- Navigating infertility can be
a complex and often stressful journey.
Each person's experience with it is different.
Emotions can swell.
Questions seem never ending.
And financial concerns can often obstruct
a couple's goal of pregnancy.
The Yale Fertility Center
is dedicated to helping couples reach their dream
of having a family with a team
of competent and compassionate professionals
who have taken this journey many times before.
By helping you navigate the technological, psychological,
and physical needs of the IVF process
you will gain perspective,
understand your options,
and feel confident about the decisions you make.
There are various steps that need
to be completed before you begin your treatment.
First you'll have a consultation with your provider.
Next you will complete all required testing needed
for insurance approval.
The insurance authorization for the IVF cycle
and your medications takes about two weeks.
Medication will be ordered
to a specialty pharmacy determined by your insurance.
You'll also be required to take an IVF teaching class.
And finally IVF consents will need
to be signed and returned.
The staff and physicians at the Yale Fertility Center
are here to help you through
this special journey every step of the way.
Our mission is to makes firsts possible.
Beginning with the first breath of your new baby.
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To begin your treatment,
you will utilize several types of injections.
One medication grows your oocytes.
One prevents the oocytes from ovulating.
And the third encourages oocytes to mature.
The final medication encourages implantation.
You will be taught how to administer
these injections yourself and you'll find
it's very easy to do.
Your first assessment will be
on the second day of your period.
When you'll come in for blood work and an ultrasound.
You'll be instructed when to begin eight
to 12 days of the hormone medication
that will encourage egg growth.
You will be administering one to four injections
of these medications a day depending
on your individual protocol.
There are three major brands of this medication.
And they are all injected subcutaneously.
Midway through this treatment
you will begin taking a second medication.
This medication is designed to prevent ovulation.
So your ovary doesn't release the oocytes prematurely.
The oocytes need to stay
in the follicle to mature prior to retrieval.
In some cases this medication might
be given before the initial medication
that encourages egg growth.
You'll administer this medication
for five to seven nights.
The final injection is called the trigger shot.
This injection is given 35 and 1/2 hours
before oocyte retrieval is scheduled
and its purpose is to help the oocytes release
from the side of the follicle.
Preparing for retrieval.
It can be intramuscular or subcutaneous.
After the trigger shot you may receive progesterone
to encourage implantation.
This could be in the form of a vaginal insert or injection.
Sometimes this shot is intramuscular
if a frozen embryo is being implanted.
Side effects from your treatment
include mild hormone related symptoms
such as breast tenderness and mild cramps.
Some bloating and perhaps being more emotional.
The specific medications you receive
will depend on your doctor's protocol
and insurance coverage.
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Your partner will accompany you
on the day of retrieval to provide his sperm specimen.
A successful egg retrieval starts
with the proper preparation.
Be sure to follow your doctor's instructions carefully
about taking your final injectable medication.
As timing between the two events is critical.
The egg retrieval will take place
in one of our procedure rooms
and usually takes about 30 minutes.
We use a combination of medications to keep you comfortable.
You'll already be familiar with the transvaginal ultrasound
which uses sound waves to create an image of your ovaries
so we can identify the fluid filled ovarian sacs
called follicles which contain eggs.
This time a guide is attached
to the side of the vaginal ultrasound probe
to accommodate a fine needle.
The needle is passed along the ultrasound guide
through the wall of the vagina into the ovary.
Using ultrasound guidance the doctor
will gently collect fluid
from the ovarian follicles one at a time.
The fluid taken from the follicles
is passed on to the embryologist
who identifies the egg.
You will recover in our comfortable recovery room suite
where your partner, a friend, or family member can join you.
Plan for someone to drive you home after your procedure.
You may experience minor discomfort
but should be recovered in a couple of hours.
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Once we've retrieved your eggs we transfer them
to our state of the art embryology laboratory.
Where they are kept in conditions to mimic your body's
and optimize their growth.
We place the eggs
in small dishes containing a culture medium.
A special fluid similar to what would be found
in the fallopian tube or uterus.
We then put the dishes into incubators
which control temperature and atmospheric gasses similar
to the conditions of your body.
The eggs are left to mature for a few hours
before being inseminated by IVF or ICSI.
In the case of conventional In Vitro Fertilization or IVF,
we add sperm to the culture medium with the eggs.
In the case of ICSI an individual's sperm
is injected into each mature egg
to assist the fertilization process.
ICSI is typically used for couples
with sperm related abnormalities
who have unexplained fertility issues,
for woman of advanced age.
or based on information from a prior IVF attempt.
The eggs remain in the incubator
to develop for up to six more days.
The earliest sign of fertilization is seen the next day.
This is called day one of embryo development.
At this stage on day one,
normal fertilization is evident
by the still single cell zygote displaying two pronuclei.
At day two normal embryos divide into about four cells.
And at day three embryos should
be approximately eight cells.
By day five after egg retrieval,
normally developing embryos reach the blastocyst stage.
An embryo now has 80 or more cells with
an inner fluid filled cavity.
And a small cluster of cells called the inner cell mass.
The inner cell mass will develop into the fetus
and the outer cells become the placenta.
Remember not all eggs will fertilize
and not all embryos will divide at a normal rate.
An embryo's visual appearance is the most common way
for us to select the best embryo or embryos for transfer
with the goal of producing a successful pregnancy.
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You will be kept apprised of the state
of your developing embryos during the IVF process.
On the day of transfer we will review your embryo status
including the number and quality of embryos available.
And discuss the final number to be transferred.
The decision on how many embryos to transfer
typically on day three or day five of embryo development
is based on a number of factors including
the age of the female partner,
her prior reproductive history and health profile,
the number and quality of the available embryos,
and the tolerance for risk of twins or multiples.
This must be a consensus decision between
the couple and the medical team
who will advise as to the quality of the available embryos
and the recommended guidelines.
Embryo transfer is simple and painless and your partner
is welcome to join you in the procedure room.
You will need to have a full bladder
as we perform an abdominal ultrasound scan
and gently cleanse the cervix.
The embryology team will load
the preselected embryo or embryos into a soft thin tube
or catheter specially designed for the transfer.
Under ultrasound guidance
the catheter is gently guided to the cervix
and into the uterine cavity
where the embryo or embryos are placed.
The process usually takes just a few minutes.
You shouldn't feel any discomfort and you'll be asked
to remain reclined for an additional 10 to 15 minutes.
In many cases additional embryos remaining
in the lab can be frozen for later use.
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Progesterone is a hormone produced by the ovarian cells
that surround the egg.
It's essential to prepare the lining
of the uterus for embryo attachment.
During egg retrieval these progesterone producing cells
are removed along with the egg.
So you'll need to take progesterone
as a supplement to improve the changes
of a successful pregnancy.
Progesterone is available as vaginal suppositories,
tablets, and creams.
As well as intramuscular injectable preparations.
In some cases another hormone, oestradiol,
is also prescribed.
Doctors will provide you with written instructions
on the timing and dosing regimen.
Your progesterone supplementation begins after
the egg retrieval and continues
at least until the day of your blood pregnancy test.
If you are pregnant you will continue
progesterone supplementation until nine
to 10 weeks of pregnancy.
All patients who are not pregnant
will stop progesterone supplementation and should expect
a period within a few days of stopping treatment.
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Prior to egg retrieval it is important
that the male partner have semen analysis testing.
If any abnormalities are shown,
the male partner will be fully evaluated
with a physical exam, genetic testing,
hormonal and imaging tests.
Then the process can begin.
The onsite Andrology laboratory offers
a variety of specialized sperm tests
and services including sperm cryopreservation,
epididymal, or testicular cryopreservation and donor sperm.
Because it's important to have fresh sperm
the specimen will be collected the day of egg retrieval.
If the male isn't available that day
or is unable to provide the specimen
the sperm can be frozen in advance.
Anywhere to several days to a month ahead of time.
If the sperm specimen has been frozen
it will be thawed the day of the egg retrieval.
In certain cases such as a previous vasectomy
or absence of the vas deferens,
the sperm may be harvested surgically.
That procedure will be done the day of egg retrieval
or the harvesting can be done in advance
and the sperm frozen.
There are two types of sperm retrieval procedures
and both can be done on an outpatient basis
under conscious sedation and local anesthesia.
Percutaneous epididymal sperm aspiration or PESA
is used in cases of blockages
and the procedure takes 20 to 30 minutes.
With testicular sperm extraction or TSE,
testicular tissue is biopsied
and examined for the presence of sperm
and the procedure lasts about an hour.
If there is no male partner
or the male partner is determined to have no sperm,
donor sperm services are available on site.
After the sperm is obtained
it is then added to the eggs
and fertilized eggs remain in the incubator to develop.
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Before our medical team transfers an embryo
they routinely use a technique called assisted hatching
to make it easier for an embryo
to implant in the uterine wall.
The cells that make up the embryo early
in its development are enclosed within
a flexible shell called the zona pellucida.
During normal development this shell thins allowing
the embryonic cells to escape or hatch out of the membrane.
To facilitate that hatching an embryologist thins
the outer shell of the embryo in a laser guided procedure
before transferring it to the uterus.
Once the embryonic cells hatch
they can then implant in the uterus to form a pregnancy.
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You can improve your chances of conceiving
in the future by freezing eggs or embryos through
the process of cryopreservation.
It's an important option for couples concerned
that their future fertility might be reduced due
to medical treatment such as cancer therapy or surgery.
Since multiple eggs are often produced
during ovarian stimulation
there are sometimes more embryos available
that are not transferred to the uterus.
Those extra embryos can be frozen to use in the future.
Eggs can also be frozen before being exposed to sperm.
Our team of specialists offers a new protocol
for egg cryopreservation with a significantly higher rate
of conception success than previous methods.
Both options for egg and embryo freezing save the expense
and inconvenience of starting
the process from the beginning.
Cryopreservation also allows patients
to transfer fewer embryos at a time.
Reducing the risk of high order multiple pregnancy.
For women at risk for ovarian hyper stimulation syndrome,
when hormone levels are too high,
embryos can be frozen until symptoms are resolved
and then used in a future cycle.
If you choose cryopreservation
it's important for you and any partner
to sign a disposition agreement
in case of ethical or legal dilemmas.
You'll also be asked to remain
in contact with the clinic on an annual basis.
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Our team has dedicated their life's work
to making miracles.
As you navigate through the steps of your IVF treatment,
know that we are here to answer all of your questions
and help you in any way needed.
We believe our years of collective knowledge
and experience combined with the best medical science
are your most valuable resources.
Thank you for entrusting us with your life changing choice.