IVF for Dummies (Part 2)

The stimulation part of the IVF cycle can be the most problematic. If patient is prescribed too little medication then she can get cancelled for a poor response. Give a patient too much and she can develop OHSS which really sucks (as was pointed out in a comment recently by one of my 5 regular readers-my Mom not included). How do we pick the protocol? Well first of all I consult my Magic 8 Ball toy that I bought on Ebay…then I spin a big wheel in my office and then I review it with Dr DiMattina, my partner, who usually changes the dose all around reminding me that he has been doing IVF since before I was in college and didn’t I read the latest paper in Fertility and Sterility. Actually, Mike and I usually agree on protocols although I really like the stop Lupron protocol for low responders and he is not a believer and uses MDL flare (which I also like…). If these comments make absolutely no sense to you, then don’t panic. If you agree or disagree with them and can cite the latest journal articles to support the thesis then you are really much too involved in your own care and are probably driving your spouse/partner over the edge.

But seriously, I review past stimulations, look at the appearance of the ovaries on sonogram and check the FSH level. From these I make my best estimate as to how to stimulate the patient. Usually we are on target. We average 11 eggs/retrieval here and that I think is ideal. Not too many…not too few..

So onto Part 2 of IVF for Dummies. Maybe I should call it something more PC but you may want to check out the book sales for those Dummies books. Not too shabby.


50. What is IVF and how is it performed?


PHASE 2: OOCYTE RETRIEVAL
Many physicians perform IVF as an office-based procedure, whereas others utilize a free-standing surgery center. Some programs are located within a hospital. There are advantages and disadvantages to each of these. We prefer to perform the egg collection within our office, as the location and staff are familiar to the patients undergoing the IVF process. We also find that the location of the IVF lab within the office encourages continuous communication between patient, physician, and embryology staff. However, clearly many successful programs utilize a surgery center or a hospital. The use of a hospital setting may allow patients with significant medical conditions (cardiac disease, severe pulmonary disease) to undergo IVF, whereas such patients would be considered an anesthesia risk in the office setting.

Although many patients are nervous about the oocyte retrieval, in fact the vast majority of women find it to be less uncomfortable than some of the screening tests leading up to IVF. The egg collection is performed under light conscious intravenous sedation using a vaginal ultrasound probe with a special needle guide adapter. The needle passes through the side of the vagina into the ovary, and the follicles are easily aspirated. The fluid containing the eggs is then inspected by the embryologist using a microscope. Both the eggs and the sperm are then placed together in small plastic dishes containing media and incubated for the next 3 to 5 days. If there is a significant male factor, then ICSI is performed several hours after the egg collection.