IVF : The Way We Do It
IVF:The Way We Do It. We believe you should consistently be able to get an advice / recommendation for a fertility treatment, handcrafted to your special reproductive potential and egg reserve. Your ovarian stimulation protocol will most certainly not be suited for the next woman. We think carefully and for quite sometime about the best adjuvant and stimulation medication protocol, after obtaining adequate information about you and your partner. Moreover, attention to details during stimulation avoids pitfalls and optimize the quality of oocytes through selecting the most appropriate size to trigger final egg maturation. We then present the regimen to you in a simplified and chronological presentation that is easy to follow.
We believe that you should be able to understand all the intricate details of treatment and train on medications within one to two visits (supplemented with phone calls and e mails). You and your reproductive endocrinologist can reach a treatment decision and even train you on execution parts of that decision in the second visit even if you did not do any fertility tests before. This is how we efficiently do it.
IVF : The Way We Do It
I. Initial visit ultrasound, labs and prior records
Basic information about you and your partner are collected through detailed history, exam and vaginal ultrasound.The main aim is to identify any specific fertility factor as well as estimate ovarian reserve. In addition we order fertility labs and preconception tests. We then discuss in details treatment options, including expected pregnancy rates, multiple pregnancy rates and potential complications.
We obtain and interpret lab results in few days and are discuss them with you especially genetic risk assessment, in person, via secure e mail or phone.
Reproductive endocrinologists should want to care for their patients to help them acheive a healthy baby, not just go through the motions and dynamics of treatment, that has minimal or no chance of working. This is an absolute guiding and ethical principal. Its related to the biological possibilities detected on initial fertility testing and its also related to their physician skills and expertise. At the end of the day infertility specialists need to be clearly convinced that a particular woman has a reasonable chance of get pregnant before initiating a proposed fertility treatment. Fertility specialists then should take that woman to her maximum potential.
II. Second Visit: Saline sonography, trial transfer, medication teach, stimulation protocol.
Checking the cavity of the uterus is essential to exclude factors that prevent implantation. Passing a catheter into the uterus helps anticipating difficulty in embryo transfer. Both are simple office procedures.
Ovarian stimulation Protocol Selection: we think deeply when assigning stimulation protocols in relation to dose and type of protocol (agonist or antagonist) and adjuvant use of medications before and during stimulation. Reviewing prior stimulation can help in improving the current protocol in terms of egg yield and quality. The physician that saw you first will conduct all day to day monitoring as well as all procedures. Attention to details during monitoring is paramount in determining the dose and length of stimulation and time for egg retrieval.
Additional procedures that we perform during an IVF cycle include sex selection, PGD, number of embryos for transfer, egg and embryo freezing are all available to you. I explain those in details.
Medication teach: a hands on exercise on using the medicine. Now You are ready to start.
III. IVF: monitoring, retrieval, embryology lab procedures.
We always strive to deliver compassionate day to day Guidance, tailored around you comfort and convenience. We want you to waste minimal time waiting because you have the rest of your life and work to attend to.
Cycle conduct: we meticulously interpret the response to stimulation through ultrasound and blood work, with each visit and modify the dose of medications to improve response in the ovaries and minimize complications. The same physician perform monitoring and daily instructions as well as all other procedures. He or she knows your story and you never have to repeat yourself to a new person each time.
Embryology procedures: egg retrieval and embryo transfer done by the same reproductive endocrinologist. Excellent embryologists attend to your reproductive tissue.
Embryo selection for transfer: aiming at transfer of the smallest number of embryos that do the job. Up to age 39 we champion single embryo transfer to minimize twin pregnancy. Sometimes, when appropriate, we employ PGS / PGD to select the best embryo for transfer
IV. Pregnancy Follow up
10-12 days later you will get a blood pregnancy test, then early pregnancy ultrasounds. The aim is to confirm viability, position and health of the embryo. I then discuss nutrition in early pregnancy. I also explain different options in prenatal screening of chromosomal abnormalities in details. These include quad screen, nuchal translucency, Non Invasive Prenatal Test. Amniocentesis and CVS.
In addition, I describe options on multiple pregnancy and fetal reduction in details. We generally transfer a single blastocyst up to age 39 to the majority of women, minimizing the risk for twins.
The years of discomfort, time wasted, untoward effects and long waiting should all be behind us. You should be able to get pregnant in few weeks, safely without loosing any work time. Fertility treatment can be successful while attending to all other aspects of your life. We want to make sure that you are not dealt a false hope but if there a small hope will go fight for it together till we realize it together.