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In Vitro Fertilization Procedure

We feel it is important to make couples at ease with the entire IVF procedure and to help them understand the process. Once the medical necessity has been determined the couple is given a large packet of information by Dr. Donahue which has detailed information about all aspects of the procedure including medications, egg retrieval and embryo transfer, consent forms, and sample calendars. The couple is given time to review all of the information.

Next the couple makes an appointment for a trial embryo transfer and official calendar. The trial embryo transfer is much like a PAP smear or intra-uterine insemination. Dr. Donahue passes a small catheter, much like the one that will eventually have embryos in it, into the cervix and injects a small amount of saline into the uterine cavity. Thus, we know if there would be a problem with the eventual transfer (i.e. scar tissue, stenosis of the cervix) or uterine cavity defects that might hurt implantation (i.e. scar tissue, polyps, myomas). Our goal is to have the eventual embryo transfer go quickly and smoothly. Dr. Donahue will sit down with the patients and review the protocol with the patients and give them their prescriptions. Again, they will have a chance to ask questions and the reasoning behind the protocol will be explained.

Next the couple will meet with the embryologist to go over all of the consent forms. Additionally, they will be given a tour of the facility. We feel that patient education is very helpful and reduces stress. Patients will be shown pictures of embryos as seen under the microscope. They will know what the fertilized egg looks like and what a typical cleavage stage embryo is.

We typically do embryo transfers on day 3, when the embryo is about 6-8 cells. Embryos may have some fragmentation and we will show patients what this looks like. Also, we occasionally do assisted hatching of the zona pellucida to help the embryo implant and photos will be shown of that. For couples where male factor infertility or fertilization defects are documented, we do ICSI (intra-cytoplasmic sperm injections). Photos are shown of this as well. The couple will receive a photo of the actual embryos we transfer. To the left is a photo of the typical embryos we transfer.

In order to re-assure our patients and ourselves, we always have two people confirm the identity of all specimens received in the IVF lab. We have a special form where this is documented and signed by both people. The date and time of egg retrieval, sperm collection, placement of egg and sperm for insemination or ICSI, and the loading of embryos into the transfer catheter is witnessed by two individuals to assure safety. We make every effort to ensure the integrity of the procedure. Our lab is currently undergoing CAP certification which will be completed in April, 2004.

At the time of embryo transfer, a trans-abdominal ultrasound is performed in order to confirm that the embryos are placed in the correct part of the uterus. The embryos are in a small catheter with small air bubbles on either side of the media containing the embryos. The couple will see the small catheter go into the uterus, and a photo will be taken to document this. Please note the picture below with the bubbles in the middle of the uterine cavity, confirming proper placement.

The patient continues with progesterone support and a pregnancy test is done two weeks later. Two weeks after that, an ultrasound is done to confirm the intrauterine pregnancy. A singleton generally looks like below.

 

 

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