IVF from A to Z
Join Dr. Elie Hobeika as he explains the step-by-step process of IVF - from initial diagnosis to embryo transfer - and everything in-between. You’ll learn about treatment timelines, chances of success, how many eggs/embryos you need and why the experience of an IVF laboratory is a critical factor to consider.
Featuring:
Learn more about Elie Hobeika, MD, FACOG
Elie Hobeika, MD, FACOG
Dr. Elie L. Hobeika strives to deliver the highest level of compassionate, individualized, and evidence-based care to all of his patients. Dr. Hobeika is board certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility. He earned his medical degree at the Université Saint-Joseph in Beirut before going on to complete his residency in obstetrics and gynecology at the Hofstra Northwell School of Medicine at Staten Island University Hospital.Learn more about Elie Hobeika, MD, FACOG
Transcription:
Deborah Howell: You know, the in vitro fertility process is a big thing to try to put your arms around. So today, we're going to explain the step-by-step process of IVF from initial diagnosis to embryo transfer and everything in between. You'll learn about fertility treatment timelines, chances of success, how many eggs and/or embryos you need and why the experience of an IVF lab is a critical factor to consider.
Joining us today to discuss IVF from A to Z is Dr. Elie Hobeika, a board-certified reproductive endocrinology and infertility specialist at Fertility Centers of Illinois.
This is the Time To Talk Fertility Podcast. I'm your host, Deborah Howell. Dr. Hobeika, while many have heard of IVF, can you bring all of our listeners through a quick explanation of what IVF is?
Dr. Elie Hobeika: So IVF or in vitro fertilization is a process by which the egg and the sperm, the two cells involved in reproduction in humans, are collected outside of the body. The egg is then fertilized by the sperm and an embryo is created and grown in a laboratory. And the embryo is then transferred back into the uterus at a specified point in time, leading to pregnancy.
Deborah Howell: Now, I know that IVF is not a new treatment. So how long has IVF actually been around?
Dr. Elie Hobeika: The attempts to achieve pregnancy with IVF date back to the 1970s actually. The first pregnancy occurred in 1973, and unfortunately resulted in a biochemical pregnancy loss. But the first IVF baby is celebrating her 43rd birthday this July. She was conceived in 1977 and was born in England on the 25th of July in 1978.
Deborah Howell: That's wonderful. And since that time, do we know how many babies have been born via IVF?
Dr. Elie Hobeika: I believe the last estimate I've seen is that that number has exceeded 7 million babies globally.
Deborah Howell: Incredible. What diagnostic scenarios require IVF?
Dr. Elie Hobeika: Well, there are many clinical scenarios where IVF is the medically recommended treatment. In the heterosexual couples, to name a few, blocked tubes, low sperm counts, and the history of failed pregnancy with inseminations or some. And IVF can also be an option for family building in same-sex couple.
Deborah Howell: Excellent. Now let's go through the IVF process step-by-step. First, you need to stimulate the ovaries to produce eggs. Can you tell us more about that step?
Dr. Elie Hobeika: So at the level of the ovaries at the beginning of every month, there is a certain number of small follicles and the follicle is the packaging of every egg. And those follicles are called antral follicles. In IVF, we aim to grow the majority of those follicles together and synchronously in a safe way. This is executed by the use of daily injections and the patients are monitored during that time on average every two days with blood work and ultrasound to dose their medication accordingly. This phase of IVF is called controlled ovarian hyperstimulation. And it is important to mention here that this is the same phase that patients donating their eggs or freezing their eggs undergo in the process.
Deborah Howell: Okay. And then how do you determine when it's time for an egg retrieval and what does that process look like?
Dr. Elie Hobeika: So as discussed earlier, the goal is to collect multiple eggs. So the timing of the egg retrieval procedure is dependent on both hormone levels and follicle size and number. We aim to maximize the number of eggs and maintain patient safety by avoiding the risk of hyperstimulation. And this is when we do too well to the point that patients may get sick.
So when the time is right, the patients are instructed to take an additional injection called the trigger shot and they will be scheduled for the egg retrieval two days later. On that day, patients are given anesthesia and put to sleep. Then we perform a transvaginal ultrasound and we use a special probe that contains a needle guide. With a very long needle, we puncture the vagina and go straight into the ovary and we drain the growing follicles, hence aspirating the fluid and eggs.
The procedure lasts for 10 to 15 minutes. Mild to moderate soreness in the pelvic area and minimal spotting are expected as part of the recovery process.
Deborah Howell: Okay. And what is an ideal amount of eggs to get during a retrieval? And does that number change with a woman's age?
Dr. Elie Hobeika: This is a common question that I get when I'm doing retrievals. There is no doubt that the optimal number of eggs that we want to get is dependent on age of the patient and on her family building goals. But what I would recommend is to look at the number of eggs collected while taking into consideration the markers of ovarian reserve that the patient has.
Where are we able to grow the majority of antral follicles in that patient? Were we able to get mature eggs from the majority of those growing follicles? If the answer is yes to both, then we achieved our goal. If not, at that point, I would encourage patients to sit with their doctors and see how they can improve and make outcomes of their cycles more optimal. Some patients have the ability to produce a large number of eggs and can achieve their family size in one IVF cycle. Whilst for others, it may take more than one cycle to do that.
Deborah Howell: Sure. Now at this point, this is where the IVF lab takes over. Can you tell us a bit about what an IVF lab is and who works there?
Dr. Elie Hobeika: So several major steps occur at the lab after the egg retrieval. The eggs are incubated, then injected with sperm and the embryos that form are grown in culture. They are transferred back to the uterus either on the third or the fifth day of development or they can be stored and frozen with or without a biopsy.
Deborah Howell: So I know that the experience of an IVF lab is critical to success. Can you shed a little light on what can make an IVF lab stand out and what people should look for?
Dr. Elie Hobeika: Yeah. This is a very important point that you're bringing up. Patients sometimes focus on the doctor and less on the lab. But at the end of the day, no matter how good your doctor is, if you're eggs and embryos are poorly managed and manipulated, the outcome will not be optimal. We are proud at FCI to be involved in the first IVF baby in the Midwest back in 1984, and to have a state-of-the-art lab that participated in the birth of more than 35,000 children so far. When I was looking at the job, for instance, this is the first thing that I looked at, because this will enable me to make a difference for my patient.
Deborah Howell: Now, if the IVF lab has retrieved eggs, is that the point when they collect a sperm sample? And what should men know about this portion of the process?
Dr. Elie Hobeika: Correct. So sperm is typically collected on the same day and we always prefer to have a fresh specimen if possible. But if the partner's not available, we can have a recourse to a frozen sample. And we advise men to abstain for two days before they produce.
Deborah Howell: Once the eggs are fertilized, then how many usually continue to develop?
Dr. Elie Hobeika: Of the eggs that fertilize normally, we expect approximately half of them to make it to the blastocyst stage.
Deborah Howell: Okay. How are the embryos monitored and for how long?
Dr. Elie Hobeika: The embryos are placed in an incubator and monitored under the microscope. And typically, they are kept in culture for five or six days.
Deborah Howell: And then at what stage do you do genetic appointments and what's involved in those?
Dr. Elie Hobeika: So genetic testing is performed on embryos that get to the blastocyst stage. And sometimes it takes five to six days to get to that stage of development. So the biopsy occurs on those days. And that involves removing some cells from the periphery of the embryo, out of the cells that typically develop into the placenta.
Deborah Howell: And while these eggs are developing, does the female partner continue medication or have appointments?
Dr. Elie Hobeika: In the setting where a fresh transfer is planned, meaning a transfer in the same cycle, the female partner will start progesterone supplementation. And the goal of that treatment is to support the lining and make it receptive for the embryo to attach.
Deborah Howell: All right. Now, the big moment, when it's time to transfer an embryo to the uterus, how do you decide which embryo and how many to transfer?
Dr. Elie Hobeika: So, if embryos are genetically tested, it is typically recommended to transfer one embryo at a time, regardless of age. If embryos are not tested, the number is dependent on the age of the patient. We know that advanced age is associated with the higher number of embryos that have an abnormality in the number of chromosomes. So this is accounted for by increasing the number of embryos transferred. Embryos are graded based on their appearance. So we go by the best grades first.
Deborah Howell: What can people expect during this embryo transfer?
Dr. Elie Hobeika: An embryo transfer is typically like a joyful experience for the patient and the provider as well. A lot of efforts have been put to get to this point in the treatment phase. And on that day, the patient gets to see her embryo and to witness the process of the transfer of that embryo from the lab to the inside of her uterus. And the process is guided by a transabdominal ultrasound. And on that day, we typically ask patients to come in with a full bladder to assist us to clearly see where we are depositing the embryo.
Deborah Howell: And this is a little bit sensitive, but what do you do with the remaining embryos?
Dr. Elie Hobeika: Remaining embryos are frozen for future use. And this may be in one to two months if the patient did not conceive with the first transfer or it could be years later when the couple decide to conceive again.
Deborah Howell: And when you compare frozen and fresh embryos, are there differences in chances of success and what kinds of success rates should people expect in general?
Dr. Elie Hobeika: So in general, the chances are similar. However, during a fresh cycle, particularly in the young age group, there may be some hormonal factors that may make implantation less likely. That's another goal of monitoring patients closely. And in this setting, we would recommend that the patient freezes all the embryo and transfer at a later point in time and have a frozen transfer in order to optimize the chances. We typically look at chances of pregnancy that vary around 65% to 70% in embryos that are genetically.
Deborah Howell: I know personally that that two-week wait, feels like forever. What happens when that waiting period is finally over?
Dr. Elie Hobeika: When it's over, I guess it's the time to get the news whether good and bad. And, in both settings, I would encourage patients to reconvene with their provider and to look back and learn from the previous experience that they went through and make that next step for future treatments in case the pregnancy test was negative.
Deborah Howell: Got it. Is it common to continue medication and seeing your fertility doctor after a pregnancy is confirmed?
Dr. Elie Hobeika: Sometimes patients and couples get so invested in the process of getting pregnant to the point that once this is achieved, a new chapter starts and they may feel less prepared and will have a whole pile of different questions to ask, which is why we're always available to accompany patients along this happy path of their journey and we're available to answer any questions they may have when they get pregnant.
Deborah Howell: That's great. And at what point does a patient graduate to OB-GYN care?
Dr. Elie Hobeika: We graduate patients to their OB between eight and nine weeks of pregnancy.
Deborah Howell: Doctor, can you share some words of hope with our listeners?
Dr. Elie Hobeika: What I would like to share with couples is that sometimes our chances of pregnancy may not be the numbers that they want to hear. At best, so far in 2021, we are able to achieve a 65% to 70% chance of pregnancy. This is not close to being 95% or 100%. That means that we may end up in situations where their pregnancy tests initially may come back to being negative. But with staying confident and doing more cycles, they will eventually end up getting the outcome that they would like.
Deborah Howell: Well, Dr. Hobeika, we can't thank you enough for being with us today and for letting us learn all these new facts and secrets about the IVF process.
Dr. Elie Hobeika: Thank you for having me.
Deborah Howell: That was Dr. Elie Hobeika, a board-certified reproductive endocrinology and infertility specialist at Fertility Centers of Illinois. Find out more about the services FCI provides for patients by calling (877) 324-4483 or head over to fcionline.com to schedule a telemedicine appointment with one of our wonderful physicians. And if you enjoyed this podcast, you can find more like it in our podcast library. Be sure to give us a like and a follow if you do. This has been the Time To Talk Fertility podcast. I'm your host, Deborah Howell. Have yourself a terrific day.
Deborah Howell: You know, the in vitro fertility process is a big thing to try to put your arms around. So today, we're going to explain the step-by-step process of IVF from initial diagnosis to embryo transfer and everything in between. You'll learn about fertility treatment timelines, chances of success, how many eggs and/or embryos you need and why the experience of an IVF lab is a critical factor to consider.
Joining us today to discuss IVF from A to Z is Dr. Elie Hobeika, a board-certified reproductive endocrinology and infertility specialist at Fertility Centers of Illinois.
This is the Time To Talk Fertility Podcast. I'm your host, Deborah Howell. Dr. Hobeika, while many have heard of IVF, can you bring all of our listeners through a quick explanation of what IVF is?
Dr. Elie Hobeika: So IVF or in vitro fertilization is a process by which the egg and the sperm, the two cells involved in reproduction in humans, are collected outside of the body. The egg is then fertilized by the sperm and an embryo is created and grown in a laboratory. And the embryo is then transferred back into the uterus at a specified point in time, leading to pregnancy.
Deborah Howell: Now, I know that IVF is not a new treatment. So how long has IVF actually been around?
Dr. Elie Hobeika: The attempts to achieve pregnancy with IVF date back to the 1970s actually. The first pregnancy occurred in 1973, and unfortunately resulted in a biochemical pregnancy loss. But the first IVF baby is celebrating her 43rd birthday this July. She was conceived in 1977 and was born in England on the 25th of July in 1978.
Deborah Howell: That's wonderful. And since that time, do we know how many babies have been born via IVF?
Dr. Elie Hobeika: I believe the last estimate I've seen is that that number has exceeded 7 million babies globally.
Deborah Howell: Incredible. What diagnostic scenarios require IVF?
Dr. Elie Hobeika: Well, there are many clinical scenarios where IVF is the medically recommended treatment. In the heterosexual couples, to name a few, blocked tubes, low sperm counts, and the history of failed pregnancy with inseminations or some. And IVF can also be an option for family building in same-sex couple.
Deborah Howell: Excellent. Now let's go through the IVF process step-by-step. First, you need to stimulate the ovaries to produce eggs. Can you tell us more about that step?
Dr. Elie Hobeika: So at the level of the ovaries at the beginning of every month, there is a certain number of small follicles and the follicle is the packaging of every egg. And those follicles are called antral follicles. In IVF, we aim to grow the majority of those follicles together and synchronously in a safe way. This is executed by the use of daily injections and the patients are monitored during that time on average every two days with blood work and ultrasound to dose their medication accordingly. This phase of IVF is called controlled ovarian hyperstimulation. And it is important to mention here that this is the same phase that patients donating their eggs or freezing their eggs undergo in the process.
Deborah Howell: Okay. And then how do you determine when it's time for an egg retrieval and what does that process look like?
Dr. Elie Hobeika: So as discussed earlier, the goal is to collect multiple eggs. So the timing of the egg retrieval procedure is dependent on both hormone levels and follicle size and number. We aim to maximize the number of eggs and maintain patient safety by avoiding the risk of hyperstimulation. And this is when we do too well to the point that patients may get sick.
So when the time is right, the patients are instructed to take an additional injection called the trigger shot and they will be scheduled for the egg retrieval two days later. On that day, patients are given anesthesia and put to sleep. Then we perform a transvaginal ultrasound and we use a special probe that contains a needle guide. With a very long needle, we puncture the vagina and go straight into the ovary and we drain the growing follicles, hence aspirating the fluid and eggs.
The procedure lasts for 10 to 15 minutes. Mild to moderate soreness in the pelvic area and minimal spotting are expected as part of the recovery process.
Deborah Howell: Okay. And what is an ideal amount of eggs to get during a retrieval? And does that number change with a woman's age?
Dr. Elie Hobeika: This is a common question that I get when I'm doing retrievals. There is no doubt that the optimal number of eggs that we want to get is dependent on age of the patient and on her family building goals. But what I would recommend is to look at the number of eggs collected while taking into consideration the markers of ovarian reserve that the patient has.
Where are we able to grow the majority of antral follicles in that patient? Were we able to get mature eggs from the majority of those growing follicles? If the answer is yes to both, then we achieved our goal. If not, at that point, I would encourage patients to sit with their doctors and see how they can improve and make outcomes of their cycles more optimal. Some patients have the ability to produce a large number of eggs and can achieve their family size in one IVF cycle. Whilst for others, it may take more than one cycle to do that.
Deborah Howell: Sure. Now at this point, this is where the IVF lab takes over. Can you tell us a bit about what an IVF lab is and who works there?
Dr. Elie Hobeika: So several major steps occur at the lab after the egg retrieval. The eggs are incubated, then injected with sperm and the embryos that form are grown in culture. They are transferred back to the uterus either on the third or the fifth day of development or they can be stored and frozen with or without a biopsy.
Deborah Howell: So I know that the experience of an IVF lab is critical to success. Can you shed a little light on what can make an IVF lab stand out and what people should look for?
Dr. Elie Hobeika: Yeah. This is a very important point that you're bringing up. Patients sometimes focus on the doctor and less on the lab. But at the end of the day, no matter how good your doctor is, if you're eggs and embryos are poorly managed and manipulated, the outcome will not be optimal. We are proud at FCI to be involved in the first IVF baby in the Midwest back in 1984, and to have a state-of-the-art lab that participated in the birth of more than 35,000 children so far. When I was looking at the job, for instance, this is the first thing that I looked at, because this will enable me to make a difference for my patient.
Deborah Howell: Now, if the IVF lab has retrieved eggs, is that the point when they collect a sperm sample? And what should men know about this portion of the process?
Dr. Elie Hobeika: Correct. So sperm is typically collected on the same day and we always prefer to have a fresh specimen if possible. But if the partner's not available, we can have a recourse to a frozen sample. And we advise men to abstain for two days before they produce.
Deborah Howell: Once the eggs are fertilized, then how many usually continue to develop?
Dr. Elie Hobeika: Of the eggs that fertilize normally, we expect approximately half of them to make it to the blastocyst stage.
Deborah Howell: Okay. How are the embryos monitored and for how long?
Dr. Elie Hobeika: The embryos are placed in an incubator and monitored under the microscope. And typically, they are kept in culture for five or six days.
Deborah Howell: And then at what stage do you do genetic appointments and what's involved in those?
Dr. Elie Hobeika: So genetic testing is performed on embryos that get to the blastocyst stage. And sometimes it takes five to six days to get to that stage of development. So the biopsy occurs on those days. And that involves removing some cells from the periphery of the embryo, out of the cells that typically develop into the placenta.
Deborah Howell: And while these eggs are developing, does the female partner continue medication or have appointments?
Dr. Elie Hobeika: In the setting where a fresh transfer is planned, meaning a transfer in the same cycle, the female partner will start progesterone supplementation. And the goal of that treatment is to support the lining and make it receptive for the embryo to attach.
Deborah Howell: All right. Now, the big moment, when it's time to transfer an embryo to the uterus, how do you decide which embryo and how many to transfer?
Dr. Elie Hobeika: So, if embryos are genetically tested, it is typically recommended to transfer one embryo at a time, regardless of age. If embryos are not tested, the number is dependent on the age of the patient. We know that advanced age is associated with the higher number of embryos that have an abnormality in the number of chromosomes. So this is accounted for by increasing the number of embryos transferred. Embryos are graded based on their appearance. So we go by the best grades first.
Deborah Howell: What can people expect during this embryo transfer?
Dr. Elie Hobeika: An embryo transfer is typically like a joyful experience for the patient and the provider as well. A lot of efforts have been put to get to this point in the treatment phase. And on that day, the patient gets to see her embryo and to witness the process of the transfer of that embryo from the lab to the inside of her uterus. And the process is guided by a transabdominal ultrasound. And on that day, we typically ask patients to come in with a full bladder to assist us to clearly see where we are depositing the embryo.
Deborah Howell: And this is a little bit sensitive, but what do you do with the remaining embryos?
Dr. Elie Hobeika: Remaining embryos are frozen for future use. And this may be in one to two months if the patient did not conceive with the first transfer or it could be years later when the couple decide to conceive again.
Deborah Howell: And when you compare frozen and fresh embryos, are there differences in chances of success and what kinds of success rates should people expect in general?
Dr. Elie Hobeika: So in general, the chances are similar. However, during a fresh cycle, particularly in the young age group, there may be some hormonal factors that may make implantation less likely. That's another goal of monitoring patients closely. And in this setting, we would recommend that the patient freezes all the embryo and transfer at a later point in time and have a frozen transfer in order to optimize the chances. We typically look at chances of pregnancy that vary around 65% to 70% in embryos that are genetically.
Deborah Howell: I know personally that that two-week wait, feels like forever. What happens when that waiting period is finally over?
Dr. Elie Hobeika: When it's over, I guess it's the time to get the news whether good and bad. And, in both settings, I would encourage patients to reconvene with their provider and to look back and learn from the previous experience that they went through and make that next step for future treatments in case the pregnancy test was negative.
Deborah Howell: Got it. Is it common to continue medication and seeing your fertility doctor after a pregnancy is confirmed?
Dr. Elie Hobeika: Sometimes patients and couples get so invested in the process of getting pregnant to the point that once this is achieved, a new chapter starts and they may feel less prepared and will have a whole pile of different questions to ask, which is why we're always available to accompany patients along this happy path of their journey and we're available to answer any questions they may have when they get pregnant.
Deborah Howell: That's great. And at what point does a patient graduate to OB-GYN care?
Dr. Elie Hobeika: We graduate patients to their OB between eight and nine weeks of pregnancy.
Deborah Howell: Doctor, can you share some words of hope with our listeners?
Dr. Elie Hobeika: What I would like to share with couples is that sometimes our chances of pregnancy may not be the numbers that they want to hear. At best, so far in 2021, we are able to achieve a 65% to 70% chance of pregnancy. This is not close to being 95% or 100%. That means that we may end up in situations where their pregnancy tests initially may come back to being negative. But with staying confident and doing more cycles, they will eventually end up getting the outcome that they would like.
Deborah Howell: Well, Dr. Hobeika, we can't thank you enough for being with us today and for letting us learn all these new facts and secrets about the IVF process.
Dr. Elie Hobeika: Thank you for having me.
Deborah Howell: That was Dr. Elie Hobeika, a board-certified reproductive endocrinology and infertility specialist at Fertility Centers of Illinois. Find out more about the services FCI provides for patients by calling (877) 324-4483 or head over to fcionline.com to schedule a telemedicine appointment with one of our wonderful physicians. And if you enjoyed this podcast, you can find more like it in our podcast library. Be sure to give us a like and a follow if you do. This has been the Time To Talk Fertility podcast. I'm your host, Deborah Howell. Have yourself a terrific day.