Both SART and the CDC (US government agency) make this easy by posting success rates for all reputable IVF clinics on their websites. Without stimulating medications, the ovaries make and release only 1 mature egg per menstrual cycle (month). Triggering to early or too late reduces success and can sometimes increase the risk for ovarian hyperstimulation (if triggered late). One of the ways that we have improved quality control in our program is by using highly specialized ultrasound equipment.
However, sometimes the response of the ovaries is poor - and a low number of growing follicles are seen. Most IVF programs in the US want a minimum of about 3-4 mature (or close to mature) follicles. If we look at 100 average fertile couples with a prior pregnancy who time intercourse in relation to ovulation, wea€™ll find that 20-25 of those couples have a positive pregnancy test.
Women that have had tubal ligation and are considering tubal reversal surgery as well as men that are considering vasectomy reversal surgery might also consider IVF. In vitro fertilization and advanced maternal age is discussed in detail on the female age page.


A day 3 FSH and estradiol test, antral follicle counts and AMH hormone levels are often done as screening tests for egg quantity. Unexplained infertility means standard fertility tests have not found the cause of the fertility issue. More importantly, we see lower rates of implantation per embryo transferred (compare "Embryos Transferred" to "Fetal Heartbeats"). For those couples that had a day 3 embryo transfer procedure we estimated the number of day 5 blastocysts that (probably) would have been available if we had cultured all embryos until day 5. The implantation rate is usually defined as the percentage of embryos transferred that implant and develop to the stage of ultrasound documented fetal heartbeat.
If there are two fetal heartbeats seen on early ultrasound (twin pregnancy) the implantation rate is 100% (both embryos implanted). If the rates drop significantly it should trigger a thorough evaluation of the entire IVF system.
However, IVF pregnancy is the process by which a fertilized egg is surgically implanted into the uterus, and it is not a natural means of making you pregnant. In vitro fertilization is the process of fertilization by manually combining an egg and sperm in a laboratory dish. In order for you to see this page as it is meant to appear, we ask that you please re-enable your Javascript! From the volume it calculates an average diameter for each follicle (as if it was a sphere). One month later 15-20 more couples will get pregnant and, in theory, at the end of 4 months all 100 couples should be pregnant.
Reduced egg quantity and quality is usually treated with either IVF, or with IVF with egg donation. The rate of miscarriage increases with the age of the female partner (compare "Fetal Heartbeats" to "Babies Born").
The purple arrows on the chart above show that some embryos will possibly be frozen after the embryos for transfer are selected.
When a couple has a 5% chance of getting pregnant each month, even if they time intercourse according to ovulation, their chance of conceiving will be much lower spontaneously.



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