In Vitro Fertilization

Consultation

At Pacific In Vitro, we begin with a consultation appointment. During this appointment, we explain the IVF process, perform various tests and review your medical history and current medical condition. Tests include pelvic exam, ultrasound exam and uterine measurement for females and a sperm analysis for males.

Based on the results of the physical examinations and medical histories, the doctor will discuss the IVF success rates for those in similar circumstances. Also during this consultation, we explain insurance coverage and the preauthorization process for IVF services, and payment policies for those not covered by their health insurance.

Female patients will be instructed to call at their next menstrual period. She will be scheduled for Baseline Hormone Screening blood tests, which check FSH (follicle stimulating hormone) LH, Prolactin, Estradiol (a naturally occurring estrogen released by the ovaries), and TSH (Thyroid Stimulating Hormone) to evaluate ovulation and ovarian health.

Once we have the blood test results, a determination is made about whether IVF is an option for you.

If IVF is determined to be a good option for you, one of our nurse coordinators will work with you to make an individualized IVF schedule. Once you’ve received your schedule you will call us and one of our nurses can address any questions or concerns you may have.

Injection Lesson

One of your first appointments will be an injection lesson, where you will learn how to self-administer the medication. We will start the injection lesson with an overview of your personalized IVF schedule, your medications and the times that your medication should be administered.

Ovarian Stimulation & Monitoring

One egg develops and matures in a normal ovulation cycle per month. The egg matures inside a follicle, which is filled with fluid and is visible on an ultrasound. When you undergo IVF, the goal is to develop and mature as many follicles using fertility medications as safely as possible. There are several different types of medications used to prepare the ovaries for the egg retrieval. The medications are derivatives from the hormones FSH and LH, which are hormones that are naturally involved in the ovulation process.

Not all office visits during this process require both partners however, both partners are welcome to attend all office visits. We will set up an appointment schedule, with the number and frequency of visits during the ovary–stimulation phase of the IVF cycle based on your individual needs. Although you must come in often during your IVF cycle, we try to schedule visits so disruption to work and home commitments is minimal. For neighbor island couples, we try to accommodate flight schedules and travel time.

Monitoring of the ovaries during treatment is important for the development of high quality eggs. Vaginal ultrasounds are done to measure the growth of the egg follicles, and blood tests are done to measure your level of Estradiol. This information is used to evaluate the ovarian response and timing of the egg retrieval. When the follicles reach a predicted size, and the Estradiol levels are within range, an ultrasound guided aspiration procedure is scheduled to harvest the eggs.

Egg Retrieval & Embryo Transfer

When the follicles are at an appropriate size, the eggs are removed vaginally via ultrasound-guided aspiration while the patient is under intravenous sedation. Egg retrieval is usually not painful and recovery is brief.

The eggs are then fertilized with identified healthy sperm. Once the eggs and sperm are collected the Embryology team begins the fertilization process. In some cases, sperm may need to be physically injected into the egg to achieve fertilization. This process is called ICSI (Intracytoplasmic Sperm Injection).

After being cultured for three to five days, the embryos (fertilized eggs) are transferred into the woman's uterus in a non-surgical procedure called an Embryo Transfer. About two weeks later, two lab tests are done, two to three days apart, to check for pregnancy. Pregnancy is confirmed by ultrasound around four weeks after transfer.

After In Vitro Fertilization and Embryo Transfer (IVF-ET)

When pregnancy occurs following IVF, it will typically be a normal pregnancy. With every pregnancy there are always risks of abnormal pregnancy, miscarriage or other problems. This is because the process of IVF-ET does not protect against such normal occurrences. Congenital abnormalities, genetic abnormalities, mental retardation or other birth defects, which occur in approximately 3% of spontaneously conceived pregnancies may also occur in children born following assisted reproductive techniques.

Following a successful IVF-ET, the patient works closely with her own OB-GYN to ensure a successful pregnancy and delivery of the baby.