How is IVF Done—Step by Step?

How is IVF Done—Step by Step?

In vitro fertilization (IVF) is the most effective, commonly performed and final infertility treatment in the world. Still, unless you have actually gone through it, most people don’t actually know what’s involved with the steps involved with this assisted reproductive technology (ART). You can consider this your introductory guide.

 

First, IVF is a sequence of procedures that involves fertilization of an egg outside a woman’s body in a specialized lab. It is often performed after other methods of trying to get pregnant have failed.

 

Here’s how IVF works, step-by-step:

 

Preparation for an IVF Cycle – Testing and Ovarian Stimulation

Before IVF, you’ll have an evaluation of your uterus and fallopian tubes to make sure there are no issues that require surgical repair. Pre-cycle testing includes hormonal evaluation to assess thyroid function and ovarian reserve, screening both partners for sexually transmitted infection, and a semen analysis of the male partner.

 

Most women will take fertility drugs for ovarian stimulation for 8-14 days; the average is 10-11 days. Ovarian stimulation is used to mature multiple eggs for egg retrieval. Even if ovulation is normal, fertility drugs are used to produce more than a single egg because pregnancy rates are higher with more eggs. An average of 10 – 20 eggs are usually retrieved for IVF. However, not all of them are viable to use as on average only about two-thirds have the appropriate maturity.

 

Your physician will carefully design a protocol to try to obtain the maximum number of eggs while protecting against development of ovarian hyper-stimulation syndrome (OHSS). Fertility drugs for IVF are usually injected, and you’ll be frequently monitored using hormonal testing and vaginal ultrasounds for the best result. Once an ultrasound determines you have a sufficient number of large enough follicles and your estrogen level is at the right level, you’ll receive a trigger shot of hCG or other medication. This replaces the natural luteinizing hormone surge a woman has that spurs the final stage of egg maturation, so eggs are capable of being fertilized.

 

Egg Retrieval

Thirty-four to thirty-six hours after receiving the trigger shot – before the eggs ovulate – you’ll have a surgical procedure to remove the eggs from follicles in your ovaries. For this egg retrieval procedure, an ultrasound is used to visually guide a small needle through the top of the vagina into one ovary and then the other. You shouldn’t experience any pain or discomfort during the process as you’ll be under sedation through an IV while closely monitored by an anesthesiologist.

 

Follicles are entered with the needle and the follicular fluid contents are removed using gentle suction that brings the egg along in the fluid; the entire process usually takes less than 30 minutes. You may feel some minor cramping the day of the procedure which is usually gone the next day. There may be a feeling of fullness and/or pressure due to expanded ovaries from the ovarian stimulation. This may last for a few weeks.

 

The fluid from the follicles – that contains the egg – is suctioned by the IVF physician through small tubing and into a test tube. The test tube is then handed to an embryologist who uses a microscope to find the egg in each test tube of follicular fluid. All the details of the eggs are carefully recorded. The number of eggs produced and removed are influenced by a patient’s age, ovarian reserve, response to ovarian stimulation and, occasionally, the ability to access the ovaries with the needle.

 

Fertilization

Once eggs reach the lab, experts examine them to determine maturity and quality. Mature eggs are transferred into a special culture medium, placed in an incubator and within a few hours of egg retrieval are fertilized with sperm. There are two ways to fertilize an egg: conventional insemination or intra-cytoplasmic injection (ICSI). Which process is used will be determined by your IVF team (physicians and embryologists) and depends on multiple factors related to the couple going through IVF. Both methods have approximately the same success rate. ICSI is used approximately 70% of the time when factors make fertilization less likely due to poor semen quality or previous IVF failure.

 

For the conventional method, sperm is placed in the culture medium in a small petri dish containing an egg; the sperm and eggs are incubated together in the dish in the lab, allowing the sperm to enter the egg on its own. For ICSI, one sperm is injected into the cytoplasm of the egg using a needle and a sophisticated operative microscope. No matter which process is used, fertilization is checked the next morning.

 

Embryo Transfer

Following fertilization, the IVF team and the couple determine exactly when embryo transfer will take place – anywhere between 1 and 6 days but usually 3-5 days after egg retrieval. However, if the decision is made to do genetic testing, first a biopsy is taken from the embryo, almost always on culture day 5 or 6. Usually 3 to 8 cells are sent for testing performed at an outside lab, while the embryos are frozen and remain in the IVF laboratory. After receiving the genetic test results, the selected embryo is chosen, thawed and transferred into the uterus, usually within 1 to 2 months after the egg retrieval.

 

The number of embryos produced depends on several factors including the age of the couple. In the past, multiple embryos were transferred in the hope of maximizing success but this often resulted in twins or rarely triplets, both of which are associated with pre-term birth and other serious complications to both babies and mother.

 

The safest approach is to limit transfer to a single embryo. To maximize the chance for success, the healthiest embryo is selected by the embryologist based on a grading system used to evaluate each embryo.

 

A soft, flexible, and thin catheter is used to transfer the embryo into the uterus. An abdominal ultrasound is used to make sure that the tip of the catheter places the embryo at the best location for the embryo to implant. Pain and discomfort are rare, and the experience has been compared to how it feels to get a pap smear. Good embryos not used for transfer are usually frozen in case the cycle is not successful or a couple wants more children following a successful first cycle.

 

Hopefully, the development of the embryo continues in the uterus and the embryo hatches and implants in the uterine lining within 1-2 days following embryo transfer.

 

Assisted Hatching

Sometimes an additional process is used to provide further help for older women, for couples who have previously been unsuccessful with IVF or with frozen/thawed embryos. Assisted hatching is a micromanipulation procedure where a hole is made in the flexible shell that surrounds the cells of the early embryo. Normally, this membrane dissolves on its own since this is necessary for embryo implantation. This extra process has not been demonstrated definitively to improve live birth rates and there may be very minor risks involved. Also, there is no evidence that it improves pregnancy or live birth rates for other types of IVF patients. Assisted hatching, if performed, is done just prior to embryo transfer.

 

Pregnancy Test

About 12 days after an embryo transfer, you’ll have a blood pregnancy test. If a pregnancy is confirmed, you’ll be followed with blood tests and eventually, ultrasounds, to confirm viability and whether there’s a multiple pregnancy. If the pregnancy appears normal at 9-10 weeks, you’ll be referred back to your obstetrician!

The Lasting Trauma of Infertility

Via The New York Times & The Broken Brown Egg

Even when it ends with a healthy baby, a long struggle to conceive may exact a brutal toll.

I recently came across a quotation by Vincent van Gogh, and it triggered something in me. “There may be a great fire in our soul, but no one ever comes to warm himself by it, all that passers-by can see is a little smoke,” van Gogh wrote, in an 1880 letter to his brother, Theo. The line haunted me for days; I was struck by this concept of the fire within. How many people do we pass every single day who are carrying around raging fires — who have a passion or a pain inside that is so great they can barely contain it?

For me, and for thousands of other people, infertility is that raging fire.

We kind of know that cousin or aunt who loves kids, and we kind of see the sadness in her eyes at baby showers, but we don’t really know the depth of her pain. We see how our co-worker lights up whenever other people talk about their children, but we don’t really know why he and his wife never had any. We read something once upon a time about recurrent miscarriage, and we felt sorry or sad, but we couldn’t picture anyone we knew who had lost multiple consecutive pregnancies.

Fire can leave serious damage behind. Because it can be hard to fully grasp what infertility involves unless you’ve dealt with it personally, many people believe that it’s all about the end game, a baby — that if you could just get to that prize, the pain of infertility would fade away. But infertility is bigger than babies. I say this often, because I want people to get it. It truly is. It can affect our physical and mental health in insidious — and sometimes enduring — ways.

I founded The Broken Brown Egg, an online community and awareness organization, in 2009, because I wanted to support women of color who are battling infertility. In the years since, hundreds of women have reached out to me to share their stories — about their struggles to conceive, and about the feelings of isolation and stress they often face, too. Research has shown that women dealing with infertility have depression and anxiety levels similar to those with cancer, H.I.V. and heart disease, and — through my advocacy work as well as my personal experiences — I have become intimately familiar with infertility’s psychological toll. Yet it took me a long time to acknowledge that infertility can be a form of trauma. It didn’t feel worthy of the term. I mean, infertility isn’t life-threatening, right?

Some researchers argue that the definition of trauma should be expanded to include the psychological and emotional response to not only physical threats, but threats to deeply held expectations of life. According to Allyson Bradow, a psychologist who wrote a paper on infertility, people affected by infertility must adjust to a major shift in life expectations while being exposed to constant reminders of their condition, through questions from family members, medical treatments or interactions with pregnant women.

“Psychologists must understand that infertility is a trauma, and often a complex trauma,” Bradow writes. “While anxiety, depression, and grief and loss are all a part of the psychological impact of infertility, there is much more to the experience which is defined by the individual.”

Infertility changes how you see yourself and the world. Somewhere along the journey, many of us stop feeling as though it is something that is happening to us, but instead begin to believe that it is a part of who we are. You become used to living in a constant state of fluctuating despair and hope. And this doesn’t turn off when and if you get pregnant. It doesn’t turn off when you hear or see the heartbeat. My son is 3. I’m still trying to turn it off.

Six months into motherhood, I felt as if I was in quicksand. I’d gotten through infertility, gotten past a failed adoption, braced my way through I.V.F. and a C-section. I should have felt invincible, but instead, I was numb. I felt as if the other shoe would drop at any moment. I had to pay for the victory that was my son, didn’t I? That was the routine of the roller coaster infertility had been for us. No success without swift defeat.

My therapist helped me to understand that I was dealing with postpartum depression, and explained that the stress of undergoing treatment for infertility has been shown to make some women more susceptible to postpartum depression. Some fertility clinics have even added counseling to their services, in the hopes of helping individuals and couples prepare for the mental effects of treatment.

Our public conversations surrounding infertility and mental health have separately been gaining traction in recent years and, thankfully, they are beginning to intersect. If you have struggled with both issues, as I have, know that you are not alone.

For more information about infertility contact us +5213296880059

pmhappointments@puntamitahospital.com

Pregnancy Loss: What to say

Pregnancy Loss

October is Pregnancy Loss Awareness Month. Your newsfeed might be filled with Mothers and Fathers sharing that they have lost a child through a post, or by changing their Facebook profile picture or banner.

This type of movement for awareness is a powerful way to reduce stigma and raise awareness. It can also trigger hard emotions, both for those who have experienced loss (sometimes you just want Facebook to be a distraction, not a reminder) and for those who are learning of their friend’s and family member’s losses.

This post will explore helpful things to say to someone who has experienced pregnancy loss — so often we say nothing, because we struggle to find the words to say something.

The best approach for supporting someone through pregnancy/infant loss with your words is to be open and provide plenty of space for the grieved parent to speak, if they so choose.

Helpful responses to pregnancy loss or infant loss:

  1. I am so sorry for your loss, I would love to hear about your baby, if you are able.

The standard “I am so sorry for your loss” is often the first thing we think to say.

This is a good thing to say —- and is made even better by following with a “I would love to hear about your baby, if you are able” This provides the parent with an opportunity to say more than “it’s ok” or just a simple “thank you” This opens the door for true sharing and connection, something that is often missing during a journey through loss and grief.

  1. I would like to help. Can I  <insert specific task> 

Another standard response to loss is the phrase “I am here if you need anything.”

Have you ever been in a situation where you could use help, but you have absolutely no idea what might be helpful? Grief is all encompassing, and hinders our ability to think logically. Most likely thinking of something for someone else to do is too much work. A sincere, specific offer can be accepted or declined based on needs. Perhaps you could watch older children, cook a meal, clean the home, do some food shopping, weed the garden, or drop-off dry cleaning. If you offer and the family accepts, be sure to follow through.

  1. I have also experienced loss. I know every situation is different,  I am hear to listen. What are you feeling?

Families who have experienced loss have many commonalities. They also have many differences. Sharing that you have experienced a loss (if you are able) breaks the silence around loss and communicates that the family is not alone. Leaving space for differences in experiences respects the individual family’s journey and provides a space for story-sharing and healing.

  1. What support systems do you have? 

I see this question as a replacement for “Everything happens for a reason.”

Each family will draw on their own personal experiences, spiritual background and/or religious community.  Each family will find their own way through grief, and part of the healing process is incorporating the loss into their life story and experience. Asking about support systems will open the conversation so the family can share what is working for them  and where they might need extra assistance. Having support networks is important in the healing journey.

  1. How is your partner/spouse?

A loss will effect the dynamics of a relationship.  Societal pressure to continue on as usual can be strong.  It is important to check-in about how the couple is doing as well as how the partner is doing.  Males in particular are socialized to not show emotion. Support from other father’s who have been in a similar situation can help normalize intense feelings.

Points to remember:

  1. Don’t assume.Pregnancy loss is a broad term and can describe a variety of experiences. Ask open-ended questions.
  2. It is OK to not have answers.You are not expected to fix or solve anything. In fact, attempts to fix can create barriers to communication.
  3. Be gentle with yourself— hearing about loss can be emotionally tiring.  Take some time for self care, even if it is as simple as a quiet cup of coffee.

Helpful Resources:

Share: Pregnancy loss and infant loss Rescources and Support Groups

StillBirthDay: Resources for families and a listing of Doulas who are trained to support families through pregnancy loss and infant loss.

Breast Cancer Prevention Tips

breastcancer_puntamita

While some factors that increase your chance of getting breast cancer are out of your control, such as age and family history, there are some things you can do to decrease your chance of developing invasive breast cancer:

Maintain a healthy weight 

Having a BMI of 30 or more can increase your chance of developing a lot of medical conditions, including breast cancer. Eating a well-balanced diet and being active can help women stay within a healthy BMI of 18.5 – 24.9. Consult your doctor for information on maintaining a healthy diet.

Limit alcohol consumption 

Moderate alcohol consumption can be a part of a healthy diet. Women should avoid drinking more than one drink a day because alcohol can increase your risk of developing breast cancer.

Exercise regularly

Trying to get 150 minutes of moderate exercise or 75 minutes of intensive exercise each week is associated with a lower risk of developing breast cancer.

Avoid hormone replacement therapy

Menopausal hormone therapy increases the risk for breast cancer. If you need to take hormones to help with symptoms associated with menopause, be sure to avoid those that contain progesterone and limit their use to less than three years.

Breastfeed for as long as you can

Breastfeeding children for at least a year can lower your chance of developing breast cancer in the future.

Focus on getting the right amount of Vitamin D

Recent studies show that vitamin D reduces cell growth and decreases the spread of cancer cells.Speak to your physician if you believe you’re vitamin D deficient.

Add omega-3 fatty acids to your diet

Foods such as salmon, chia seeds, and walnuts, are high in omega-3 fatty acids, which are protective against breast cancer.

Even if you take all the necessary precautions to prevent breast cancer, it’s important to follow the necessary guidelines for breast cancer screening. The updated guidelines state that women should get yearly mammograms after the age of 40 and screenings every three years for women in their 20s and 30s.

Does Having An Abortion Affect Your Future Fertility?

does-having-an-abortion-affect-your-future-fertility

Termination of an untimed or unwanted pregnancy happens. Life happens. Fast forward to where it is time to contemplate the start family expansion. Women often worry if they won’t be able to have children in the future. A viable concern is whether the termination (often of years past) has an effect of fertility fast forward. Does having an abortion affect your future fertility? The answer is that it does not.

The data is clear. Terminations either through medical or surgical means do not impact future fertility. Only those abortions associated with complications potentially may impact future fertility. The risk of a major complication resulting from a legal abortion is extremely low – 0.23%. As a matter of perspective, vaginal delivery and C-sections have greater maternal health risks than a termination.

Although exceedingly rare, the complications that can impact infertility are related to the procedure or incomplete removal or expelling of the products of conception. These include uterine injury, infection and significant hemorrhage, that could require further surgical intervention.

Moving forward with family expansion is exactly about moving forward and optimizing care, promoting health and working toward a healthy and established family.

We are here to help. Please contact us for a free initial consult.

What hormonal problems can affect women?

problemas-hormonales-en-la-mujer-punta-de-mita

What hormonal problems can affect women?

Women’s hormonal imbalances are a frequent cause of infertility. Amenorrhoea, menstruation disorders, alteration in the thyroid gland, hyperprolactinemia ¿Do they sound familiar? These are just some of the hormonal problems that can affect women.

By applying female diagnostic tests it is possible to have an accurate diagnosis of what’s happening in a woman’s body that isn’t allowing her to ovulate correctly, and consequently impending natural pregnancy. These tests, that are analytical among other procedures, are useful to determine what type of hormonal imbalance a woman is suffering, by doing so doctors later proceed to apply the adequate treatment to cure the disorder.

What are female hormonal problems?

Disrupted ovulation may be caused by physiological reasons or it can be related to a pituitary alteration, area of the brain that regulates hormones. When there is a late menses it could be for two reasons: 1) Pregnancy 2) there is a reason the body is not functioning correctly. The most common hormonal imbalances in women are:

Amenorrhoea:

A menstrual cycle is considered to be normal when it has a duration between 21 and 35 days. However, if there is a longer duration it is possible there is a factor extending it, and we must identify it in order to help the body function normally. Amenorrhea is the absence of the menstrual period, permanent or temporal, during a time that would be equivalent to 3 cycles or a 6 month time frame. Amenorrhea could be primary, referring to women who haven’t had their period between the age of 14-16, this can translate to a situation where after having their menses, they can disappear for 6 months or more. It can have its origin in the brain ( hypothalamus and pituitary), as a response to ovarian failure or it could be located in the genital area ( vagina and uterus)

After presenting signs of amenorrhea, and pregnancy has been ruled out, the most frequent causes are disorders like: polycystic ovary syndrome, hyperprolactinemia or ovarian failure, among others.

Hormonal disruption: hyperandrogenism

Hyperandrogenism is when a woman presents high level of androgens, typically male hormones like testosterone. This Hormonal Disturbance causes hirsutism, an excess of dark and thick hair located in the areas where male hair appears: chin, upper lip, arms, lower back, “linea alba” or breast. There can also be signs of baldness, acne problems, menstrual irregularity, type 2 diabetes or high blood pressure, among others. One of the most frequent causes of hyperandrogenism is the polycystic ovary syndrome, even though it can rarely be due to the outbreak of an ovarian/adrenal tumor, or not present an identified cause at all.

Alterations in thyroid gland: thyroid dysfunction

Known as hyperthyroidism and hypothyroidism, thyroid gland alterations can cause irregular menstrual cycles and damage fertility in a woman. It is important to control the thyroid gland before and during pregnancy because it is related to a higher maternal-fetal morbidity and mortality. The thyroid is a gland located in the anterior part of the neck and its function is to regulate hormones linked to the endocrine system. In hypothyroidism the thyroid works slower than normal. On the contrary, in hyperthyroidism the thyroid works over the normal pace. In both situations, this changes can cause weight alterations, fatigue, weakness, depression, constipation, irritability, etc. These alterations have an unknown origin. Normally, it is due to a genetic problem, but there is also a determined group of women who have a higher risk of presenting these problems, women who suffer autoimmune diseases ( rheumatoid arthritis, celiac disease, graves disease, inflammatory bowel disease, multiple sclerosis, etc), and those who have had thyroid surgery or taken determined drug therapies, especially related to mental disorders

Hyperprolactinaemia:

When there are high levels of prolactin, it can be the cause of amenorrhea and it is a frequent fertility problem. Prolactin is the hormone in charge of producing breast milk. If deciding to become pregnant, prolactin must present normal levels, below 25 gn/ml. Hyperprolactinemia can find its origin in many causes. On one side, it can be caused by the ingestion of drugs like antidepressants, antipsychotics, hormonal or opioids, etc. On the other side, it can have a physiological cause, like stress, lack of sleep, breastfeeding, pregnancy, ect. Moreover, it can be the consequence of other diseases like tumors, polycystic ovary syndrome, hypothyroidism, etc.

Polycystic Ovary Syndrome:

Polycystic Ovary Syndrome is an endocrine disruption that produces ovulation problems and hyperandrogenism. As mentioned in the previous article, PSO is caused by an excess of LH hormone (luteinising) and a high level of insulin, together they alterate a woman´s body making it produce high levels of testosterone. In these cases, ovules do not finish their maturation process during the menstrual period, and instead of expelling blood the ovaries stay inside the body generating small cysts.

Early menopause:

Menopause is the process where a woman stops having the menstruation period, not abruptly but rather unhurried, this means a new stage in her mature life. It appears between the ages of 45-55 approximately, and it also leads to climaterium, condition in which a woman abandons her fertile phase. Early menopause can develop before turning 40, damaging women’s fertility. As mentioned in the previous post, when having family background there is a greater possibility to suffer it, likewise in the cases of autoimmune diseases or hypothyroidism. However, in practice, early menopause doesn’t have an specific cause

As mentioned at the beginning of the article, all these hormonal conditions generate, among others, endocrine and hormonal symptoms, menstruation alterations and fertility problems. This is why couples have difficulties conceiving a child, therefore, a full diagnose must be done in order to detect what is failing and solve it, if possible before starting the assisted reproduction treatment to have a better prognosis success.

Want to start a family? In PMH Fertility Center we can help you. If you need guidance or have any doubt, do not hesitate to contact us, we’ll be happy to help you.