PREPARING FOR CONVENTIONAL IVF
Sher Institute for Reproductive Medicine
The objective with In Vitro Fertilization is to consistently transfer several good quality embryos into an optimal
uterine environment. This requires an individualized and meticulous approach to the evaluation and treatment of
the following factors that are known to influence IVF outcome:
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THE NUMBER AND QUALITY OF THE EMBRYOS/BLASTOCYSTS FOR TRANSFER:
The number of embryos/blastocysts: The number of eggs a woman produces is influenced by her
ovarian responsivity to gonadotropin fertility drugs such as Follistim, Gonal-F, Pergonal, Humagon or
Repronex. This responsivity in turn relates to her proximity to menopause. Ovarian responsivity can be
assessed by measuring FSH and estradiol (E2) and Inhibin B, on the 3rd day of a prior menstrual cycle.
If the plasma FSH level is greater than 9.0MIU/ml in association with a plasma estradiol level of greater
than 70pg/ml by EIA, and/or the plasma inhibin B level is less than 45 pg/ml, it would point to the
likelihood that the woman would be relatively resistant to ovarian stimulation.
The quality of embryos/blastocysts: Clearly, the quality of the ivf laboratory is pivotal in ensuring
that quality embryos are produced following IVF Highly technical procedures such as intracytoplasmic
sperm injection (ICSI), assisted hatching (AH) and embryo biopsy, should only be performed by
embryologists with the necessary experience and rehearsed skill, lest fertilization rates and embryo
quality be severely compromised
2)
THE INTEGRITY OF THE UTERINE CAVITY AND THE QUALITY OF THE UTERINE
LINING:
The integrity of the uterine cavity: Hysterosonography (Fluid ultrasonography-FUS) is a simple office
procedure performed under mild sedation, where a sterile salt/water solution is injected into the uterus
and an ultrasound exam is performed. The procedure permits a detailed inspection of the inside of the
uterus for surface lesions such as polyps or fibroid tumors that may be protruding into, encroaching
upon, or distorting the uterine cavity. Such lesions compromise the ability of the embryo to attach to the
uterine wall, and as such should be removed before initiating fertility treatment.
Sometimes, direct visualization of the uterine cavity is needed. This calls for the performance of
hysteroscopy, a procedure where a thin, telescope-like instrument is inserted through the cervix into the
uterus for visual inspection of the cavity. Diagnostic hysteroscopy can readily be performed in the
doctor's office using local anesthesia and mild sedation.
PREP FOR CONVENTIONAL IVF AT SIRM (2)
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Evaluation of the uterine cavity by FUS or hysteroscopy is an essential part of the screening process at
SIRM.
A dye X-Ray test or Hysterosalpingogram (HSG) is NOT sufficiently sensitive or specific to exclude the
presence of small lesions in the uterine cavity.
Evaluating the uterine cavity for infection: It is important to exclude infection with microorganisms
such as Ureaplasma urealyticum; which, if present, may compromise fertilization and implantation.
Ureaplasma infection is usually asymptomatic, and can be eradicated through appropriate concurrent
antibiotic treatment of both partners. There is evidence that when Ureaplasma is present in semen,
fertilization rates are reduced.
Evaluating the uterine lining: An additional uterine factor that can affect the success of IVF is the
thickness and consistency of the endometrial lining following administration of fertility medications.
This can be evaluated through the performance of an ultrasound examination prior to egg retrieval.
Evaluating for immunologic dysfunction: In more than 30% of cases where the cause of infertility
resides with the woman, or is ”unexplained” there is an underlying contributing immunologic problem
that interferes with embryo attachment. The high emotional, financial and physical toll associated with
IVF, mandates that these immunologic problems be addressed early on. Accordingly we require that an
immunologic evaluation be performed prior to IVF in the following situations:
 "unexplained " infertility or prior recurrent miscarriages
 underlying female organic pelvic disease
 a history of prior IVF failures
 a history of recurrent miscarriages, or ….
 Whenever there is a personal or family history of immunologic disease such as lupus erythematosis,
Hypo/hyperthyroidism, rheumatoid arthritis, etc.
(3)
SPERM QUALITY AND FUNCTION:
Until the advent of IVF, treatment of moderate and severe male factor infertility yielded dismal results.
The introduction of IVF yielded offered the first ray of hope but results were still disappointing. The
advent of ICSI, a high-tech procedure, where a single sperm is directly injected into each egg, changed
all that. Now, as a result of ICSI, IVF birth rates in selected centers of excellence even exceed those
achieved with conventional IVF performed for indications other than male infertility.
In Vitro Fertilization exacts an emotional, physical and financial price and no one gets through the process
without paying the toll. Accordingly, all couples should learn what they can reasonably expect before
committing to IVF. Simply put, it is important to shape realistic expectations and to plan this trip before
embarking on the journey.
Accordingly, at SIRM we require that all of our patients be fully informed of the services contemplated, through
a detailed medical consultation with one of our physicians, a clinical coordinator, and/or with a psychological
counselor. We also require that relevant consent forms and agreements be carefully reviewed and signed prior
to initiating a cycle of treatment at SIRM
PREP FOR CONVENTIONAL IVF AT SIRM (2)
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The following is a list of the tests that are selectively performed in preparation for a cycle of IVF at
SIRM. Those tests that have been performed within 18 months need not necessarily need to be repeated.
Please ask the clinical coordinator for clarification. Many of the blood and diagnostic tests listed below
may be performed by your Ob/Gyn or internist.
FEMALE TESTS:
If done within 18 months do not repeat unless specifically ordered by SIRM’s physician.
TYPE OF TEST/PROCEDURE
TIME
COMMENTS TESTS PERFORMED IN DATE
PRECEDING
18
MONTHS,
IF
NORMAL
NEED
NOT
BE
REPEATED!
BLOOD TESTS
FSH,E2,
CD 3
TSH
Anytime
Prolactin
Rubella ab
ABO/Rh
HepB Sag
HepC ab
RPR/VDRL
Chlamydia antibodies
HIV
Any time
CERVICAL CULTURES
Ureaplasma urealyticum
UTERINE ASSESSMENT
Fluid Ultrasonography or
hysteroscopy
CD 6 -13
Uterine Measurement (US)
Uterine Lining
PREP FOR CONVENTIONAL IVF AT SIRM (2)
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Not to be done during menstruation
EXAMINATION
*Only for patients over the age of 40
and/or past history of systemic
disease or previous medical/surgical
complications
M.D. clearance
Pap Smear
Mammogram*
EKG, Blood Chem*
MALE TESTS:
If done within 18 months do not repeat unless specifically ordered by SIRM’s physician
BLOOD TESTS
Anytime
DATE
Selectively ordered
FSH/LH/Testosterone/Prolactin
HepB Sag
HepC ab
HIV
RPR/VDRL
Chlamydia antibodies
Selectively ordered
Anti-sperm antibodies
SPERM DNA INTEGRITY T(SDI)
TEST ( SYN: SCSA
selectively ordered ( if never initiated a
pregnancy that went beyond 12 weeks
SEMEN ANALYSIS
3-4 days of abstinence
Count
Motility
Morphology
CULTURES
Any time
Ureaplasma
SELECTIVE
EXAMINATION of MALE
We are very familiar in working with couples at a distance, and it is rarely necessary for out-of-town patients to
spend more than 2 weeks at an SIRM center. Many patients treated at SIRM come from out-of-state or out-ofPREP FOR CONVENTIONAL IVF AT SIRM (2)
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country. Accordingly, we have developed a system of working with patients and their primary care physicians
at a distance.
Please keep in mind that the way we prepare couples for IVF at SIRM using a combination of the Oral
Contraceptives (OC's), enables us to plan and schedule each cycle, often months in advance, with precision.
This allows patients/couples to conveniently schedule IVF at SIRM, around their own calendars.
Patients/couples should inquire as to eligibility for acceptance to Outcome-based Pricing (OBP) plan, where if
an IVF procedure at SIRM, does not result in the birth of a baby, most of the financial obligation to SIRM, fall
away. Also, most couples who are eligible for OBP, will also be eligible for Medical Financing of their IVF,
at SIRM.
IF YOU HAVE ANY QUESTIONS PLEASE DO NOT HESITATE TO CONTACT US AT. SIRM
DURING REGULAR OFFICE HOURS (FROM 9:00AM TO 4:00PM)
PREP FOR CONVENTIONAL IVF AT SIRM (2)
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