IVF is an option for couples who are unable to conceive naturally because of problems involving
IVF is also an option for
Typically, this is what happens during your IVF cycle:
If you have no medical or gynecologic problems that need to be treated before undertaking IVF, and if you respond appropriately to stimulation, the entire IVF process, from pre-IVF testing to the first pregnancy test, usually takes 2-3 months.
Some patients may be advised low-dose IVF or natural cycle IVF instead of standard IVF, especially if they had failed IVF cycles with standard stimulation.
Fertility medications are kept to a minimum. Clomid may be used for five days, followed by two injections of gonadotropins. In most patients, this results in 3-4 follicles from which eggs may be retrieved for IVF.
The patient will rely on the single egg that she ovulates naturally, and she must be monitored closely with ultrasound and blood values in the days preceding expected ovulation. Before her natural LH surge, she will be given an HCG injection to help mature the egg, and 32-36 hours later, the egg will be retrieved, inseminated and cultured in the laboratory.
Women who wish to delay motherhood until they have achieved certain career goals may now freeze and bank their own eggs for future use, but are advised to do so before they reach age 30.
After age 37, a woman’s fertility potential begins to decline rapidly because her remaining eggs are older and therefore more likely to have chromosome abnormalities. This also explains the increased risk of miscarriage in older women. For this reason, it is not advisable to attempt egg freezing after age 35, because the very same risks will apply.
Egg-freezing patients must undergo standard IVF stimulation to maximize the number of eggs that they can bank. They may do more than one cycle of egg freezing. The only difference from standard IVF is that after egg retrieval, the eggs are frozen (cryo-preserved) and may be stored until the patient is ready to use them.
Egg freezing is also an option for reproductive-age women desiring to have children if they have ovarian tumors or ovarian cancer which require surgery or other treatment such as chemotherapy and radiation, which generally render the ovaries infertile. For this reason, egg freezing must be done before treatment is undertaken.
In the past 25 years, micro-manipulation techniques have been developed using specially designed microscopes to perform highly delicate operations on sperm, egg cells and embryos. Initially, these were used for intra-cytoplasmic sperm injection (ICSI) – injecting a single sperm into each mature egg retrieved at IVF – and for assisted hatching, when a tiny hole is made in the protective covering of each embryo before it is transferred to the uterus, in order to facilitate hatching out to implant in the uterine lining .
Eventually, micro-manipulation skills led to the possibility of embryo biopsy – in which a cell is detached from a viable embryo (usually at the 8-cell stage) for genetic analysis. This is called pre-implantation genetic diagnosis (PGD) which has become commonly used in the past 15 years to screen embryos for chromosome abnormalities, for the presence of gene mutations linked with specific diseases, or for sex selection - in order that only chromosomally normal embryos which do not contain a specific disease screened for, and/or which are male or female are selected for embryo transfer.
Since a number or serious diseases are linked with the female X chromosome, PGD can determine the sex of each viable embryo by identifying the sex chromosomes present in each embryo (XY chromosomes if male, XX if female).
The first condition for successful PGD outcome is that the patient must get pregnant. If IVF/PGD is performed on a normal healthy woman younger than 37, who has no infertility problems, her chances of pregnancy are 60% or more. Chances are lower for women with infertility problems and for women older than 37.
In the past, when the male partner in a couple desiring to have children together has had a vasectomy, he would require surgery to reopen the two tubes delivering sperm into the seminal stream that were cut and sealed off at vasectomy. Alternatively, the couple could consider using donor sperm or adoption.
With the advent of intra-cytoplasmic sperm injection (ICSI) to inseminate eggs retrieved at IVF – in which only as many sperm cells are needed as the number of eggs – various techniques were developed to recover sperm from the testes or epididymis of men who had undergone vasectomy.
In percutaneous epididymal sperm aspiration (PESA), a fine needle is injected through the skin to aspirate the sperm. MESA involves a microsurgical approach: a small incision is made over the epididymis, and sperm is identified with the aid of a microscope.
In TESE (testicular sperm extraction), an incision is made to access the sperm-bearing testicular tissue; this is best done with a microscope to identify biopsy sites that are most likely to yield sperm cells, which will be isolated in the laboratory from the tiny tissue samples taken. Sperm retrieval procedures in conjunction with IVF are performed by an experienced urologist.
Post-vasectomy patients who had a normal semen analysis before vasectomy usually will have enough sperm recovered not just for immediate use but also for cryopreservation.Testicular or epididymal sperm retrieval is also used for patients with non-obstructive azoospermia or obstructive azoospermia not due to vasectomy, provided their urologist has reasonable expectation of recovering some sperm.
If you have no health insurance, or you are unable to do these pre-IVF tests through your primary doctor, the following is a rough estimate of what it would cost out of pocket, at facilities we work with. (If you know of other radiologists or reference labs who can do these tests cheaper, please let us know so we can share the information with other self-pay patients).
The panels for each individual cost about $900 at the discounted price. We will give you a discount card that you will fill out with your name and the invoice number when you get the bill from the lab – you send back the card with a payment corresponding to 30% of the indicated charges.IVF medications
Medications represent a significant part of the expense of IVF treatment for patients who have no insurance, or whose plan does not cover fertility treatment. Most of the expense goes to medications used to stimulate the growth and development of multiple ovarian follicles during the IVF cycle in order to retrieve at least eight mature eggs. This can cost as much as $2,500 for patients requiring the ‘average’ stimulation dose. Younger women with normal weight usually require less stimulation.
All other medications used in the typical IVF cycle will cost an additional $500-700. This includes the pre-IVF medication Lupron, which prepares your ovaries for stimulation, if Dr. Brandeis decides this will be the protocol most appropriate for you; and the post-retrieval medications intended primarily to prepare the lining of your uterus to maximize the chances of embryo implantation, and therefore, of conception.
Under a program called Compassionate Care, Serono, the company that manufactures Gonal-F, the most widely-used ovarian stimulation medication in the past 10 years, offers a 50-75% discount to patients who have no insurance or whose plan does not cover fertility medications. The discount depends on the patient’s income level. From our experience with the program, almost all applicants are given the 75% discount, which represents considerable saving on a baseline cost of $2500 or more.
Flat fee for self-pay IVF with two-step payment If you have no insurance coverage, or your plan does not cover IVF, the following explains the self-pay fee:
Services covered by the IVF cycle fee With Dr. Brandeis –