1.Ovarian stimulation and egg development
During the first half of a normal cycle, follicles (the fluid-filled sacs that contain the eggs) develop and a single egg is released. There is no question that the chances of success with IVF increase if there is more than one oocyte available for use in the ART laboratory. A combination of medications and hormones is, therefore, routinely utilized during the early part of an IVF cycle. The goal is the synchronous development of multiple follicles and eggs.

The response to the medications is monitored through a combination of blood tests and pelvic ultrasounds. Once this monitoring indicates that the eggs have reached maturity, hCG is given. The egg retrieval is scheduled 36 hours after hCG administration.

2. Egg Retrieval
The eggs are removed from the ovaries with a needle that is inserted through the vagina. This procedure is performed using ultrasound guidance, which allows precise placement of the needle into each follicle. Intravenous sedation makes this a painless procedure - general anesthesia is not required. The contents of each follicle are collected into a test tube and immediately transferred into the ART laboratory where the eggs are identified, isolated, evaluated, and placed into an incubator in less than two minutes.

3. The ART Laboratory
The eggs, sperm, and embryos are handled under sterile conditions at all times. Once an egg is identified, it is placed into a special culture medium for two to six hours before it is inseminated. After the egg retrieval, the husband will be asked to obtain a sperm sample. The sperm are then isolated from the remainder of the ejaculate and added to the eggs to allow fertilization to occur. After 18 to 24 hours, the first signs of fertilization occur. The ART laboratory personnel will notify you at this time as to how many of the eggs were successfully fertilized. The embryos are incubated in the laboratory for an additional 48 hours (72 hours total). By this time, they will have developed between four and ten cells.

4. The Embryo Transfer
Embryo transfer is essentially a painless procedure performed in a small room adjacent to the ART laboratory. An appropriate number of embryos (see below) are loaded into a small catheter. This catheter is then introduced through the cervix and into the uterus, and the embryos are gently deposited in the uterus. You will stay in the Surgery Center for up to one hour. After you return home, we suggest very minimal activity for the first twenty-four to forty-eight hours. After that, you may resume normal activity.

5. After the Transfer
Progesterone, the hormone responsible for preparing the lining of the uterus to accept a pregnancy is often given for at least a couple of weeks following the transfer. Small additional doses of hCG may also be given - this stimulates the ovaries to produce additional progesterone.

The first pregnancy test can be done as soon as twelve days after the embryo transfer. This test is almost always repeated after two days. If the tests are positive, we will continue to provide your care, including ultrasounds, for the next couple of months and then refer you back to your obstetrician. If the tests are negative, we will arrange a post-cycle consultation at which time the events of the cycle will be analyzed and plans made for the future. If unsuccessful, an attempt may be repeated in two to three months.

Confidentiality
Your participation in this program will remain strictly confidential.

Expectations from the IVF Cycle
There are many ways to look at "success" rates, and current success rates for the BRM program are discussed in detail later. Suffice to say our pregnancy and delivery rates are among the best in the country. There are many reasons IVF procedures may be unsuccessful:
- the attempt may be cancelled prior to egg retrieval if an adequate ovarian response is not achieved,
- not all follicles contain an egg,
- not all eggs will fertilize,
- not all embryos will develop normally.

We try very hard to minimize any couple's risk of higher order multiple pregnancies while maximizing their chances of achieving a pregnancy. For most couples under age 38, we will transfer three embryos at most in any given procedure.