Fertility Services

Step 1 – Suppressing female hormones with medication in order to prepare the body for treatment.

The intent here is to create a baseline state (the body’s natural state during the initial days of a menstrual cycle). Suppression medication maximizes the chances for an optimal baseline, which in turn yields a better environment to begin stimulation of the ovaries. Once parameters for a baseline state have been met, an IVF cycle can begin. Specific criteria that we evaluate to define a healthy baseline state include:

• Absence of ovarian cysts
• Proper hormone levels
• Adequate uterine lining

Step 2 – Hormone therapy to stimulate ovaries into producing follicles (eggs)

During this step, medication composed of Gonadotropins, which are hormones (FSH and LH) naturally produced by the pituitary gland to stimulate ovarian function and ovulation, is administered daily. This will gradually induce the ovaries to produce multiple follicles (small sacs that contain immature eggs). The medication allows the ovaries to support growth of more mature follicles, rather than the usual one or two produced during a typical menstrual cycle. On average, stimulation continues for a period of 10-14 days to encourage production of multiple follicles.

Step 3 – Monitoring the progress of healthy follicle production

During these 10-14 days of hormone therapy, Dr. Behera and her staff will periodically use ultrasound and blood testing to monitor the progress and growth of follicles. At this time, they will also be checking on how the patient’s body is responding to the medication, as well as closely following the patient’s hormone levels to fine tune and customize the protocol and dosing. This step is necessary in order to maximize both, patient safety and successful outcome.

Step 4 – Retrieval of eggs and collection of sperm

Once follicles reach the appropriate stage, Dr. Behera and the staff at Bloom will prepare the patient for an egg retrieval procedure. The medication hCG will be used to cause eggs to reach maturity and break free from follicle walls. This process is often called the ovulation trigger. The actual egg retrieval will take place approximately 2 days later (35-38 hours post-trigger).

During the retrieval, Dr. Behera will draw fluid from each follicle and then pass it to the embryologist. The embryologist carefully isolates the eggs from within the fluid and keeps them in a highly-controlled, ideal environment so that they can fertilize and grow. The Bloom lab staff will be able to provide an exact count of the number of eggs retrieved that day.

That same day, sperm will be collected and prepared to mix with eggs for fertilization.

Step 5 – Fertilization of eggs

Immediately after the egg retrieval, our embryologists work carefully to fertilize the eggs. Through the insemination technique, eggs and sperm will be brought together is a glass dish and incubated in a highly controlled environment for 48 to 120 hours.

Another commonly-used method of fertilization is through ICSI – intra-cytoplasmic sperm injection. During ICSI, a single healthy sperm is selected and directly injected into an egg for fertilization. ICSI is typically recommended for those couples with male factor infertility issues or who have had prior difficulties of achieving pregnancy through regular infertility treatment.

Embryos are then nurtured with close and continuous monitoring as they grow over the following 3-5 days. At this point, the embryo health and quality can be assessed, which allows the embryologist and Dr. Behera to determine and select the appropriate embryo(s) for implantation to achieve the best chances of conception.

Step 6 – Embryo transfer

Embryos are transferred into the uterus either 3 or 5 days after the egg retrieval. Dr. Behera and the lab staff will recommend, while conferring with patients, which and how many embryos to transfer based upon embryo quality, and best chances to obtain a healthy pregnancy outcome.

Typically embryos are transferred on Day 3 if there aren’t many eggs retrieved or embryos developed. If the embryos are deemed too fragile to go through the self-selection process of growth until Day 5, then it may be advisable to transfer those embryos on Day 3, rather than Day 5.

The goal at Bloom Reproductive Institute is to achieve the highest pregnancy rates with the lowest chances of multiple pregnancy. This is best accomplished with Day 5 transfers. After 5 days, the cells in the embryo have divided many times, resulting in a compact group of cells. The embryos that survive to this stage are typically stronger and known as blastocysts. Hence, fewer embryos need to be transferred to obtain high pregnancy rates, compared to earlier stage embryos.

Step 7 – Pregnancy testing

Approximately 11 days after embryo transfer, pregnancy hormone testing (hCG test) is done in clinic. Other hormone levels are also reevaluated to ensure the environment is most supportive for the early pregnancy. These levels will be monitored every 2-3 days for the first week to measure the appropriate progression of pregnancy hormone, rising hCG levels, which should increase as the pregnancy progresses in the first trimester. Once the pregnancy hormone levels have reached the threshold where an early pregnancy can be seen, the staff at Bloom will arrange the first early obstetrical ultrasound between the fifth and eighth week of gestation. During this ultrasound, Bloom staff will monitor early signs of pregnancy health, including fetal heartbeat and serial growth.

Once we have met the goals of achieving a healthy onset of first trimester pregnancy, the patient then graduates from Bloom to continue prenatal and obstetrical care with the OB/GYN provider of their choice.