Yesh Tikva
A Jewish Fertility Community
Fertility Roadmap
Module 6
IVF, or In Vitro Fertilization, is a process where eggs are fertilized by sperm outside the body in a laboratory setting, creating embryos. These embryos are then monitored to ensure proper development and can undergo genetic testing if desired. Once ready, the embryo(s) are either frozen for future use or transferred into the uterus with the hope of establishing a healthy pregnancy. The process can offer a path to parenthood for individuals or couples, including single parents by choice and LGBTQ+ families, hoping to grow their families with fertility treatments.
IVF may be recommended for various reasons, such as:
1. Unsuccessful IUIs or other fertility treatments.
2. Fallopian tube issues or blockages.
3. Male factor infertility, such as low sperm count or motility.
4. Endometriosis or uterine abnormalities.
5. Genetic concerns requiring embryo testing to avoid passing disorders down to the child.
6. Fertility preservation before cancer treatments.
7. Using donor eggs to create embryos.
8. When using a gestational carrier.
Starting IVF is a significant step, often reached after much discussion and consideration with your medical team. It can represent hope and a path forward, even if the journey feels overwhelming. Your first steps will likely involve an initial consultation, meeting your IVF nurse, and completing any required pre-treatment appointments, such as an injection course or mental health consult. These early stages help prepare you emotionally, physically, and logistically for the treatment ahead.
What will this section cover?
Practical Advice for Managing Treatment
Managing Appointments
IVF usually means a lot of appointments. Morning monitoring in particular can be logistically challenging, requiring careful planning to balance work, childcare, and other responsibilities. Issues with the clinic, doctors running late, etc. can also impact timing. Do your best to remain flexible while still advocating for your needs at the clinic—appointments often shift, and persistence pays off.
A few “tricks of the trade” from Yesh Tikva:
– Try getting the earliest appointment.
– Call your clinic back a few times to check if the appointment slot you want has opened up. Just because the answer is no the first time doesn’t mean someone won’t have rescheduled by later on.
Interacting with Medical Staff
Be your own best advocate. Don’t leave an appointment until your questions have been answered – you have every right to understand the process. Call the office or send messages through your patient portal if there’s something you don’t understand outside of the appointment – you don’t need to wait until the next time you go in.
Helping you through this process is the medical staff’s job. You can be polite – while also being incredibly direct about your needs.
Work and Childcare Considerations
If you’re working, you’ll need to decide how much to share with your employer. A simple explanation about medical appointments may suffice, but if you feel comfortable, informing your boss or HR representative in advance can help accommodate your schedule. Building a support system at work—such as a trusted colleague—can make the process more manageable. If you’re facing secondary infertility, if possible, consider arranging childcare help if possible.
Resources to Navigate the Journey
Fertility Notebook – Bring your notebook (or a great notetaking app) to every appointment so you can review it at home. Take the time to write down all or your questions before your appointments.
Fertility Friend – Sign up for a Fertility Friend from Yesh Tikva. You’ll be matched with someone who has been in your shoes and can help guide you and break down the process.
Lifestyle Adjustments
Healthy habits like a balanced diet, regular exercise, and stress-reducing activities such as mindfulness or yoga can support your treatment. Avoiding harmful habits, like smoking or excessive alcohol usage, is also essential.
Medical Processes and Procedures
Step 1a: Sperm Retrieval (if applicable)
For male or assigned-male-at-birth (AMAB) partners, the sperm retrieval method for IVF depends on individual circumstances and reproductive health. In some cases, hormonal medications may be prescribed before retrieval to stimulate sperm production or address underlying issues such as low sperm count or quality. The retrieval method is tailored to each individual’s needs, ranging from non-invasive techniques to surgical procedures:
Natural Ejaculation:
The most common, non-invasive method.
Typically used when there are no significant abnormalities in sperm quality or quantity.
Testicular Sperm Extraction (TESE):
A surgical procedure to retrieve sperm directly from the testicles.
Often used when sperm count is extremely low or absent in the ejaculate due to blockages or other factors.
Percutaneous Epididymal Sperm Aspiration (PESA):
A minimally invasive procedure to extract sperm from the epididymis.
Suitable for men with obstructions in the reproductive tract.
Microsurgical Epididymal Sperm Aspiration (MESA):
A more detailed surgical method to retrieve sperm from the epididymis.
Used for men with severe blockages or specific conditions.
Step 1b. Other Sperm Options (if necessary)
Donor Sperm:
Often chosen by single parents by choice, LGBTQ+ couples, or individuals unable to retrieve viable sperm.
Donors are screened for genetic and health conditions to ensure the best outcomes.
Cryopreserved Sperm:
Frozen sperm may be used if previously preserved due to medical treatments (e.g., chemotherapy) or convenience.
Step 2. Sperm Washing
Once sperm is collected, it often undergoes sperm washing, a laboratory technique that separates healthy, motile sperm from seminal fluid, debris, and non-motile or abnormal sperm. The process increases the chance of successful fertilization by selecting the healthiest sperm and reducing the risk of infection or complications when used in in vitro fertilization (IVF).
The retrieved sperm is used immediately or cryopreserved until the egg retrieval process.
Step 3: Ovarian Stimulation
This step focuses on gently preparing the ovaries to produce multiple eggs in a single cycle (as opposed to one mature egg in a normal menstrual cycle), maximizing the chances of successful fertilization. Through carefully monitored hormonal medications, the ovaries are stimulated to develop multiple follicles, each potentially containing a mature egg. This process is designed with care and precision to support your body’s natural functions while optimizing the retrieval outcome.
Hormonal Medications:
Medications (e.g., gonadotropins) stimulate the ovaries to mature multiple eggs in one cycle. The goal is to maximize the number of high-quality eggs available for retrieval and later, fertilization.
Monitoring:
Regular ultrasounds will track follicle growth, while blood tests check hormone levels.
The monitoring ensures the right timing for egg retrieval and avoids complications like ovarian hyperstimulation syndrome (OHSS).
Step 4: Egg Retrieval
Once follicles have reached the desired size, a trigger injection (e.g., hCG or a GnRH agonist) is given to fully mature the eggs. Egg retrieval is typically performed 36 hours after the trigger shot. The goal is to retrieve the eggs just before they’re naturally released from the follicle.
Anesthesia or Sedation:
Typically, the patient is given light sedation or general anesthesia, depending on the clinic’s protocol and individual comfort levels.
This step ensures the procedure is pain-free.
Ultrasound Guidance:
To guide the physician, an ultrasound probe is inserted vaginally to visualize the ovaries and the follicles.
Egg Aspiration
Using a thin, hollow needle attached to the ultrasound probe, the physician aspirates (sucks out) the fluid and eggs from each follicle in the ovaries.
The procedure typically takes 15-30 minutes, depending on the number of follicles.
Egg Collection:
The aspirated fluid containing the eggs is immediately handed to an embryologist, who examines the fluid under a microscope to identify and collect the eggs.
Not every follicle will contain a mature egg, but the goal is to retrieve as many as possible.
Recovery:
After the procedure, the patient is moved to a recovery area and monitored as the sedation wears off. Mild cramping or spotting is normal, and most patients can go home within an hour or two and are asked to rest and hydrate.
Egg Evaluation:
The retrieved eggs are assessed in the lab for maturity and quality and then prepared for the fertilization process.
Step 5: Fertilization
The choice of fertilization method is a crucial step in the IVF process and is tailored to the specific needs of each individual or couple. The method chosen depends on factors such as sperm quality, prior fertilization success, and individual medical history, ensuring the best chance of creating healthy embryos.
Conventional Fertilization:
Healthy sperm is added to a petri dish containing the eggs.
The sperm swims toward and attempts to penetrate the egg naturally.
Intracytoplasmic Sperm Injection (ICSI):
Typically due to male factor infertility or low sperm count, a single healthy sperm is injected directly into an egg using a fine needle.
Step 6: Incubation and Embryo Development
Fertilized eggs (now called zygotes) are placed in a specialized incubator designed to mimic the environment of the human body, maintaining optimal temperature, humidity, and nutrient levels to support development.
Embryologists carefully monitor the zygotes over the next several days:
Day 1:
Successful fertilization is confirmed by checking for the presence of two pronuclei containing DNA – one from the sperm and one from the egg.
Days 2-3:
The zygote begins dividing, forming a multi-cell embryo.
Day 5-6:
Embryos may reach the blastocyst stage, consisting of hundreds of cells and two distinct parts: the inner cell mass (which becomes the baby) and the trophectoderm/outer layer (which forms the placenta).
Step 7: Preimplantation Genetic Testing (if applicable)
PGT can reduce the risk of miscarriage and improve success rates, especially for those with known genetic risks or previous IVF failures. The steps for individuals opting for genetic testing:
Step 7a: Embryo Biopsy
The embryo is placed under a high-powered microscope, and using a specialized tool, a small sample of cells is taken from the trophectoderm/outer later
The procedure is minimally invasive and does not harm the inner cell mass (future baby).
After the biopsy, the embryo is cryopreserved (frozen) to ensure it remains viable while the genetic testing is completed.
Step 7b: Genetic Testing
The biopsied cells are sent to a specialized genetics laboratory where the DNA is analyzed through one of the following types of tests:
PGT-A (for Aneuploidy): Screens for chromosomal abnormalities, such as missing or extra chromosomes (e.g., Down syndrome, Turner syndrome).
PGT-M (for Monogenic Disorders): Identifies specific inherited genetic conditions, like cystic fibrosis or sickle cell anemia.
PGT-SR (for Structural Rearrangements): Detects chromosomal structural abnormalities, like translocations or inversions.
Step 7c: Results Interpretation and Embryo Selection
The lab generates a report indicating which embryos are:
Euploid: Genetically normal and suitable for transfer.
Aneuploid: Containing genetic abnormalities and unsuitable for transfer.
Mosaic: Containing a mix of normal and abnormal cells (these embryos may sometimes be considered for transfer with careful counseling).
Based on the results, the fertility team and patients select the healthiest embryo(s) for transfer.
Step 8: Embryo Transfer
The embryo transfer is one of the final and most exciting steps in the IVF process, where a carefully selected embryo is placed into the uterus with the hope of achieving a successful pregnancy. Depending on the circumstances, this can be done as a fresh transfer immediately following fertilization or as a frozen embryo transfer (FET) in a later cycle. Each approach has its unique benefits, and the choice is tailored to the individual’s needs and overall treatment plan.
Steps to a Fresh Embryo Transfer
After egg retrieval and fertilization, the embryos are monitored as they develop over the next few days, typically reaching the blastocyst stage on Day 5 or 6.
1. Timing the Transfer
A fresh transfer happens within the same cycle as the egg retrieval. The embryo is transferred soon after fertilization and development, usually 3-5 days post-retrieval.
2. Endometrial Preparation
The uterus is prepared for implantation using hormonal medications (e.g., progesterone) or by timing the natural cycle. The goal is to ensure the uterine lining (endometrium) is thick and ready to support an implanting embryo.
3. The Transfer Procedure
The patient lies on an exam table, and a thin, flexible catheter containing the embryo(s) is inserted into the uterus. Ultrasound guidance ensures the embryo is placed in the ideal location for implantation.
The procedure is quick, usually taking 10-15 minutes, and is typically painless. You can normally watch the embryo being placed in the uterus.
4. Post-Transfer Care
Patients are advised to rest for a short period before resuming normal activities. Progesterone or other supportive medications continue to maintain the uterine environment.
5. Pregnancy Test
The two-week wait begins, and about 10-14 days post-transfer, a blood test measures hCG levels to confirm pregnancy.
Steps to a Frozen Embry Transfer (FET)
If embryos are frozen after genetic testing or for other reasons, a transfer cycle occurs later. Many of the steps are identical to the steps in a fresh embryo transfer.
1. Planning the Transfer Cycle
The FET cycle can be performed in a subsequent month or later, giving the patient’s body time to recover from ovarian stimulation.
The cycle can be natural (tracking the body’s natural ovulation) or medicated (using hormones to control the timing).
2. Endometrial Preparation
Similar to fresh transfers, the uterus is prepared for implantation using hormonal medications (e.g., progesterone) or by timing the natural cycle. The goal is to ensure the uterine lining (endometrium) is thick and ready to support an implanting embryo.
3. Thawing the Embryo
The selected embryo(s) is carefully thawed on transfer day in the laboratory.
Thawing is a delicate process, and embryologists assess the embryo’s viability before proceeding.
4. The Transfer Procedure
The patient lies on an exam table, and a thin, flexible catheter containing the thawed embryo(s) is inserted into the uterus. Ultrasound guidance ensures the embryo is placed in the ideal location for implantation.
The procedure is quick, usually taking 10-15 minutes, and is typically painless. You can normally watch the embryo being placed in the uterus.
5. Post-Transfer Care
Patients are advised to rest for a short period before resuming normal activities. Progesterone or other supportive medications continue to maintain the uterine environment.
6. Pregnancy Test
The two-week wait begins, and about 10-14 days post-transfer, a blood test measures hCG levels to confirm pregnancy.
Step 9: IVF Outcomes and Next Steps
When IVF is Successful: The first weeks of pregnancy are often accompanied by cautious optimism and frequent monitoring. Lean on your care team for guidance, and seek support if anxiety about maintaining the pregnancy arises. Celebrate your success while allowing space for any lingering emotions from the journey.
When IVF is Unsuccessful Cycles: Unsuccessful cycles can be devastating. It’s important to grieve and take steps to heal. Remember, your journey is unique, and there is no single right way forward. Some options might be:
Acknowledge Your Grief: It’s completely understandable to struggle with an unsuccessful cycle. Allow yourself to feel and process your emotions without judgment for grieving.
Seek Support: Turn to loved ones, fertility support groups, your Fertility Friend or therapists to share your experience and gain perspective.
Celebrate Progress: Recognize the courage and strength it took to pursue treatment, regardless of the outcome.
Reframe Your Focus: Shift your energy toward evaluating next steps with your medical team, such as trying again, exploring alternative treatments, or taking a break.
By integrating these strategies, you can navigate the emotional landscape of IVF with resilience and hope.
Emotional and Mental Health Support
Coping with Emotional Challenges
The IVF journey can be emotionally intense, with highs and lows that test your resilience. It’s normal to feel a mix of hope, anxiety, and frustration. Here are some practical ways to manage these emotions:
Support From Partners (If applicable)
Open communication with your partner is crucial to navigating this journey together. Here’s how you can work as a team:
Share Expectations: Talk openly about how each of you is feeling and what you need from one another.
Delegate Roles: Divide responsibilities – such as attending appointments together, managing medications, and reshuffling on other household tasks – to reduce stress and manage the mental load.
Involve Family Wisely: If you’re involving family or friends, discuss together what information to share and what kind of support you both need. Agree on boundaries to maintain emotional well-being. Agree to check in and recalibrate boundaries if needed as time passes.
Support from Friends and Family
Set Boundaries: If you choose to share, set clear boundaries about what information you’re comfortable revealing. Providing specific ways they can support you can help loved ones navigate this delicate topic.
Prepare for Challenges: Insensitive comments or advice, even when well-meaning, can hurt. It’s okay to gently redirect conversations, restate boundaries or step away. Navigating relationships with friends or relatives who are pregnant or parenting may also be challenging. Prioritize your emotional well-being in these interactions.
Lean on Support Systems: Encourage your circle of loved ones to help with practical tasks, like meal preparation or childcare so that you can focus on your treatment.
Need More Support? Consider signing up for a Fertility Friend from Yesh Tikva. You’ll be matched with someone who knows what infertility and treatment is like and wants to support you.
The IVF journey is a path of hope, resilience, and determination in growing your family. Lean on your support system, advocate for your needs, and remember to care for yourself emotionally and physically. You are not alone—help, resources, and Yesh Tikva are always available to guide you.
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