During the initial phase of the IVF process many drugs are used. Initially, drugs are used to stimulate the ovaries in hopes of producing many follicles and then to assist the release of mature eggs from the ovary. Every cycle of IVF is unique and your particular combination of drugs is dependant on many factors including, but not limited to age and diagnosis. Fertility drug combinations can vary from cycle to cycle and from patient to patient. Typically your physician or nurse will go over in great detail your personal plan of action in order to induce proper ovarian stimulation. You can expect about 2-4 weeks of drugs during this initial phase of your IVF cycle. It is very common to use injectable hormones during the stimulation of your cycle

Some of the types are:

• Follicle Stimulating Hormone (FSH), such as Follistim, Fertinex, Bravelle, and Gonal-F
• Human Chorionic Gonadotropin (hCG), such as Pregnyl, Novarel, Ovidrel, and Profasi. This drug is usually used along with other fertility drugs to trigger the ovaries to release the mature egg or eggs.
• Human Menopausal Gonadotropin (hMG), such as Pergonal, Repronex, and Metrodin. This drug combines both FSH and LH.
• Gonadotropin Releasing Hormone Agonist (GnRH agonist), such as Lupron, Zoladex, and Synarel
• Gonadotropin Releasing Hormone Antagonist (GnRH antagonist), such as Antagon and Cetrotide

The egg retrieval procedure is performed about 36 hours after human chorionic gonadotropin (HCG) is given to mature the eggs. You will receive light anesthesia, either from an anesthesiologist or a nurse anesthetist. Your eggs will be removed by ultrasound-guided retrieval. Your physician will aspirate the follicles one by one. The eggs and fluid are then placed into a tube that is then given to the embryologist. You will not have any memory of the procedure or will not be in any pain during the egg retrieval.

The egg retrieval procedure takes about 40 minutes and risks are minimal. Slight cramping may occur after the procedure, but usually subsides within a day or so. Recovery time, at the facility, is typically one hour and then bed rest at home for the remainder of the day. Many women are able to return to work the very next day.

The embryologist will look for eggs in the fluid that was aspirated from the follicles, keep in mind that all follicles may not include a mature egg. The eggs are evaluated for maturity and then placed in an incubator. The male partner usually gives a fresh semen sample during the partner�s egg retrieval process. Many male patients will have a frozen stored prior to egg retrieval day, as a sample may not be available on the day of the retrieval. A semen analysis is completed and the sample is washed with a special solution of nutrients to isolate the motile sperm. Fertilization takes place in the embryology lab. Dependant on your diagnosis and your fertility clinics practices two different types of fertilization may take place. In the standard type of IVF, the sperm is placed into the dish containing the egg and the sperm will naturally penetrate the egg and fertilize it on their own. If your physician suspects that there may be a problem with fertilization (possibly due to a male factor) or for other reasons, intracytoplasmic sperm injection (ICSI) may be used. A single sperm is injected with a needle into the egg.

After approximately 20 hours, the embryologist will check for proper fertilization. In 24 to 72 hours, the embryologist can determine if the embryo is growing properly. Not all eggs will fertilize and growth and cell division can cease at any point.

The sperm and eggs (oocytes) are placed in growth media containing special nutrients that permit them to live outside of their natural environment. The embryo will now develop and divide in the embryology lab for 2-5 days in the special culture media. If embryos make it to 5 days, they become blastocysts. Embryologists are able to get more information from a blastocyst rather than a 2-3 day old embryo. Not all embryos will make it to this stage. It is important to discuss your clinics policies with embryo transfers.

The embryo transfer typically takes place two to five days after fertilization. Different factors will determine the specific day that your embryo transfer will take place. (It may be anywhere from a 2-5 day transfer.) Factors may include the number and quality of the embryos and the fertility clinics policy. It is up to the patient and the physician on how many embryos to transfer back into the uterus. (Age, embryo quality, and clinic policies may affect the number of embryos transferred.) Sometimes more than one embryo will be transferred in hopes of increasing the chances of pregnancy. Most clinics will transfer one to two good quality embryos to decrease the danger of high order multiple pregnancies.

During the embryo transfer the women will be awake. The physician and embryologist will work as a team in transferring the embryos from the incubator back into the women's uterus. The transfer is essentially painless and will only take about 20 minutes or so. Some women are asked to have a full bladder in order to assist the viewing capability during the transfer. This may cause mild discomfort for the patient, but can be subsided shortly after the transfer is complete. Most fertility clinics will have the patient rest for an hour after the procedure. Bed rest is advised for the remainder of the day. Some clinics ask that you remain on bed rest and/or light activity for the following 2 or 3 days.

Typically a blood test will be performed in two weeks to check for pregnancy.