Assisted Reproductive Technologies

In Vitro Fertilization

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 IVF works

During 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.

IVF, step by step

An IVF cycle is broken down into four stages:

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.

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.

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.

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 Considerations
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.

RFF: Revised Formulation Female

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  • 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.

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Important Considerations:
Gonal-f® RFF Pen (follitropin alfa injection) is indicated for the induction of ovulation and pregnancy in the oligo-anovulatory infertile patient in whom the cause of infertility is functional and not due to primary ovarian failure. Gonal-f® RFF Pen is also indicated for the development of multiple follicles in the ovulatory patient participating in an Assisted Reproductive Technology (ART) program. Gonal-f® RFF Pen (follitropin alfa injection) should only be prescribed by physicians specializing in fertility or reproductive health. Gonal-f® is a potent gonadotropic substance capable of causing mild to severe adverse reactions, including Ovarian Hyperstimulation Syndrome (OHSS) in women with or without pulmonary or vascular complications, and multiple births. Gonal-f® is contraindicated in women who exhibit prior hypersensitivity to FSH preparations, primary gonadal failure, uncontrolled thyroid or adrenal dysfunction and pregnancy. Nursing women should not use Gonal-f®. Common side effects include headache, abdominal pain, enlarged abdomen, and injection site disorders. For complete product details, see full prescribing information.

Important Considerations:
Women: Gonal-f® (follitropin alfa for injection) is indicated for the induction of ovulation and pregnancy in the anovulatory infertile patient in whom the cause of infertility is functional and not due to primary ovarian failure. Gonal-f® is also indicated for the development of multiple follicles in the ovulatory patient participating in an Assisted Reproductive Technology (ART) program.
Men: Gonal-f® (follitropin alfa for injection) is indicated for the induction of spermatogenesis in men with primary and secondary hypogonadotropic hypogonadism in whom the cause of infertility is not due to primary testicular failure. Gonal-f® (follitropin alfa for injection) should only be prescribed by physicians who are thoroughly familiar with infertility problems and their management. Gonal-f® is a potent gonadotropic substance capable of causing Ovarian Hyperstimulation Syndrome (OHSS) in women with or without pulmonary or vascular complications. Gonal-f® is contraindicated in women and men who exhibit prior hypersensitivity to recombinant FSH preparations or one of their excipients, high levels of FSH indicating primary gonadal failure, uncontrolled thyroid or adrenal dysfunction, sex hormone dependent tumors of the reproductive tract and accessory organs, and an organic intracranial lesion such as a pituitary tumor; and in women who exhibit abnormal uterine bleeding of undetermined origin, ovarian cyst or enlargement of undetermined origin and pregnancy. Women who are pregnant or nursing should not use Gonal-f®. The most common side effects in patients using Gonal-f® include headache, ovarian cysts, nausea and upper respiratory infections in women and in men, acne, breast pain and growth, and fatigue. Injection site reactions were also reported. Reports of multiple births have been associated with Gonal-f® treatment. For complete product details, see the full prescribing information.

For complete product details, please read the Prescribing Information offered below.


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