In Vitro Fertilization, or IVF, was first performed in 1978 and has become the standard for treating the many fertility disorders in men and women.  With IVF, women are given fertility medications to stimulate the development of multiple eggs.  The eggs are retrieved in the office, and cultured in vitro (in the laboratory) with sperm to create embryos.  Usually, 2 to 3 embryos are placed back into the uterine cavity (womb) 3 to 5 days later where they may attach and develop in hopes of achieving a pregnancy.

The typical in vitro fertilization cycle consists of several phases including the suppression phase, the stimulation phase, the egg retrieval, the embryo transfer, and the follow up phase.  Each step of the treatment is performed by Dr. Nabal  Bracero.

The Suppression Phase

medsThe Suppression Phase begins the month before your scheduled egg retrieval.  We will spend this month “suppressing” your ovaries to prepare them for the stimulating medication that will begin the following month.  We suppress the ovaries using oral contraceptives and a medication called Lupron.

The Stimulation Phase / Fertility Drugs

A woman typically makes one mature oocyte, or egg during each monthly menstrual cycle.  To optimize pregnancy rates during IVF it is important to have more than one mature oocyte (egg) available for fertilization.  We can stimulate the production of multiple eggs using injectable fertility medications which contain human follicle stimulating hormone (FSH), a natural hormone which induces the development of multiple eggs.  These medications are taken once or twice a day and are administrated for 10-12 days.

The Stimulation Phase / Monitoring

sonogramUse of these powerful fertility drugs requires careful monitoring with ultrasounds and blood tests to limit any potential side effects.  Ultrasound allows us to obtain an accurate picture of how many eggs are developing. Blood tests of estradiol also allow us to monitor the development of the eggs.  Once your follicles have reached their optimum size, a midcycle hormonal surge is essential to prepare the oocyte for fertilization, just like your own natural LH surge.  This is accomplished with the use of an intramuscular injection of hCG. Retrieval of the eggs occurs approximately 36 hours later.

The Egg Retrieval

3202926-patient-undergoing-egg-retrieval-procedureEgg (oocyte) retrieval is done in a dedicated procedure room within our fertility center.  A small needle is advanced under ultrasound guidance through the upper portion of the vagina into the follicles of the ovary.  There is no incision.  The fluid is aspirated and immediately taken to the laboratory, where the oocyte is identified.  The procedure is done under deep intravenous sedation to prevent any pain or discomfort during the procedure.

Insemination of the Eggs

17319238-intracytoplasmic-sperm-injection--sperm-injected-into-an-oocyte--detailed-illustrationShortly after retrieval, the prepared sperm is placed into a highly specialized culture solution with the oocyte.  If Intracytoplasmic Sperm Injection (ICSI) is being performed, then the injection of the sperm takes place at this time.  They are placed in a controlled environment and observed periodically over the next 18-20 hours to determine if fertilization has occurred.  The oocytes that have fertilized are nowconsidered embryos.  These embryos are transferred to a different culture media and are monitored closely over the next 2 to 6 days.  The exact nature of what is done will be highly dependent on the needs of the individual couple.  The healthy embryos are then transferred to the patient’s uterus or cryopreserved (frozen) for future use.


The embryos will be returned to the uterus 3 days (standard IVF) or 5 days (blastocyst transfer) later.  A small highly specialized plastic catheter will be passed through the cervix into the endometrial cavity.  No sedation is needed for this procedure. After 30 minutes of rest, you may resume most normal activities.

Post Embryo Transfer

For the next 10-12 days, progesterone supplementation will be given to help the developing embryos implant. The pregnancy test is done 14 days after the egg retrieval.