Thank
you for your interest in Northwest Fertility Center’s (NWFC) in vitro
fertilization (IVF) and embryo transfer (ET) program!
IVF is a high tech method of assisted reproduction, which requires
the teamwork of professional physicians, embryologists and nurses.
Eggs are removed from the female partner and are combined with sperm
from the male partner in a special laboratory where fertilization
occurs. Several days later the resulting embryo(s) are transferred
to the uterus. Other embryos might be cryopreserved (frozen) for future
use. Essentially IVF bypasses the Fallopian tubes where normal fertilization
takes place.
Our center has been established since 1986 under the direction of
Dr. Stoelk. The NWFC and Dr. Stoelk are well recognized in the Pacific
Northwest for excellence in all types of fertility care, especially
for our success with in vitro fertilization (IVF). The Northwest Fertility
Center has consistently achieved pregnancy rates higher than the national
average. What makes one fertility center have higher success rates
than another? The answers are varied. We believe our high success
rates can be directly attributed to the fact that Dr. Stoelk is the
only physician making decisions regarding your care, thus providing
consistent, yet individualized medical management. He will be the
one performing the egg retrieval and embryo transfer. It is a very
significant advantage to have only one highly skilled IVF physician
manage your fertility treatment.
Our philosophy is to treat each patient as an individual. We do not
believe in recipe type protocols that are used for all patients. No
two people have the same set of circumstances that led to their difficulty
to conceive. Our goal is to assist in building families through a
quality infertility investigation and appropriate treatment. We recognize
the financial and emotional strains that infertility treatment may
cause and make every effort to keep emotional and financial cost to
a minimum. Along the way, we try to educate so you can participate
in the decisions that must be made.
Indications for IVF Participation:
-
Absent, Blocked, or Damaged Fallopian Tubes. If
the egg and sperm can not meet, IVF is the most successful and least
invasive option. Prior to the availability of IVF, many major surgeries
were performed with low chance for pregnancy to occur.
- Sperm
abnormalities. Men with low sperm counts, low motility,
high abnormal sperm forms, sperm antibodies, and vasectomy can now
opt for IVF. We have the capability to isolate one sperm and inject
it directly into the egg if necessary, thereby making it possible
to solve infertility due to almost any male (sperm) problem.
- Endometriosis.
Endometriosis is an abnormal condition where the normal lining of
the uterus (the endometrium) is also found in other various areas
in the pelvic cavity. This tissue should not grow outside the uterus.
The endometrial implants outside of the uterus create a toxic environment
for the egg, decreasing chances of fertilization. IVF takes the
eggs out of this hostile environment and into the laboratory where
fertilization takes place.
-
Unexplained infertility. (When no exact cause for infertility
has been found and pregnancy has not occurred using other fertility
treatments). It is not known why some couples that appear normal
do not conceive naturally or with basic fertility treatments. There
is an unknown factor that can be successfully treated with IVF.
If you have any questions, call our office. We have informed healthcare
professionals available to assist you. We look forward to meeting
you and hope that this information will answer some of your questions
regarding our IVF program.
The following are phases of our
in vitro fertilization and embryo transfer program:
- Preliminary
phase
- IVF
Process
a. Ovarian (egg) stimulation and monitoring
b. Oocyte (egg) retrieval
c. Fertilization by sperm insemination or intracytoplasmic sperm
injection (ICSI)
d. Embryo transfer
e. Embryo cryopreservation (freezing) and storage
- IVF
follow-up phase
I. Preliminary phase
Dr. Stoelk will evaluate
your unique situation by performing a complete history and review
of previous medical records. The basic preliminary testing completed
on all patients includes an exam, pelvic ultrasound, semen analysis
and some blood testing. If recent testing has been preformed he will
usually not have you repeat them. Unfortunately, many other IVF programs
have a long checklist of required tests. This greatly increases your
costs before you ever begin IVF and is seldom included in the cost
estimate. Rarely do these “extras” result in added success. Since
we wish to keep your financial costs to a minimum, we will only order
additional testing if your history or medical diagnosis indicates
a need, rather than having a long list of routine tests performed
on everyone. You will be given a thorough review of the IVF process,
explanation of the medications and procedures prior to signing informed
consents.
II. The IVF Process
A. Ovarian (egg) Stimulating and Monitoring
For IVF to have a good chance of success multiple eggs must be obtained.
Usually women only mature one egg a month. There are many methods
used to stimulate production of multiple eggs. Based on your age,
diagnosis and history Dr. Stoelk will select a specific individualized
protocol and dosage for you. There are three different medications
(hormones) that help properly stimulate the ovaries. As strange as
it may sound the first one is Birth Control Pills.
Birth Control Pills are often given for two reasons. First, they help
regulate your cycle and secondly they decrease your risk of cyst formation
that could delay your IVF start date. The second
medication used is Leuprolide (Lupron). Leuprolide inhibits the natural
release of the eggs. This permits us to properly time the egg retrieval.
Leuprolide continues daily for approximately 2-3 weeks. Leuprolide
is administered by subcutaneous injection. Another IVF protocol uses
either Cetrotide or Ganerelix instead of Leuprolide.
The third drug (hormone) used are the
gonadotropins (Bravelle, Follistim, or Gonal F). These injections
stimulate the ovaries to produce multiple mature eggs. Some of the
common side effects to these hormones are mood swings, pelvic bloating
and sometimes headaches, but never any lasting health problems. The
usual duration of fertility drug administration is 8-11 days. Fertility
drugs are administered subcutaneously (under the skin). These fertility
drugs all contain follicle stimulating hormone (FSH) the same hormone
that is produced by the pituitary each month to stimulate egg growth
and development. These injections provide levels of FSH much higher
than what the pituitary would ordinarily release, thus stimulating
many eggs. Initial response will be monitored every 2-3 days by blood
Estradiol testing. As the follicle/eggs get closer to maturity, transvaginal
ultrasounds will be performed as well. When these studies indicate
optimal follicular development, the patient is administered an injection
of HCG (Ovidrel, Pregnyl or Novarel) which triggers the eggs to undergo
the final stages of maturation. Egg retrieval is scheduled approximately
36 hours after the HCG injection. Two days after the egg retrieval,
you will start progesterone supplementation. Progesterone is the hormone
that is produced by the ovary after ovulation occurs and maintains
the uterine lining. It promotes a good environment for the embryo
to implant and grow.
B. Oocyte (egg) Retrieval
Egg retrievals are performed in our clinic procedure suite by transvaginal
ultrasound aspiration. You will be given IV sedation and pain medication.
A vaginal ultrasound probe is inserted into the vagina and a needle
is passed through the wall of the vagina to each ovary. The follicular
fluid and eggs are then aspirated from each follicle. The number of
eggs retrieved varies greatly depending on your age and medical diagnosis:
usually anywhere between 5 and 40 eggs are retrieved with the average
being between 10-15. The procedure usually lasts about 30-45 minutes.
Most women return to work the next day following the IVF retrieval.
C. Sperm Insemination and Fertilization
The follicular fluid removed from the ovary is immediately examined
in the IVF embryology laboratory for the presence of eggs. The eggs
are isolated and placed in petri dishes with special culture media.
On the same day of the egg retrieval, a sperm sample is obtained from
the male partner. The semen is processed, then placed with the eggs
in the petri dish. Approximately 60-80% of the eggs will fertilize
and become embryos. Dr. Stoelk will call you the day after egg retrieval
to review how many eggs fertilized.
A special IVF laboratory technique called ICSI (Intracytoplasmic
sperm injection) is used when men have a very low sperm count or previously
had a vasectomy. ICSI is a technique where a single sperm is picked
up under a microscope using a microsurgical instrument and directly
injected into the egg by our embryologist. This procedure has completely
revolutionized the treatment of severe sperm problems. Many men, who
have had a vasectomy, can now select this method instead of doing
a vasectomy reversal.
D. Embryo Transfer
Once the egg has fertilized it is called an embryo. The embryo progresses
through various stages of development. First it begins to divide into
multiple cells. Once the embryo has divided into so many cells that
you can no longer count them, it is called morula (day 4). Next these
cells begin to compact creating a hollow looking appearance in the
middle of the embryo -- now called a blastocyst (day 5). We prefer
to transfer at the blastocyst stage for several reasons:
- To place the embryos back into the uterus at approximately the
same day they would arrive in the natural setting.
- To allow a natural self-selection to take place. By waiting the
5 days, the less healthy embryos will become apparent and usually
stop developing. Thus we can transfer the embryos with the best
potential of implantation.
- Fewer of these “select” embryos need to be transferred, therefore
giving higher pregnancy rates with less risk of multiple babies.
The IVF embryo transfer procedure is not painful or difficult.
Usually two or three embryos will be selected to be transferred. Other
embryos that make it to the blastocyst stage will be vitrified (frozen)
for future thaw and transfer. The embryos are placed into the uterus
by passing a thin, flexible catheter through the cervical opening.
You will not need any pain medication for this procedure. This is
always performed under ultrasound guidance. Many of our patients elect
to have acupuncture performed at the time of transfer by our licensed
acupuncturist or by their already established acupuncturist. You will
be asked to remain resting for approximately 30 minutes after the
embryo transfer, then home with minimal activity for the remainder
of that day.
E. Embryo Cryopreservation by Vitrification (freezing)
and Storage
When multiple embryos proceed to the blastocyst stage the remaining
blastocysts will be cryopreserved by vitrification for future thaw
and transfer. We have been freezing embryos since the mid 1980’s and
the embryos can be maintained in the cryopreserved state for many
years. Vitrification is the best method to successfully freeze and
store embryos (and eggs) performed in leading IVF centers.
Phase III Post IVF
During the follow up phase of IVF women will receive daily doses of
progesterone to support the uterine lining. Dr Stoelk has always used
vaginal capsules instead of painful Progesterone in oil shots. Approximately
eight to ten days after embryo transfer a blood pregnancy test will
be obtained. If you are pregnant, the progesterone supplementation
continues to approximately 7-8 weeks of pregnancy. Additional pregnancy
tests and blood progesterone levels may be drawn to monitor the pregnancy’s
progress and change the dose of progesterone if necessary. An ultrasound
is usually done 2-3 weeks after the initial pregnancy test, to determine
the number of embryos that implanted and the attachment site. Most
often a fetal heartbeat can be detected during this initial pregnancy
ultrasound. Fetal cardiac activity seen at this point is a very good
indicator that the IVF pregnancy is viable and will progress to delivery
of a baby. Another ultrasound may be done 2-3 weeks after the first
one to confirm normal growth and development. Usually it is at this
time you will stop progesterone supplementation and see your OB/GYN
physician for continued prenatal care. There have been over four million
IVF babies born world-wide and some 58,000 American IVF babies are
born each year. IVF techniques do not increase birth defects over
“naturally” conceived pregnancies.
