Connect with us

IVF is an option for couples who are unable to conceive naturally because of problems involving

  • • The fallopian tubes (tubal factor)
  • • low sperm count or poor sperm quality (male factor)
  • • pelvic adhesions (pelvic factor)
  • • severe endometriosis

IVF is also an option for

  • •Unexplained infertility (when a couple fails to conceive even after the usual fertility tests come back as ‘normal’)
  • •Women older than 37
  • •Women who have failed to conceive through ovulation induction and/or insemination
  • •Women under 37 who have been unable to conceive after trying for more than a year of unprotected intercourse
  • ● Preparatory to the IVF cycle, you may be put on the pill for a month for better control of cycle timing and to help prevent ovarian cysts which can interfere with stimulation.
  • ● If you are put on the pill pre-IVF, the IVF cycle itself begins when you get your first period after the pill. In any case, the IVF treatment cycle begins on the day you get your period in the month you plan to undergo IVF.
  • ● You must call us the day you get your period (Day 1 of your IVF cycle).
  • ● During the cycle, you will be seen several times at the office (or at a lab and radiology
  • office) for blood tests and ultrasound.
  • ● Please be prepared to commit yourself for 10-12 days to going for blood tests and ultrasound on the days you are instructed to do so. This is necessary for optimal results in your stimulation. If you work, we will give you the necessary excuse note so that during your stimulation, you can take a couple of hours off every day to do these tests.
  • ● These procedures should be done first thing in the morning, so that results are available by 5 p.m., as the doctor needs these to determine your daily medication and dosage.

Typically, this is what happens during your IVF cycle:

  • Cycle Day 1 (CD 1) CALL US
  • CD 2 Baseline blood tests and ultrasound If results are normal, stimulation is generally started on Day 3 of the cycle
  • CD 3 Day 1 STIM: Start stimulation at dosage given by Dr Brandeis for 2 days (initial dosage depends on patient’s age, weight, previous response to stimulation, number of follicles seen on Day 2 ultrasound)
  • CD 4 Day 2 STIM
  • CD 5 Day 3 STIM: Blood (E2) and ultrasound – to determine your response to medication, as shown by the estradiol level and by the number and size of ovarian follicles seen on ultrasound. After the first two days, the daily dosage will be adjusted according to this response.
  • CD 6 Day 4 STIM
  • CD 7 Day 5 STIM: Blood (E2) and ultrasound. Typically, you will start a daily injection of Cetrotide (or Ganirelix) if the estradiol level is 200 and/or 1-2 follicles reach an average 10mm diameter. A second stimulation medication is usually added for the remaining days of stimulation.
  • CD 8 Day 6 STIM
  • CD 9 Day 7 STIM: Blood (E2, LH) and ultrasound. NB: Some patients may need to return daily for the remaining days of stimulation.
  • CD 10-12: Days 8, 9,10 STIM: Blood (E2, LH, PROG) and ultrasound DAILY. NB: Some patients may require 1-2 more days of stimulation, in which case, daily blood and ultrasound monitoring will continue.
  • ● When at least two of your follicles are 18mm in average diameter, you will take the last medication before egg retrieval (HCG or Lupron), both injectable, to help mature the eggs in time for the retrieval.
  • - It is given 34-36 hours before the scheduled egg retrieval. Usually this is given at night for a morning egg retrieval two days later. (Ex: Saturday night for a Monday morning retrieval.)
  • - You will take no other medications until after egg retrieval.
  • ● You and your partner are expected to be at CNY Albany by 7:30 a.m. on the day of egg retrieval. At this time, you will pay CNY the fee balance ($3000 or more, depending on the type of IVF you are doing) to cover all the procedures you are doing with them.
  • ● You can be discharged 2-4 hours after the procedure, after anesthesia effects have worn off.
  • ● You will be given prescriptions for medications to be taken until the first pregnancy test two weeks after embryo transfer. Most patients are able to go to work the next day.
  • ● You will return to Albany 3-5 days later for the embryo transfer, which requires no anesthesia, so you can return home after one hour.
  • ● Staying home for a few days and avoiding any strenuous activity is usually recommended, but many patients can resume their regular activities right away except gym work and heavy lifting.
  • ● 12-14 days after embryo transfer, a blood pregnancy test will show if you have conceived. An ultrasound will check if you have any post-retrieval ovarian cysts.
  • • If the pregnancy test is positive, you will repeat the blood tests every 2-3 days to make sure that the pregnancy hormone levels are rising appropriately. Ultrasound will show how many embryos have implanted.
  • • Three weeks after embryo transfer, ultrasound will be able to detect the fetal heartbeat. This is considered the definitive clinical sign of pregnancy.
  • • At this time, Dr. Brandeis will refer you to the obstetrician of your choice for pregnancy follow-up, pre-natal care and eventual delivery.
  • • The ovaries are stimulated for a period of 10-12 days with injectable fertility medications in order to produce at least eight mature eggs instead of the single one produced in natural ovulation.
  • • The eggs are then taken from the ovaries in a simple transvaginal aspiration done under sedation anesthesia.
  • • The mature eggs retrieved are inseminated in the laboratory by micro-injecting into each egg a single sperm cell from your husband/partner or anonymous sperm donor.
  • • The fertilized eggs are cultured in the laboratory for 3-5 days until they develop into 8-cell embryos (by Day 3) or blastocysts (by Day 5). (In normal conception, the embryo is at blastocyst stage when it travels from the fallopian tube to the uterus).
  • • Selected embryos will be transferred to your uterus with a catheter in a simple, painless procedure similar to intra-uterine insemination. No anesthesia is necessary.
  • • 10-12 days after embryo transfer, a blood pregnancy test will show whether you have conceived or not. Ultrasound will be done to check for any post-retrieval ovarian cysts.
  • • If the pregnancy test is positive, blood tests will be repeated every 2-3 days to make sure that the pregnancy hormone levels are rising appropriately, and ultrasound will determine how many embryos have implanted.
  • • Three weeks after embryo transfer, ultrasound will be able to detect the fetal heartbeat. This is considered the definitive clinical sign of pregnancy.
  • • At this time, Dr. Brandeis will refer you to the obstetrician of your choice for pregnancy follow-up, pre-natal care and eventual delivery.

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.
Pre-IVF Costs
These include:
  • • Your initial consultation with Dr. Brandeis
  • • The basic fertility tests listed above
  • • Blood tests for infectious-disease and genetic screening
  • • Office visits before you start your IVF treatment
If you have health insurance:
  • ● All these pre-IVF costs are covered by any health plan that covers infertility, even if your personal policy does not cover fertility treatments like IVF.
  • ● HMO plans, as well as Medicare and Medicaid, do not cover infertility treatment or medications.
  • ● However, some HMO patients may be able to do the basic tests and the infectious disease screening tests through their primary physician, in which case the HMO would cover the services. - If your PCP agrees to order the genetic testing, these may also be covered.

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).

  • •Transvaginal pelvic sonogram $150
  • •Hysterosalpingogram 250
  • •Semen analysis 150
  • •Infectious disease and genetic screening for both partners are done by Bio-Reference Laboratories, which offers a 70% discount on all lab work sent to them if the patient has no insurance or if her insurance does not cover the tests.

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:

  • ● The total cost of medical and laboratory services for a standard IVF treatment cycle is $4,900.
    This does not include medications which you will purchase directly from a fertility pharmacy (see below).
  • ● The first payment of $1,900 - in cash, certified check or money order – covers Dr. Brandeis’s fees for medical management of all your pre-IVF tests and procedures, and his management and monitoring of the IVF cycle itself (office visits, sonogram and blood drawing) over a two-month period covering the pre-IVF cycle and the actual IVF cycle to the first pregnancy test. The first payment is due at the time Dr. Brandeis orders your pre-IVF tests.
  • ● The balance of $3,000 will be paid on the day of egg retrieval to CNY.
  • ● As explained above, we are able to keep the cost of IVF down because of this arrangement with CNY.

Services covered by the IVF cycle fee With Dr. Brandeis –

  • ● Ordering and coordinating all tests and procedures for you and your partner from the day you decide to proceed to IVF
  • ● All office visits, telephone consultations, and telephone instructions after you have paid Dr. Brandeis’s cycle fee until the first pregnancy test
  • ● Medical management of your IVF process and monitoring of stimulation
  • ● Blood drawing and office ultrasound as needed With CNY
  • ● Anesthesia for egg retrieval
  • ● Egg retrieval
  • ● Laboratory fees for
  • - Embryology, including ICSI & assisted hatching
  • - Laboratory culture for 3-5 days
  • ● Embryo transfer
  • Plus – at no extra charge:
  • ● Freezing of extra embryos
  • ● Embryo storage for six months
  • ● One frozen embryo transfer