So you have tried “conventional” therapy for some time and have not been successful. You may have been treated with fertility drugs, undergone artificial insemination, or you may have had laparoscopy to treat scar tissue or endometriosis. For one reason or another the egg and sperm are just not able to “meet “or implant in the uterus. The problem may be traced to tubal function, pelvic adhesions or scar tissue preventing release of the egg from the ovary. It is also possible that the sperm cannot get into the egg either because of low sperm number or structure or thickened egg shell. What can be done now?
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Boca Fertility was established in 1982, and we have been performing IVF since 1988. After your initial consultation, several tests will be scheduled. Your husband will have a semen analysis to accurately count the number of sperm, and to evaluate their shape and how well they move. Your uterine cavity will be evaluated by Saline Infusion Sonography to make sure there are no abnormalities such as uterine polyps or fibroids which may interfere with implantation. A trial transfer will be performed at the same time to make sure that there is not going to be a problem when the embryos are transferred into the uterus. The depth of the uterine cavity is measured so that the embryos can be transferred into a predetermined location within the cavity during the actual IVF cycle. |
| The actual IVF treatment consists of suppression and stimulation cycles. |
 During the suppression cycle, you may be instructed to take birth control pills alone or
in combination with Lupron to prevent ovarian cysts and to block spontaneous ovulation during the stimulation cycle. In some cases
Lupron may be started 1 week after ovulation.
 When you start your next menses, you can expect to have an ultrasound to make sure your ovaries contain no cysts that can interfere with proper egg development. Taking into consideration your age, day 3 of cycle FSH (follicle stimulating hormone) level and ultrasound appearance of your ovaries, the doctor can determine how much fertility medication injections you require. |
 You will be taking fertility shots for about ten days to stimulate multiple eggs to develop. You will continue to take Lupron all this time and you can expect several ultrasounds and blood tests to monitor the development of the eggs. Women can respond differently to the fertility drug injections and may need adjustments in the amount of medication taken. Another stimulation protocol utilizes Antagon instead of Lupron
to suppress spontaneous ovulation. Utilizing Antagon simplifies the treatment since
no suppression of ovarian function is necessary in the preceding cycle. The pregnnacy
rates are comprable regardless of the stimulation protocol selected for you by your doctor.
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This medication is given when the follicles (eggs) reach about 20 millimeter in size. The egg retrieval is scheduled about 34 to 36 hours after the HCG injection.
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 The eggs are removed from the ovaries by transvaginal ultrasound technique.
This minor surgical procedure is performed in our certified in-office operating room suite. The procedure takes about 15 min. and is performed under intravenous sedation given by our board-certified anesthesiologist. You will be going home about 30 minutes later. You may feel tired afterwards, so plan on taking the rest of the day off. |
 Now that your eggs have been removed from your ovaries, the next step is for the embryologist to prepare your eggs and your husband’s sperm for fertilization. In cases where the sperm cannot penetrate the egg because of low sperm count, abnormally shaped sperm or low motility, the embryologist will inject one sperm directly into each egg. This procedure is called Intracytoplasmic Sperm Injection or ICSI. |
 Utilizing "ICSI" (pronounced "icksy"), which stands for IntraCytoplasmic Sperm Injection, a single sperm is all that is needed. It can be injected, using microscopic techniques (micromanipulation), directly into an egg. In this procedure, the wife undergoes a normal IVF cycle. However, when it is time to fertilize the egg, a single sperm is drawn into a very thin-tipped pipette. The tip of the pipette is inserted into the egg and the sperm is then released directly into the egg. This process can be repeated for each egg. |
| Once fertilization occurs, the embryologist will monitor the fertilized eggs for three to five days to make sure that they develop normally. |
| 1. |
Zygote - the fertilized egg, as it appears 16-18 hours as after fertilization, showing the male and female genetic material (pro nuclei) is called a zygote. Sometimes more than one sperm can penetrate the egg resulting in an abnormal zygote which will not be transferred into the uterus. |
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| 2. |
8 cell stage embryo - as it appears 72-80 hours after fertilization. Generally, 2 embryos will be transferred into the uterine cavitry. If more than 3 such embryos are available, your doctor may choose to allow them to grow two more days in the laboratory to a blastocyst stage. At BocaFertility transfer of two blastocysts on day 5 results in an overall delivery rate exceeding 50%. |
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| 3. |
Blastocyst - the embryo as it appears five days after fertilization. Since implantation rate for blastocysts is significantly higher than day 3 embryos, only 2 blastocysts need to be transferred minimizing the risk of multiple pregnancies. |
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 Preimplantation Genetic Diagnosis (PGD) is a very promising diagnostic test for detection of chromosomal (genetic) abnormalities in the embryo during in vitro fertilization (IVF) therapy. This testing however is limited because of the high-cost of the procedure, technical difficulties in performing the procedure and diagnostic limitations. PGD involves removal of one or two cells from an early 8 cell stage embryo and the use of sophisticated procedures which check the cells for any genetic abnormalities. Only those embryos which are found to be normal are then transferred into the uterus, while the abnormal ones are discarded. At this time most studies suggest that PGD is indicated in patients with genetic abnormalities, such as hemophilia, as a way to prevent transmitting the abnormal gene to their children. However, to date, this procedure has not been shown to be helpful for patients with repeated IVF failures, older patients or patients with recurrent miscarriages. Another problem with PGD is the 5 to 7% false-negative results (undetected abnormal embryos), necessitating amniocentesis later in pregnancy to make sure that the embryo is completely normal. |
 The doctor will discuss with you the number of embryos to be implanted. At BocaFertility we usually transfer the embryos on day 5 at the blastocyst stage. The advantage of blastocyst transfer is that only 2 embryos need to be transferred to achieve a very good pregnancy rate, minimizing the risk of multiple pregnancies. Prior to the transfer you will be given valium to make you feel relaxed. You will be given a photo of the embryos transferred for your record.
 A speculum will be placed in your vagina and the embryos will be gently transferred into a predetermined site within your womb using a very soft catheter. The transfer of the embryos is not painful and takes only a moment to accomplish.
Following the transfer of embryos, you can expect to rest for an hour before leaving the office. We recommend that you continue to relax at home for the next 24 hours. |
 Your pregnancy test will be scheduled two weeks after your retrieval and you will be notified of the result within 1-2 hours. A positive result indicates that an embryo implanted and you will be scheduled  for an ultrasound about 2 weeks later. The ultrasound allows the doctor to document the number of embryos implanted and to check the baby’s heart rate. At this time you can expect to be referred to your obstetrician who will be taking care of you for the remainder of your pregnancy. |
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