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Our IVF clinic is conveniently located in Dallas Tx and we have extensive experience with all IVF procedures including ICSI, assisted hatching, blastocyst transfer, PGD, and other micromanipulation techniques.
Our Dallas, Texas Donor Egg Program is one of the largest and most successful in the Southeast. Superior success rates are important to controlling infertility treatment costs as often fewer cycles are required to achieve pregnancy.
IVF success rates are influenced by many factors including female age,the presence of male infertility , the causes(s) of infertility, genetics, previous treatments and more. While no one can predict a particular outcome, our physicians always discuss IVF success rates in detail with each couple.
IVF refers to the creation of embryos by placing
sperm and eggs in a test tube or culture dish in a laboratory
setting. In order to perform IVF, oocytes (eggs) must
be obtained by stimulating the ovaries with FSH
or hMG. Many eggs are required to produce enough quality embryos for transfer.
During an IVF cycle, once the eggs mature, they are retrieved in a procedure
termed transvaginal oocyte retrieval. Patients are instructed
to inject hCG approximately
36 hours prior to egg retrieval to mimic the natural cycle release
of LH.
This procedure is performed in an operating room
under light sedation using intravenous anesthesia. The oocyte
retrieval IVF procedure involves the passage of a needle  through the thin posterior
wall of the vagina into the ovarian follicles and aspirating the
oocytes.
Sperm is processed and used to fertilize the oocytes and create
embryos. These embryos are allowed to grow in the incubator for
an additional 3 to 5 days before
being transferred. If blastocyst transfer is attempted, the embryos
will incubate until they have differentiated into two distinct
cell types, usually 5-7 days.
Once the embryos mature, the IVF patient is scheduled
for embryo transfer. The transfer procedure uses a small tube
placed through the cervix using ultrasound guidance, which places
the embryos directly into the uterus with the hope that the embryos
will implant in the endometrium (lining of the uterus), and result
in a pregnancy .
Before undergoing an IVF treatment cycle patients
will consult with their fertility specialist (Dr. Chantilis, or
Dr. Lee) to discuss their treatment and prognosis. After an IVF treatment
plan has been decided, there will be some pretreatment testing
in order to optimize chances of pregnancy. Most women will need follicle stimulating hormone (FSH) and estradiol blood tests performed
on the third day of their cycles (days 2, 3, or 4 are acceptable).
These tests will be used to help determine the responsiveness
of the ovary to fertility medications and will be used to determine
the initial starting dosage of fertility medications.
Additionally, most IVF candidates should have a uterine evaluation (within 2 years from your procedure) such as a hysteroscopy, hysterosalpingogram
(HSG), or sonohysterography to ensure that the endometrial (uterine)
cavity is normal. Most abnormal uterine cavities will need to
be corrected before undergoing an IVF procedure. Many of these procedures are performed at our IVF clinic located in Dallas Texas.
The husband must have a semen analysis within
6 months from the intended IVF treatment cycle to rule out male infertility. Additionally, we
ask that all couples (both husband and wife) have an HIV test
within 1 year before undergoing an IVF treatment cycle.
All IVF patients will undergo ovulation induction
with gonadotropins (FSH).
These products are administered according to IVF
treatment protocols.
You should experience a menstrual period within 7
to 14 days from starting the Lupron injections. Please notify
the clinic when you start your period so that we may schedule
a baseline sonogram and blood estradiol test. The purpose of these
tests is to confirm that the Lupron has, in fact, suppressed your
ovaries to a baseline state.
This means that your ovaries should contain no follicles
that are greater than 15 mm in size, and your blood estradiol
level should be less than 50 pg/ml. In approximately 10-15% of
IVF patients, one or both of these two conditions are not met. Depending
upon the results of these tests, we may extend the Lupron medication
for another week and ask you to return for another sonogram and
blood estradiol test, or occasionally may perform an ovarian cyst
aspiration (performed in the office).
After ovarian suppression has been achieved with
Lupron or Ganirelix Acetate/Cetrotide, ovarian stimulation using gonadotropin
fertility medication may commence at a scheduled time referred
to as the IVF cycle start. On the cycle start day, you may be instructed
to reduce the initial dose, which will be continued throughout
the stimulation phase of your cycle until hCG is administered.
The individualized dosage of medication for each IVF patient will be based
upon age, weight, number of ovaries, cycle day 3 FSH and
estradiol levels, and response to previous stimulation cycles.
IVF patients will take this initial dose of medication for 2 days before
returning on the morning of gonadotropin Day 3 for an estradiol
blood test. Your dose may be changed based upon the level of estradiol.
IVF patients will take medication for 2 more days before
returning on medication Day 5 for an estradiol blood test. Sonograms are conducted starting on Day 7 of stimulation. In general,
IVF patients will return for follow-up sonograms and estradiol blood tests
usually every 1 to 3 days in order to monitor follicular growth.
In general, you will be asked to return more
frequently towards the end of your ovarian stimulation. Most people
require 8 to 12 days of ovarian stimulation, and most people require
4 to 6 sonograms and/or estradiol levels during this period of
time.
Different treatment protocols are employed for different patients. Remember
that every patient's treatment is individualized and may not match
a specific protocol. Some patients may require much higher doses of FSH, others might receive only pure FSH such as Gonal-F or Follistim whereas some my have Repronex incorporated into their protocol.
IVF patients
should have nothing to eat or drink in the eight (8) hours prior
to retrieval. The egg retrieval will be performed on the
6th floor of the Margot Perot building at the Presbyterian Hospital
campus of Dallas. The procedure is conducted under intravenous
sedation, administered by an anesthesiologist, so that patients will
be comfortable during the egg collection.
Most patients are candidates for vaginal ultrasound
retrieval. This oocyte retrieval involves the use of a vaginal
probe sonogram to guide a needle through the posterior wall of
the vagina into an ovary. The vagina is otherwise protected from
the needle because the needle is passed through the vagina using
a protective guide. The procedure usually last about 30 minutes.
Patients are allowed to go home after a 1 to 2 hour recovery.
After the IVF egg retrieval, procedures such is ICSI may be performed. In this procedure, the sperm is inserted directly into the egg. Other procedures, such as assisted hatching might also be performed.
We also have an active and very successful
donor egg program at our Dallas Texas location. An egg donor is used when the mother can no longer use her eggs for conception.
A semen analysis must be performed within 3 months
prior to the IVF cycle in the Presbyterian Hospital Andrology
Laboratory located on the first floor of the Margot Perot building.
A semen specimen will be required on the day of egg retrieval,
and should be collected in the ARTS center. Abstinence from intercourse
is required for 2 to 4 days prior to egg retrieval. We recommend
that ejaculation occurs the same evening when hCG is given to
assure better quality sperm for the IVF procedure.
If a significant male infertility is present, you may
be asked to prolong the period of abstinence before the day of
the oocyte retrieval. Specific instructions regarding this collection
will be reviewed at a later date. If you anticipate any collection
difficulties, please notify your doctor or one of the ARTS nurses.
As soon as possible after the egg retrieval,
you and your husband will be given the preliminary results on
the number of oocytes retrieved. Please realize that the quality,
number, and/or maturity of the eggs may not be evident because
the eggs are surrounded by follicle cells (called granulosa cells),
which sometimes prevent quick evaluation. Superovulation yields
various types of eggs, including mature, immature, post mature,
and nonviable eggs. Following the egg retrieval, you will be given
detailed instructions concerning the next steps of your treatment.
IVF patients participating in our donor egg program will consult with the donor egg coordinator. The mature eggs will be retrieved from the donor in the same manner as above after FSH stimulation. They will then be combined with the father's sperm.
Please leave a list of times and phone numbers with
the staff to assist us in meeting your needs promptly. Someone
will need to drive you home following this procedure. If you experience
pain, bleeding (more that a period), temperature > 101 degrees,
or other side effects following the procedure, please notify your
physician.
You will be contacted by our staff one day after
your egg retrieval and given the status report on the number of
oocytes that fertilize. At this time, fertilization is seen in
most cases, but embryo replacement can only be confirmed when
the fertilized egg divides normally, usually after another day.
As you know, one of the risks of IVF is lack of fertilization.
Sometimes a reason for this is understood, but many times no reasons
are evident. If this occurs, please consult your fertility specialist regarding
future plans.
A blastocyst is an embryo that has been cultured
from 5-6 days and differentiated into two distinct cell types.
This compares to embryos that are cultured by 3 days until the
6-8 cell stage. Blastocysts are "heartier" and more
likely to implant and produce an ongoing pregnancy. For this reason,
fewer blastocysts, sometimes one, can be transferred to the uterus in an IVF cycle.
This dramatically reduces the rate of high order multiple births.
Blastocyst transfer cannot be used in every couple and your physician
will discuss its appropriateness in your case.
If a couple's embryo is scheduled for PGD, it will be performed at our IVF clinic Texas location in Dallas. PGD is employed to screen embryos for specific genetic abnormalities and for identifying broken, translocated, or an abnormal number of chromosomes. After the PGD procedure, the screened embryos will be transferred to the uterus.
On the day of your embryo replacement, report to
the ARTS Center 30 minutes prior to your scheduled embryo replacement
time. Husbands are encouraged to be present. The procedure is
similar to having an intrauterine
insemination ( IUI ). You will rest on your back at the ARTS
Center for approximately one hour. We will leave you and your
husband alone during this time. You must have someone with you
to drive you home after embryo replacement.
If an IVF couple is scheduled for the PGD (preimplantation genetic diagnosis) procedure, a small biopsy will be taken from the embryos prior to transfer. This cellular material allows us to identify the sex of the embryo and to screen for certain specific genetic diseases.
On the day after your oocyte retrieval, you will
be instructed to start progesterone injections. Progesterone is
a hormone produced by the ovaries only during the post-ovulation,
or luteal phase, of your ovarian cycle. Progesterone develops
the endometrial lining of your uterus to support and maintain
pregnancy. Although your ovaries are producing progesterone, supplementation
is required because some of the cells, which produce progesterone
in the ovary, are removed during the egg retrieval, and some of
the medications you received may contribute to a progesterone
deficiency after the oocyte retrieval.
Please call your ART physician’s office at 214-363-5965 in Dallas between 8:30 a.m. and 3:30 p.m. on the first (or second) day of menstrual flow, and let us know that you are an IVF patient.
The IVF and infertility specialists at Dallas- Ft. Worth, Tx Fertility Associates have considerable experience conducting IVF cycles. Our superior IVF success rates are a reflection of our teams vast experience with assisted reproductive technologies. Infertility treatments can be expensive and we try to control IVF cost. We have a separate Web page which discusses infertility treatment cost and lists the insurance plans accepted.
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