FAQ - IVF - In Vitro Fertilization
There are many factors that go into this. Many times, a fresh embryo transfer (3-5 days from retrieval) can be done. This is assuming that your labs and ultrasound leading up to retrieval all look appropriate. If you are considering Pre-Implantation Genetic Testing of your embryos, if your labs/lining are not adequate, or if you are at risk for or are diagnosed with OHSS, freezing your embryos will be planned.
The hormone medications (FSH + hCG and or Lupron) given to stimulate the ovaries in the attempt to produce an abnormally high number of eggs during IVF leads to a risk of Ovarian Hyperstimulation Syndrome (OHSS). OHSS can be painful and can cause nausea, dizziness, vomiting, and in especially serious cases, hospitalization, organ failure, or worse. The risk is significantly more apparent in specific demographics (young women or those with high AMHs as well as those with PCOS). However, this risk of OHSS can be substantially reduced with careful monitoring, appropriate protocol dosing, and the use of Lupron (instead of hCG) to trigger. With the close attention given by CNY Fertility providers to the various risk factors, OHSS can be avoided in most Instances.
The risk that IVF results in a multiple gestation pregnancy and birth can rise from 1% to upwards of 30% when transferring multiple embryos. Multiples results in an exponentially greater risk for several serious incidences like cerebral palsy, excessive bleeding during delivery, premature birth (and associated cognitive issues) and infant mortality. Fortunately, this risk can be virtually eliminated by transferring within the ASRM guidelines which will be discussed with you by your nursing team.
Medications used for IVF may include: Gonal-F/Follistim (FSH), Menopur (HMG), HCG-LH Supplement, Cetrotide/Ganirelix, Letrozole, Low Dose Naltrexone (LDN), Z-Pak, Prednisone, Omnitrope (HGH), Lupron Acetate Trigger, HCG Trigger, and prenatal vitamins.
Medications used for embryo transfer may include: Estrace, Z-Pak, LDN, Prednisone, low-dose aspirin, Prograf, Endometrin, Progesterone in Oil, and prenatal vitamins.
Yes, you will need someone to accompany you to your procedure, be available to receive your post-procedure instructions, and see to it that you arrive back home or to your home/hotel safely. We have several medical taxis we can recommend prior to procedure date.
Inflammation and immune issues can be contributing factors in infertility. Dr. Kiltz recommends adding our full immune protocol which may include Low Dose Naltrexone (considered a “miracle drug” that simply reduces inflammation) Intralipid Infusions, Neupogen, Lovenox injections, oral prednisone, low-dose aspirin, Prograf, Plaquinil, PRP (platelet-rich plasma), and HCG washes to your cycles. Additional potential immune treatments like Humira, IVIG, and cannabinoid oil (CBD) may also be recommended.
Because the use of many over the counter medications has not been studied with fertility treatments, we recommend you take Extra Strength Tylenol, per the package instructions, for pain. If you experience any pain that is not controlled, you will want to alert our office immediately and/or be seen locally in an urgent care or ER. You cannot take Tylenol if currently using or planning to use Intralipid medication (see medication FAQ’s).
Yes!
Dr Kiltz recommends keeping a “low and slow” approach, keeping the body at a state of rest and avoiding any strenuous exercise. You can have intercourse while in your IVF preparation, however, it is recommended your partner abstain for 2-5 days prior to the scheduled IVF. As your ovaries start to enlarge, it may be recommended to avoid intercourse earlier in the Cycle.
Dr. Kiltz recommends a diet high in fat and low in carbohydrates. Be sure to remain hydrated. It is best to abstain from alcohol, smoking, or any other harmful substances. Check out our Family Building Guide for more information on dietary and lifestyle recommendations!
Dr. Kiltz strongly encourages a “low and slow” approach, keeping the body at a state of rest and avoiding any strenuous exercise.
When you leave your retrieval, you will be informed how many eggs were able to be retrieved during the procedure. The following morning, a nurse will follow up with you to check in on how you are feeling and provide an initial “fertilization report” to let you know how many of your eggs successfully fertilized. From there, embryos will be checked on day 3, and then day 5, 6, 7, if applicable. You will receive an end-of-cycle report loaded to your patient portal from our Embryology Team, which outlines the final progress of your embryos.
A fresh semen sample is ideal, where possible, for your treatment cycle. Prior to the date of collection (either your egg retrieval, IUI, or egg thaw,) your partner should abstain for 2 to 5 days.
In some cases, there may be recommended preparation to complete 30, 60, or 90 days prior to treatment. Your nursing team will review these specifics should they apply to you. For IVF only, the tentative timeline is as follows:
Day 1 of cycle:
Reach out to your nursing team via the patient portal or call our office to schedule your first appointment. If your period falls outside of office hours, please await a portal response once the office is open or call during regular office hours. If you do not get periods, please reach out when you have medications and are ready to begin. We will schedule an appointment to see where you are at in your cycle and create a plan from there.Day 2-4
Your first appointment will be scheduled during this time frame. We call this your baseline appointment. Once results are received from this appointment, you will be provided with your medication protocol. If any testing comes back abnormal, we will inform you and update your plan accordingly.Day 3-10
Follicular, Egg, and Lining DevelopmentThe first phase of an IVF cycle is follicle development. During this time, you will have multiple appointments for blood and transvaginal ultrasound to most accurately track growth and development of your follicles. We will also evaluate your uterine lining, especially if preparing for a fresh embryo transfer. Frequent monitoring allows us to track anticipated procedure timing, adjust medications as needed, and accurately determine the day that you administer your trigger shot. Your egg retrieval will take place 35 hours from the administration of your trigger shot. While most clients stimulate for 10 days, you may stimulate shorter or longer than this based on your body’s response to the medications.
Day 12(ish)
Retrieval takes place!Sperm Preparation
If the sperm is being provided by a male partner, it is most often collected through ejaculation into a sterile cup the morning of the egg retrieval. This can be collected in our office, or at home. If necessary, sperm can be collected using more advanced sperm retrieval procedures like PESA, TESA, or TESE. Sperm can also be collected ahead of time, frozen, and then thawed the morning of the retrieval – this is particularly useful if the male partner will not be able to present at the office the day of the procedure. Sperm may also be provided by a donor.
Once the andrology lab receives the semen, the andrology team will clean and concentrate the sperm from the larger sample of semen. After this first step of isolation, the sperm is washed and suspended in a solution that mimics the environment of the Fallopian tubes in the female reproductive tract.
Once this process is complete, the concentrated motile sperm will be transferred to the embryology lab where fertilization will take place.
The Retrieval
The Egg Retrieval Procedure is a minor outpatient procedure done to collect the developed eggs from the woman’s ovaries so that they can be fertilized in the laboratory. It is performed 35 hours after the “trigger,” at one of our offices under light anesthesia for comfort and lasts approximately 5-10 minutes.
During the procedure, a tiny hollow needle with suction capabilities to pierce through the vaginal wall and drain the fluid from the follicles which contain the developed eggs. The follicular fluid containing the eggs is immediately transported about 20 steps to our IVF laboratory and sorted through by one of our embryologists who will find, isolate, and nurture your eggs in media as they await fertilization. The number of eggs retrieved will depend on your age, history, fertility diagnosis, medication protocol and response to medications.
Fertilization of Eggs in the Lab
The most used (and most efficient) was to fertilize eggs is through a process called ICSI (Intracytoplasmic Sperm Injection). This is a special fertilization technique whereby sperm are loaded into a micro needle and injected directly into the egg. Only mature eggs can be injected. ICSI holds a 70-80% fertilization rate, where conventional IVF falls around 50% or less.
Final Steps
The final step in your IVF process is either a fresh embryo transfer back to the carrying uterus 3-5 days after egg retrieval, or to freeze the embryos on day 3, or day 5, 6, 7 pending protocol.
For more information on treatment timeline, watch our YouTube video: What is the timeline for treatment? When do I need to be at a CNY fertility clinic?
You will call on cycle day 1 and be given a date for baselines. Once those results come in, a nurse will call you to provide you with steps for starting your medications. The nurse will give you a date to go have your lining checked via ultrasound and to have another set of labs (roughly a week after you start medications.) Typically, once your lining has reached a thickness of 8.0mm or greater and shows a trilaminar pattern, we will schedule your transfer though there are times when you may be encouraged to transfer outside those parameters based on the advice of our providers. We typically will have a few dates to choose from but sometimes, based on your lab work, we may need it to fall on a specific date and will advise you of that at the time of your lining check. At the time your transfer is scheduled, you will be advised of any new medications to begin, such as progesterone or other adjuncts.
Syracuse, Albany, Buffalo NY, Sarasota FL, and Colorado Springs, CO.
Frozen transfers usually happen approximately 3 to 4 weeks after retrieval, depending on when your post-retrieval menses starts.
This will depend on your consultation with our provider team. There are several IVF protocols including, but not limited to:
Natural IVF – an IVF cycle without medications. This leads to retrieval of 0-1 eggs. While it is not often recommended, some clients have requested this approach in the past.
Mini IVF – an IVF cycle where a low dose of oral and injectable stimulation medications are used for approximately 8-12 days, followed by a trigger shot to induce ovulation. Retrieval takes place 35 hours from trigger shot.
Standard/High Dose IVF – an IVF cycle where a moderate to high dose of injectable medications (with or without oral medications) are used to stimulate follicle and egg production in the ovaries for 8-12 days, followed by a trigger shot. Retrieval takes place 35 hours from trigger shot. While many see higher dose protocols as equaling higher ovarian response, this is not always the case.
Our medical providers are well versed in all protocols, which may benefit your personal experience. Medications may include Letrozole, FSH (Follistim or Gonal-F), Menopur, HCG- LH, Antagonist (Ganirelix or Cetrotide), Trigger shot (HCG and/or Lupron), as well as transfer medications if applicable. Our team will work with you to review your protocol and order the appropriate medications for you!
While a trilaminar lining is preferred, sometimes there are cases where we will recommend transferring without it being trilaminar.
IVF, also known as In Vitro-Fertilization, is the most effective fertility treatment. It involves a multi-week/month process in which eggs are removed from a female’s ovaries, fertilized with sperm outside of the body, grown in our lab for 3-7 days, and then eventually transferred back into the uterus to continue development for the remainder of gestation. IVF is used with a multitude of medication protocols to produce a greater number of high-quality eggs, leading to the development of embryos. It is used successfully for both medical and elective reasons.
For more information about IUI and other treatment options, watch our YouTube video: What is Timed Cycle, IUI & IVF, and what treatment types may be available to me?
The number of embryos to be transferred will be determined by you, the physician and the embryologist prior to the embryo transfer to maximize the possibility of pregnancy and minimize the risk of multiple gestations. Patient age, infertility factor(s), embryo quality, previous failed cycles, and other factors are taken into account. Multiple pregnancies can be devastating to the health of both mother and children. To curtail the problem, national guidelines published by the Practice Committee of the Society in Assisted Reproductive Technologies (SART) of the American Society for Reproductive Medicine (ASRM) recommend limits on the number of embryos to transfer of which we adhere to.
Our Syracuse, Albany, Buffalo, Sarasota, and Colorado Springs offices perform all IVF retrievals/transfers and other major fertility procedures. To learn more about doing IVF, Tubal Reversals, Donor Egg IVF or other fertility treatments at CNY when you don’t live near one of our retrieval and transfer centers, check out our Traveling for Fertility Treatment page.
Yes, you will need someone to accompany you to your procedure, be available to receive your post-procedure instructions, and see to it that you arrive back home or to your hotel safely.
Blastocyst embryos (usually day 5, but also 6 and 7) are more developed and thus stronger, more resilient, and generally have a better chance of a successful implantation. This does not mean that day 3 (cleavage) embryos cannot make the most beautiful babies. Generally, if you have plenty of embryos that are developing well, we let them continue to day 5 before transferring or freezing. If the number and quality of developing embryos is lower, then we highly recommend doing day 3 transfers as no home (regardless of how great our embryology lab is) is better than your uterus for that developing embryo and future child of yours.
No, after an embryo transfer, you may resume your normal daily activities. Comprehensive studies have confirmed that bed rest may actually be harmful to the developing embryo since inactivity combined with high levels of estrogen can promote blood clot formation as well as a rise in insulin resistance. We recommend restraining oneself from any and all intense exercise like cross fit, sports, running, and jumping. However, nice brisk walks should be continued and are a nice way to connect and spend time with your partner or enjoy some nice quiet you-time!
YES, please take all medications prior to your appointment except your vaginal medication if you are doing a morning transfer. If your embryo transfer is scheduled to happen first thing in the morning you may hold off on your morning vaginal medications until after your transfer. If your embryo transfer is scheduled to happen in the afternoon, you may take your morning vaginal medications.
All of our offices see patients that are doing IVF; however, all retrievals and transfers take place at our Syracuse, Albany, Buffalo, Sarasota, or Colorado Springs offices.
Yes, we do. Mini IVF is really the same procedure as (normal) IVF, only with a reduced medication protocol. Therefore, the cost of Mini IVF is still $3,900, but you would see a substantial reduction in the cost of your medications which can make a cycle much more affordable.
Mini IVF isn’t just a financial decision; it can also be medically useful for those who are “poor responders,” to medication and therefore don’t benefit from high doses of medications often used in a traditional IVF. Additionally, many who would normally make many embryos from a traditional IVF cycle would prefer to create fewer embryos with the hope that they do not have to make the difficult decision of what to do with remaining embryos after a successful IVF cycle.
Mini IVF is very similar to (normal) IVF, only with a reduced medication protocol. The cost of the mini IVF treatment is the same as standard IVF, but there is a substantial reduction in the cost of medications.
