Download IVF: What Is Involved?

Center for Women’s Reproductive Care at Columbia University
IVF Recipients
Dear Patient,
Thank you for your interest in the Center for Women’s Reproductive Care at
Columbia University. We hope that the following information provides you with a
complete overview of our In Vitro Fertilization Program and the services we provide.
On a personal note, I would like to tell you about my approach to providing fertility
care. My philosophy is to look for reasons to help people have children, rather than
reasons not to. We are always looking for opportunities to enhance access to care
and always provide several treatment options for our patients. We are committed to
providing the most appropriate care required to achieve your pregnancy, thereby
minimizing your expenses.
We have an outstanding interdisciplinary treatment team to provide your care and
one of the largest and most successful IVF Programs in the country. Our most recent
SART/CDC pregnancy success rates are attached for your information. Our offices
are located at:
Manhattan Location
1790 Broadway, 2nd Fl.
New York, NY 10019
Westchester Location
244 Westchester Avenue, Second Floor
White Plains, NY 10604
Phone: 646-756-8282
Fax: 646-756-8280
E-mail: [email protected]
We look forward to meeting you and providing your individualized care. Please do
not hesitate to call if you have any questions or require additional information at
646-756-8282.
Sincerely,
Mark V. Sauer, MD, FACOG
Director, Division of Reproductive Endocrinology
Professor, College of Physicians & Surgeons Columbia University
WHAT IS "IN VITRO FERTILIZATION” (IVF)?
"In Vitro" is a Latin phrase which means "in glass". It is used to indicate a procedure
or an event is taking place outside of the body and within the laboratory. In this case,
the event that is taking place in the laboratory is “fertilization". This refers to the
time of conception when a sperm and an egg unite to form an embryo.
WHY IS IN VITRO FERTILIZATION USED?
IVF is used to both diagnose and treat a couple’s infertility. Women of reproductive
age have a normal potential chance of fertility per cycle (fecundity). However,
recently more women are being considered subfertile for various factors. In Vitro
Fertilization is useful as a diagnostic tool because it demonstrates the interaction of
sperm and egg. Usually, this interaction takes place inside the woman's body and is
therefore beyond the scope of more conventional diagnostic procedures. In the
laboratory, however, it is possible to observe the functional capabilities of the sperm
and egg: their overall appearance and survival as well as their ability to unite with
each other and produce viable embryo. Such diagnostic information may help to
improve a couple's chances of successful pregnancy. In Vitro Fertilization is better
known as a treatment for subfertile couples. For many couples, especially those with
permanently damaged fallopian tubes, IVF is the only treatment that can lead to
pregnancy. When successful, IVF will result in a pregnancy that is just as normal as
a naturally occurring pregnancy.
WHO CAN BENEFIT FROM IVF?
There are many couples that may benefit from IVF. The age of the couple may be an
important factor regardless of their diagnosis of subfertility. Accordingly, we offer
treatment to women through the age of 45 years. Below are the diagnostic categories
for which IVF is the treatment of choice:
1.
Absent or diseased fallopian tubes – This is the most common reason for
I.V.F. Usually this condition is the result of ectopic pregnancy or infection.
Causes of tubal disease may include endometriosis and pelvic adhesions from
previous infections, surgery or the use of an intrauterine device (IUD); many
causes may be unknown.
2.
Cervical Factors – Cervical factors are those that prevent sperm from
entering the uterus.
3.
Male Factor – Complications such as oligospermia (low sperm count) or
asthenozoospermia (low motility) or azoospermia (absence of sperm in the
semen) are considered Male Factor.
4.
Immunological Factors – Examples of immunological factors include antisperm antibodies.
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Idiopathic Infertility – This term means "infertility of unknown cause," and
indicates that all previous diagnostic procedures have failed to explain why the
couple is experiencing a delay in conception.
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SUMMARY OF THE IVF PROCESS
The IVF process is composed of the following 5 phases:
1.
3. Fertilization
TheOvarian
IVF process is composed
of the following
5 phases:
2. Egg
Stimulation
& Embryo
Retrieval
Culture
& Monitoring
1.
4. Embryo
Transfer
5. Pregnancy
Ovarian Stimulation and Monitoring
One of the keys to success in IVF is to obtain multiple eggs and multiple
embryos. To achieve this we use a hormone protocol to stimulate the
ovaries to produce multiple eggs. This improves your chances of
success. This technique is in contrast to the natural (non-stimulated)
menstrual cycle in which only one follicle and one egg is produced.
Although it is possible to perform IVF during a natural cycle using only
one egg and one embryo, the success rates are greatly improved by
transferring more than one embryo.
The IVF hormone protocol begins when the woman's period begins. A
hormone called Leuprolide acetate is administered which suppresses the
ovaries' natural tendency to produce a single follicle. Following this
period of suppression, another hormone gonadatropins is used to
stimulate the ovaries to produce more than one follicle.
2.
Egg Retrieval
During this stimulation phase and when the estrogens have reached an
appropriate level, the hormone human chorionic gonadotropin (hCG)
will be given to induce ovulation. HCG causes ovulation, which is the
release of eggs from follicles, 36 hours after it is administered.
However, before this ovulation can occur, we remove the eggs from the
follicles during a procedure called an egg retrieval.
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During the egg retrieval, the eggs are collected from the follicles using a
transvaginal aspiration technique performed with ultrasound guidance.
This is a minor surgical procedure, and requires only light sedation. The
retrieval of the eggs takes about 45 minutes from start to finish and the
woman is able to go home after two to three hours of observation.
3.
Fertilization and Embryo Culture
As each egg is retrieved it is taken from the operating room into the
gamete laboratory just a few steps away. Here the eggs are combined
with sperm and cultured for the next 24 hours. During this time the eggs
will undergo fertilization to become embryos, if there are a sufficient
number of embryos, and if you have previously consented to freeze,
cryopreservation will be performed so that you may use any remaining
embryos in the future.
4.
Embryo Transfer
At the end of a 48-72 hour period, the embryos have divided to reach the
2 to 8 cell stage, and will be transferred into your uterus. This is a very
simple procedure performed in a treatment room and is similar to a
pelvic examination. After the transfer you will remain resting in our
recovery area for ½ - 1 hour and your partner or a friend is encouraged
to keep you company during this time.
5.
Pregnancy
In the two week period following the transfer you will be given the
hormone progesterone every day to help support the early pregnancy. In
the second week, you will have two samples of blood drawn to see if
you are pregnant.
If the test shows that a pregnancy has been initiated, the progesterone
will be continued until four to five weeks after the transfer when a fetal
heartbeat can be identified on transvaginal ultrasound scan. Then, you
will be referred to the care of your obstetrician and the progesterone will
be tapered off. Any risks or complications for mother or child during the
pregnancy are the same as for naturally occurring pregnancy.
COST OF TREATMENT
Please see our price lists for the cost of the treatment and/or cycles. The cycle
fees include embryology laboratory expenses, pelvic ultrasound monitoring,
blood tests and professional fees. Fees will change from time to time so please
contact the office for the most recent price list. This does not include
medications or tests required prior to initiating your IVF cycle.
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If you choose to file claims for insurance reimbursement we will do our best to
help you fill out the necessary forms. However, we do not accept insurance
assignment, EXCEPT FOR THE APPROVED LIST OF INSURANCE
COMPANY CONTRACTS. Please check with the business office to
determine which insurance companies have contracts with our infertility
practice.
ADMISSION PROCESS
It is necessary for both you and your partner (if applicable) to meet with one of
our physicians for a consultation. Please bring your medical records, including
diagnostic tests, therapeutic procedures, semen analysis, etc. for the physician
to review with you. During your initial consultation any additional tests or
therapeutic procedures which might be of benefit to you before an IVF attempt
is made will be discussed. The consultation is an opportunity for you and your
partner to ask as many questions as you wish.
TREATMENT TEAM MEETING
Every week we have an IVF meeting. Your case will be reviewed by our staff,
which includes the following members of our treatment team; andrologist,
embryologist, psychiatrist, several reproductive endocrinologists and nursing
staff. A treatment plan will be devised based on the recommendations of the
treatment team. Following this we will schedule a nursing
teaching/consultation session.
NURSING TEACHING SESSIONS
In this teaching session you will meet with one of our nursing staff who will
provide you with a more detailed description of the IVF cycle, including the
timing and logistics of various procedures (e.g. ultrasound scans, the egg
retrieval and embryo transfer, etc.). You will learn how to prepare and
administer the various hormones that you will use. We will answer any further
questions you have with regard to the IVF process.
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