in vitro Fertilization (IVF)

In vitro fertilization (IVF), the most common assisted reproductive technologies (ART) procedure, is used to overcome a variety of fertility difficulties, particularly tubal problems and sperm deficiencies.¹

How in vitro fertilization (IVF) works

During in vitro fertilization (IVF), medications are often used to help stimulate the development and release of a woman's eggs. The eggs and sperm are then collected and placed together in a laboratory dish (in vitro is Latin for "in a glass") to fertilize. If the eggs are successfully fertilized, the embryos are then transferred into a woman's uterus. Hopefully one of the fertilized eggs will implant and develop just as in unassisted conception.

in vitro fertilization (IVF), step by step

An in vitro fertilization (IVF) cycle is broken down into four stages:

in vitro fertilization (IVF) Stage 1: Ovarian stimulation, monitoring and ovulation triggering

The goal of this stage is to create a large number of mature follicles so as to increase the chances of fertilization. Since a woman's body normally releases one mature egg every month, a medication such as Gonal-f^® (follitropin alfa for injection) is used to stimulate the ovaries to develop more follicles. Follicles are fluid-filled sacs in which eggs mature. At the beginning of the cycle, each follicle is approximately 1-2 mm in diameter.

During this stage, injection of a medication such as Cetrotide^® (cetrolix acetate for injection) may also be prescribed. This medication is used to prevent a premature surge of luteinizing hormone (LH), which could cause early ovulation.

During this stage, your healthcare provider may use ultrasound to monitor the number and size of maturing follicles in your ovaries. Blood tests may also be used to monitor hormone levels, which will help determine the best time to administer medication and to retrieve the eggs.

in vitro fertilization (IVF) Stage 2: Egg retrieval

In the second stage, a medication such as Ovidrel^® PreFilled Syringe (choriogonadotropin alfa injection) is used to stimulate the release of mature eggs. Your healthcare provider will identify the mature follicles using ultrasound, and then, with a needle, withdraw as many eggs as possible from both ovaries. At this point, each follicle is approximately 16-20 mm in diameter. You'll be sedated for the procedure and will probably require mild pain medication afterward. Most woman can go home a few hours after the procedure.

in vitro fertilization (IVF) Stage 3: Fertilization

About two hours before the eggs are retrieved, a semen sample is collected. Approximately 50,000 sperm are placed with each egg in the incubator, where they will hopefully form an embryo. When only a few sperm are available, intracytoplasmic sperm injection may be attempted.

The next day, the eggs will be examined under a microscope to determine whether fertilization has occurred. If it has, the embryos will be ready to transfer into the uterus in about 72 hours.

in vitro fertilization (IVF) Stage 4: Embryo transfer

The uterine lining is prepared for implantation, often by supplementing with progesterone medication. The embryos are placed in a tube and transferred back into the uterus. The procedure is usually painless, though some women may experience some cramping. The number of embryos transferred depends on a woman's age, cause of infertility, pregnancy history and other factors. Depending on your situation, you'll probably need to rest for 24 hours after the transfer and limit activities the following day. Ask your doctor to be sure.

Important Safety Information
As with all prescription medications, side effects may occasionally occur with use of fertility drugs. Doctors specializing in fertility or reproductive health should only prescribe these products. Patients prescribed gonadotropins and GnRH analogs should be monitored carefully by a trained fertility specialist. Risks include the following events which can be serious: hypersensitivity reactions; ovarian hyperstimulation syndrome (OHSS); pulmonary and vascular complications, and multiple births. For complete product details about a specific fertility drug, please refer to the Full Prescribing Information offered below.

• Full Prescribing Information for Gonal-f^® RFF (follitropin alfa for injection) 75 IU vial
• Full Prescribing Information for Ovidrel^® PreFilled Syringe (choriogonadotropin alfa injection)
• Full Prescribing Information for Cetrotide^® (cetrorelix acetate for injection)

RFF: Revised Formulation Female

To view the download, you need Adobe® Acrobat® Reader® installed. Don't have Adobe Acrobat Reader on your computer? Download it free, here.

Adobe Acrobat Reader is a registered trademark of Adobe Systems Incorporated.

• 1. Frequently Asked Questions About Infertility page. American Society for Reproductive Medicine Web site. Available at: http://www.asrm.org/Patients/faqs.html. Accessed February 6, 2009.