In-vitro Fertilization is the process of fertilizing an egg outside the body in a laboratory setting. After your physician has determined that IVF is needed, you will need to complete additional screening, which includes

1. IVF Interview
   This is done by a member of our IVF team and takes about an hour to complete. It includes a review of your health history and an overview of the IVF process. An IVF calendar is completed for you. Your calendar includes daily medications, appointments, estimated egg retrieval, embryo transfer, and pregnancy test dates.
   
2. Social Worker Visit ( See under "Counseling Services" )
   
3. Blood work screening for any health or communicable conditions which may be present.
   You and your partner will be screened for conditions such as HIV, blood type and Hepatitis B and C. The female undergoing the procedures will also be tested for conditions such as exposure to rubella (German Measles), varicella (chicken pox), and CMV. They will also test for anemia, infection, liver function, thyroid function, etc. These tests will be more fully explained to you when you go to the IVF Interview.
   
4. Water Sono (See "Services" for explanation)
   
5. HSG (See under "Services" for explanation)
   
6. Injection teaching to learn how to safely administer the medications you will be using in your cycle. (See "Services" for explanation)
   
7. All the medications you will need for your cycle will be ordered by a nurse on our staff. The pharmacy will then contact you for your insurance/payment information.
   
8. You will need to call Mather Billing to set up the financial part of IVF at 631-476-2802. This must be done prior to starting the stimulation part of IVF.
   

Now you are ready to "start". You will be given a day to return to the office for blood-work and sonogram. Once your bloodwork and sonogram are done you may leave the office. After 5 pm you can pick up a voice mail message at a number we will give you on the first day. Your message is retrieved with a PIN number. Your message will tell you your medication dose and when to return to the office. The return dates are determined by your response to the medicines, so we will not be able to tell you exactly how often you will be returning.

Egg Retrieval
Once a reasonable number of your follicles are mature and your hormone levels are appropriate, the doctor will order the drug HCG (see under “medications”). Approximately 34.5 to 36 hours later you will be scheduled for your procedure. The retrieval is done with sedation through an IV. The doctor makes a small puncture through the vaginal wall into the ovary to retrieve every egg inside. This is done with low suction. You will receive a local anesthetic, so there is little, if any, pain associated with the retrieval. The two possible side effects, other than those from the medications they use for sedation, are cramping and spotting. Usually the day of retrieval is spent resting, and you return to normal activities the following day.

Embryo Transer
Three days after the eggs are retrieved and fertilized, the resulting embryos are placed back into the uterus using a thin catheter. This procedure does not use any sedation, and takes just a few minutes. It is done using abdominal ultrasound guidance. You can return to work or light, normal activities following the procedure.

GIFT (Gamete Intra-fallopian Transfer)
The transfer of eggs and sperm into the fallopian tubes through an incision below the umbilicus using a laparoscope. If the fallopian tubes are normal, and there is not a severe male factor problem, then you may be a candidate for GIFT. The eggs are retrieved as in IVF, and with a small amount of sperm, and placed immediately back into the fallopian tubes. This procedure lasts longer than a regular retrieval. The side effects and risks are those associated with ovarian stimulation and general anesthesia.

ICSI (Intra-Cytoplasmic Sperm Injection)
This is used in cases where there are few sperm in the ejaculate (semen), or the sperm have low motility. This procedure allows one sperm to be injected into a single egg (ooctye). If there were no sperm in the ejaculate, the male may need a procedure called a TESA (testicular epididymal sperm aspiration) to obtain the sperm they could use for ICSI.

Assisted Hatching
This involves the manipulation of the embryo under the microscope to chemically dissolve or weaken a portion of the zona (shell). It is done prior to the transfer on day 3, its purpose is to increase the ability of the embryo to hatch and hopefully assist with implantation.

Cryopreservation of Embryos
Additional embryos not being used at the time of an IVF cycle can be frozen for use at a later time. They are transferred to a special solution. They are then cooled at a carefully controlled rate. When they are needed in future cycles, they are thawed in a machine designed to carefully control the warming rate. After thawing, they are washed free of the freezing solution and may be used for another transfer cycle. Any embryos that appear to be abnormal will not be transferred.

PGD (Preimplantation Genetic Diagnosis)
Laboratory technique to remove and evaluate a cell from a developing embryo for chromosomal analysis to diagnose genetic conditions. Chromosomes are made of genes that instruct a body how to function. The presence of an extra or missing chromosome can result in lack of implantation, pregnancy loss or other conditions such as Downs Syndrome. Speaking with your physician will help to determine if you are a candidate for this procedure.

Sperm Retrieval Procedures
When the male partner has conditions such as: azospermia (no sperm present in the ejaculate), congenital absence of the vas deferens (CAVD), or blockage of the sperm ducts, a surgical procedure can be done to obtain the sperm directly from the testicular tissue. This is an ambulatory out-patient procedure, and will be discussed with a urologist well versed in this type of surgical intervention. The names of those urologists are available when you sit down with the physician at the time of your consult.