Soft-IVF® Protocol
Compared with conventional In Vitro Fertilization, Soft-IVF uses milder, shorter ovarian stimulation which, for some patients, can result in the development of higher quality eggs.
There is a significant reduction in the treatment cost and number of office visits: typically four to five visits per treatment.
The probability of a successful outcome for most patients is 25% to 33% per cycle of treatment. Soft-IVF can be an effective treatment for moderately severe male factor infertility and has also been used as a treatment option for "low responders".
Most patients will be able to continue their everyday lifestyles during their treatment. It is our goal to make your conception experience pleasant, relaxed, and as natural as possible.
Soft-IVF® Procedure
Soft-IVF treatment consists of:
- Ovarian stimulation to induce growth of multiple eggs within the ovaries.
- Ultrasound guided egg retrieval.
- Fertilization of the eggs.
- Transfer of the resulting embryo(s) into the uterus.
- Establishment of pregnancy.
This is an example of an Soft-IVF treatment sequence. Actual treatment is individualized and can take less or more time to complete:
- Ovarian Stimulation
Soft-IVF ovarian stimulation typically results in the development of several eggs within the ovaries. The treatment begins with the onset of a menstrual period.
Oral contraceptives are used initially to prime the ovaries for optimal response. You will have an ultrasound the day after your last oral contraceptive pill to rule out any ovarian cysts (very unlikely). Your menstrual period will start approximately three days after your last oral contraceptive pill. The start of this period is day one of your new menstrual cycle.In the morning of cycle day three, you will have a Lupron injection. The volume of the Lupron injection is very small, and it is given subcutaneously (just under the skin). Lupron starts the ovarian stimulation.
In the evening of the following day (stimulation day two), you will take an FSH injection. FSH stimulates maturation of multiple eggs in the ovaries. FSH injections, like Lupron, are given subcutaneously with tiny needles. FSH injections are administered every other day usually for a total of four to six doses.
In the evening of stimulation day six (the day of the third FSH injection), you will start taking Clomid tablets daily for a total of approximately four to six days. Clomid continues ovarian stimulation and reduces the likelihood of premature ovulation.
Two or more ultrasound examinations are performed to assess the number and size of the developing ovarian follicles (grape-like "blisters" containing eggs). Once the size of the follicles indicates that the eggs are ready, you will have a subcutaneous injection of Human Chorionic Gonadotropin hormone (HCG). This medication triggers the final stage of egg maturation. Thirty-five hours after the HCG injection, the eggs are aspirated from the ovaries.The ultrasound image below shows a stimulated ovary. Each of the grape-like follicles (dark circles) contains a microscopic egg.
- Egg Retrieval
Thirty-five hours after the HCG injection, the egg retrieval procedure is performed at our Center. This is normally a 5 to 10 minute procedure and we use conscious sedation for analgesia.
Using ultrasound guidance, the tip of a thin needle is passed through the top of the vagina into the cul-de-sac (a space behind the uterus). The ovaries are located near the bottom of the cul-de-sac allowing the tip of the aspirating needle to enter the ovarian follicles which contain the eggs and aspirate the follicular fluid from them. The fluid is examined under a microscope to identify the eggs.
Medications are used for pain relief. It is possible to have a short lasting menstrual-like cramp sensation when the tip of the needle passes through the top of the vagina (once for each ovary). The actual follicle aspiration is typically not felt by the patient. The egg retrieval is a very safe procedure. - Fertilization
On average, four to eight eggs are aspirated during the Soft-IVF egg retrieval procedure. The eggs are identified under the microscope and placed in petri dishes filled with culture medium. The composition of the medium resembles the fluid secreted by the Fallopian tubes. This allows the eggs and embryos (fertilized eggs) to develop in our laboratory environment at the same rate as inside the Fallopian tubes
The male partner collects a semen specimen by masturbation the day of the egg retrieval. The highest quality sperm are extracted from the semen and combined with the eggs six hours after the egg retrieval. The process of fertilization takes place over several hours during the night.
If the fertility history suggests a possibility of male infertility significant enough to keep the eggs from being fertilized this way, Intracytoplasmic Sperm Injection (ICSI) is performed. In ICSI, a single sperm is inserted into an egg. This can significantly increase the fertilization rate for selected patients.
Evidence of fertilization can be seen the next day, 14 to 16 hours after insemination. The fertilized eggs are transferred into a growth medium and continue to be cultured in our laboratory.
The next day, the eggs are examined for signs of fertilization. A normally fertilized egg (zygote) will show two pronuclei representing the genetic material from the egg and sperm (see images below).
The following day embryos reach 4 cells, the day after 8 cells and, by the fifth day after the egg retrieval, the embryos should reach the blastocyst stage.
Fertilized Egg
Four Cell Embryo
Eight Cell Embryo
Blastocyst
- Embryo Transfer
The embryo transfer is performed one to five days after the egg retrieval. The Gamete Embryologists assess the embryos prior to the embryo transfer to determine their likelihood of implantation.
For selected patients, an Assisted Hatching procedure performed just prior to the embryo transfer increases the likelihood of embryos hatching out of their egg shell, implanting, and resulting in a successful pregnancy.Just prior to the embryo transfer, the embryo(s) is/are "loaded" into the tip of a very thin embryo transfer catheter containing a very small volume of transfer medium. The catheter is then passed through the cervical canal to within 5 mm of the top of the uterine cavity and the embryo(s) is/are gently released. Typically the transfer only takes a few seconds to complete. No resting is required afterwards.
Most partners usually select one to four embryos for the transfer. Approximately one-third of IVF pregnancies are twins and there are very few triplet or higher order pregnancies.
There may be more embryos than the future parents wish to have transferred. It is possible to vitrify (freeze) these embryos and store them in liquid nitrogen. The majority of the embryos should survive the vitrification and thawing process. The implantation rate of the surviving embryos is similar to the "fresh" embryos.
- Establishment of Pregnancy
After the embryo transfer, the front and back walls of the uterus gently hold the embryos, keeping them within the uterus. There is no restriction of physical or sexual activity.
The lining of the uterus is made receptive for the embryos through the action of the hormones estrogen and progesterone produced by the ovaries. Ovarian progesterone production is supplemented with three Lupron injections identical to the Lupron injection you took at the beginning of your ovarian stimulation.
A blood pregnancy test is done approximately two weeks after the embryo transfer. If the pregnancy test is positive, an ultrasound examination is scheduled two weeks later to visualize the implantation site and to look for a heartbeat. Once a heartbeat is seen, there is a 90% to 95% probability that the pregnancy will continue to a baby.
The ultrasound picture on the left shows a six week pregnancy. The pregnancy sac is approximately 25 mm in diameter. The baby inside the sac is about 13 mm long, and yet it is possible to already distinguish the head and the "tail" portion of the baby's body as well as strong cardiac activity.
At this point, your pregnancy becomes indistinguishable from a conception through intercourse.
If you have any questions regarding Soft-IVF, please contact us by phone at 650-322-0500 or via email at care@BayIVF.com. To request an appointment, please go to the Request an Appointment page.
