In Vitro Fertilization & Embryo Transfer (IVF/ET)

IN VITRO FERTILIZATION & EMBRYO TRANSFER (IVF/ET)Louise Brown was the 1st woman to give birth to a baby born through in vitro fertilization, in 1978. Her ovaries were stimulated with fertility drugs to produce multiple mature eggs, which are then removed from her body through laparoscopy and were thereupon fertilized with her partner’s sperm. The resulting embryos were cultured for two days in a petri dish containing partner’s processed sperm, at which point one (1) was transferred into her uterus. The entire process has dramatically changed over the last 4 decades.  By way of a few examples: a) we no longer perform egg retrieval (ER) laparoscopically. Instead we use transvaginal ultrasound-guided needle extraction; b) today, rather than simply adding live sperm to the petri dish containing eggs, we mostly achieve fertilization through injecting single sperm into each egg (intracytoplasmic sperm injection – ICSI; c) when it comes to f embryo transfer we perform the process under ultrasound guidance 3-5 days post-fertilization.


Basic IVF performed at Sher-IVF utilizes the following processes:

  • Preparing for Controlled Ovarian Stimulation (COS)
  • Undergoing COS
  • The Egg Retrieval (ER)
  • Sperm Preparation
  • Fertilizing Eggs
  • Embryos Selection for Transfer
  • Embryo Transfer (ET)
  • Freezing (cryopreserving) Left-Over Embryos


Making In Vitro Fertilization Cost Affordable

Sher –IVF attempt to make IVF more affordable through offering a number of IVF package plans along with financing options.

Natural Cycle (NC)- IVF
NC-IVF eliminates the use of fertility drugs. The woman is monitored daily as she approaches ovulation. On some occasions she will be given an hCG “trigger” shot to mature her developing eggs. One or two eggs are then retrieved through transvaginal needle-guided aspiration and thereupon the cycle proceeds as with conventional IVF cycle. NC-IVF yield very much lower success rates than does conventional IVF and I rarely advocate its use.


The process is similar to conventional IVF, only with Mini-IVF a very low dosage of injectable fertility drugs and/or oral fertility drugs (e.g. Clomid/Serophene or Letrozole) are used. I personally am not in favor of this approach because success rates are very much lower.

The use of approaches such as natural cycle IVF or Mini-IVF might cost less than conventional IVF but because the chance of success is much lower, the ultimate cost of having a baby is far greater, Moreover, aside from the financial cost, there is also an emotional component that increases with the number of attempts undertaken. It should always be remembered that in the final analysis, it is the cost of having a baby, rather than the cost of component procedures involved that counts.

Introducing Micro-IVF – A More Successful Alternative

MICRO-IVF is an IVF approach suited to younger women (<35Y) who have good ovarian reserve (an AMH of >2.0ng/ml or 15pmol/L). Because less medication and abbreviated monitoring and a shorter stimulation is usually needed, the cost is significantly lower than for conventional IVF.  Micro-IVF is about 3 times more likely to produce a baby per attempt than IUI.


When you schedule your IVF at Sher-IVF, key components of your cycle, such as medications, appointments, ultrasounds, tentative egg retrieval, embryo transfer and pregnancy test dates are laid out for you in advance.


How to interpret blood beta hCG levels after IVF: The earliest and the most important indicator of IVF outcome is the blood beta hCG level. It is first measured about 10 days after egg retrieval with fresh (conventional) IVF, 10 days after ovulation in natural-cycle IVF and 10 days after initiating progesterone in embryo recipient cycles (frozen embryo transfer-FET; embryo donation; egg donation transfers; and embryo donation). The 1st measurement should be >10MIU/ml. This value should (roughly double every 48 hours until about 6 weeks into gestation and thereupon rises more slowly. Failure to follow this trend and sequence, usually is the result of failing implantation (a chemical pregnancy), an impending early miscarriage and in cases where the level continues to rise but erratically or slowly, could also indicate a tubal (ectopic pregnancy). If the level rises faster and more than doubles in the early stage of pregnancy, it could suggest a multiple gestation and if it sky-rockets upward to very high levels in the early stage of pregnancy it could suggest a molar pregnancy.  In cases where the level starts high, then drops down for a day or two whereupon it resumes the doubling effect every 48 hours it may indicate that a multiple pregnancy has reduced spontaneously, to a singleton. In rare cases, the beta hCG might initially be undetectable or start off <5MIU/ml and thereupon start doubling appropriately, culminating in a viable pregnancy. This is why it is important to measure the hCG level at least twice before discounting a viable pregnancy being on the make.


Does Acupuncture improve IVF success?
There is little evidence that acupuncture improves ovarian blood flow. In contrast there appears to be a definite improvement in uterine/endometrial blood flow. This why, I advise my patients to confine acupuncture treatments to the day before, the day of, and the day after ET. This having been said, opinions vary with regard to whether acupuncture indeed enhances implantation following IVF-ET. Certain studies support a benefit while others do not. Notwithstanding, many patients find that acupuncture therapy gives them additional confidence and peace of mind. In the end, it is a personal decision.