A response to ovarian stimulation depends on a number of different factors, the most important include available eggs, appropriate hormone levels, proper administration of any medications and lifestyle/environmental factors.
In order to respond to ovarian stimulation, a woman must have eggs available to respond; this is sometimes referred to as ovarian reserve. If a woman has diminished ovarian reserve (identified by high blood levels of follicle stimulation hormone (FSH), low blood levels of Anti Müllerian Hormone (AMH) or a low antral follicle count on ultrasound), she may not have as robust (or any) response to stimulation. For these patients, an alternate stimulation protocol may be tried or donated eggs may be used (from a woman known or unknown to the patient).
It is possible that a woman does have the necessary eggs but lacks the appropriate pituitary hormones to respond. In this case, using a different medication- one which may contain both FSH and luteinizing hormone (LH) may allow for an optimal response.
Lifestyle factors can also affect a woman’s response to stimulation. Optimizing weight, diet and stress and cessation of use of tobacco, alcohol and recreational substances can also improve a response to ovarian stimulation.

Photo ID: For your safety, IVF Phoenix™ requires that all patients provide photo identification prior to undergoing any surgical procedure within our facilities.

Responsible Adult: It is our responsibility to insure that you get home safely after your procedure, post- anesthesia. Therefore, you must have a responsible adult, over the age of 18, with whom you have a relationship, accompany you to this surgical appointment. They must stay at the center during your procedure, and be available to take you home after you are discharged. If both you and your partner are having procedures on the same day, we require a 3rd party be available to drive the couple home. We prefer that this person also be available to make sure that you are doing well once you get settled in your home.

No Children: Children are not allowed in the practice on the day of your procedure. Please arrange for childcare prior to arrival. Unfortunately, children cannot be brought with you to your surgical procedure at any time or under any circumstances.

Preparing for My Surgical Procedure with Anesthesia

Diet: Conscious sedations is used in our surgical procedures. If you have never been sedated before, there are important things to remember. For your safety, one important rule is to ensure that you do not eat or drink anything after midnight the night before your procedure. If you have a specific medical condition or special situation, please discuss with your nurse before this time frame.

Appropriate Clothing: Patients should follow these guidelines:

• Wear comfortable clothes
• No jewelry
• No perfume
• Refrain from makeup
• No contact lenses

Semen Collection

For most patients arriving to the practice for their egg retrieval, a semen sample will be required by the Embryology Team in order to fertilize the egg(s) after your procedure. Male partners are encouraged to collect their sample at home prior to arriving for the retrieval. Once you arrive, please inform the Reception Desk staff that you have your sample so they can notify the Embryology Team. If you are traveling more than one and a half hours to the practice, you may collect a sample in our offices after you arrive. The period of abstinence from ejaculation is 3 days and no more than 4 days, as sperm DNA fragmentation increases with longer abstinence.

Arrival and Departure for Surgical Procedures

Patients should arrive 90 minutes before your scheduled procedure, or as instructed by your nurse. After checking in at the Reception Desk, the clinical team will bring you and your partner back to the procedure area. Your nurse will check your photo ID, review your recent food and beverage consumption and have you change into a surgical gown. Next, you will meet your Nurse Anesthetist, who will start an IV (intravenous) in your arm for medication administration. The office will review your medical history before beginning your sedation medication. During your procedure, your partner or accompanying adult will wait in the Reception Area. Most of the procedures are completed within 30 minutes. Most of our patients take about 30-60 minutes to recover before they return home. We find that our patients recover best when they are in a familiar, comfortable place usually in their home. From start to finish, patients should expect to be at the practice for 2½ to 3 hours.

IVF Phoenix™ requires out of town egg donors or recipients to visit our clinic initially, then if coordinated efficiently and if there is good offsite monitoring, we can expect the patient, to be seen by us at the end of the stimulation cycle, or at the peak of estrogen administration for endometrial development.  Unlike many other clinics, mock cycles are not necessarily required. Depending on your circumstances, you will most likely need to be here for five to nine days. This is something your donor egg/ART coordinator will help determine.

One option that some couples choose is to have the male partner visit IVF Phoenix™ for sperm collection prior to the couple’s visit for the woman’s cycle. This option requires the man to travel to IVF Phoenix™ one time, and the couple to travel to IVF Phoenix™ one time.

Yes, but you should refrain from high-impact exercise and opt for workouts such as walking, swimming, yoga, or cycling during IVF treatment. Leading up to the beginning of the IVF cycle you may exercise as you normally do, but as you get closer to the egg retrieval we will ask that exercise be modified for health and safety reasons.

We won’t know the exact date of egg retrieval until two days prior to the procedure. We typically estimate it about 12-15 days from the start of your  superovulation medications.

The cost of IVF depends on the treatment and options selected. A member of the IVF Phoenix™ team would be pleased to sit with you to review the costs.

Basically there are two choices, surgery to attempt to repair the tubes or IVF. There are pros and cons to each choice and the best choice depends on your personal situation. Surgery offers the option of attempting pregnancy naturally indefinitely without repeated treatments, but carries the rare risks of surgery and in some cases is not successful depending on the type of tubal ligation or tubal damage done initially. IVF offers the chance for pregnancy without having to undergo an operation and maintaining contraception or birth control against future pregnancies after completion of your family.

From the point of your initial consultation with IVF Phoenix™, you may potentially start an IVF cycle within weeks. Dr Couvaras will determine the appropriate time frame for your fertility treatment but each individual patient or couple decides when it is right for them to begin. The initial consult and diagnostic evaluation usually takes a week up to a couple of months (depending on your menstrual cycle, logistical and financial details such as your travel schedule, availability, insurance requirements, etc.)

After reviewing all diagnostic testing results with Dr Couvaras, the next step is to focus on logistical details such as reviewing the calendar, obtaining IVF medications and learning how to mix and administer them. There are consent forms to be signed, financial details to finalize and possibly some other small details that your primary nurse coordinator will assist you with so you are comfortable before officially starting. This may be done within a couple of weeks or months, again depending on your schedule, insurance, and availability.

Once the IVF cycle starts, it typically takes about 10 – 12 days on average until it is the appropriate time to schedule the egg retrieval. During this time you will be taking injectable fertility medications and will need to return to IVF Phoenix™ for several visits during that time to evaluate the response to the stimulation medication with blood work and trans-vaginal ultrasound. Once you reach the time of the egg retrieval, this is but another hurdle to cross, and we need to make and find a euploid embryo (s). Once we get to the frozen embryo transfer, you’ve almost reached the finish line and the pregnancy test will occur 11 days after the thawed blastocyst transfer, (day5), to determine the outcome of the IVF treatment cycle. At IVF Phoenix, we have been seeking protocols to improve the outcomes for frozen embryo transfers, and recently, in a small cohort of patients, have been seeing 18 out of 23 FET continuing with ongoing pregnancies. This may be a fluke or the law of small numbers, but the improvement from 50% to 76% is startling and impressive. Unfortunately, we can not be sure what recent changes may be responsible for the dramatic improvement. Thus, we counsel our patients to follow all of the parts of the new protocol until we are able to discern what may be leading to the high outcomes.

From the point of your initial consultation with IVF Phoenix™, you may potentially start an IVF cycle within weeks. Dr Couvaras will determine the appropriate time frame for your fertility treatment but each individual patient or couple decides when it is right for them to begin. The initial consult and diagnostic evaluation usually takes a week up to a couple of months (depending on your menstrual cycle, logistical and financial details such as your travel schedule, availability, insurance requirements, etc.)

After reviewing all diagnostic testing results with Dr Couvaras, the next step is to focus on logistical details such as reviewing the calendar, obtaining IVF medications and learning how to mix and administer them. There are consent forms to be signed, financial details to finalize and possibly some other small details that your primary nurse coordinator will assist you with so you are comfortable before officially starting. This may be done within a couple of weeks or months, again depending on your schedule, insurance, and availability.

Once the IVF cycle starts, it typically takes about 10 – 12 days on average until it is the appropriate time to schedule the egg retrieval. During this time you will be taking injectable fertility medications and will need to return to IVF Phoenix™ for several visits during that time to evaluate the response to the stimulation medication with blood work and trans-vaginal ultrasound. Once you reach the time of the egg retrieval, this is but another hurdle to cross, and we need to make and find a euploid embryo (s). Once we get to the frozen embryo transfer, you’ve almost reached the finish line and the pregnancy test will occur 11 days after the thawed blastocyst transfer, (day5), to determine the outcome of the IVF treatment cycle. At IVF Phoenix, we have been seeking protocols to improve the outcomes for frozen embryo transfers, and recently, in a small cohort of patients, have been seeing 18 out of 23 FET continuing with ongoing pregnancies. This may be a fluke or the law of small numbers, but the improvement from 50% to 76% is startling and impressive. Unfortunately, we can not be sure what recent changes may be responsible for the dramatic improvement. Thus, we counsel our patients to follow all of the parts of the new protocol until we are able to discern what may be leading to the high outcomes.

Acupuncture is the insertion of thin metallic needles into anatomically defined locations on the body to affect bodily function. Acupuncture needles are regulated by the FDA just like other medical devices such as surgical scalpels and hypodermic needles. This helps ensure that the needles meet standards for quality and sterility. In Illinois, practicing acupuncturists must show proof of adequate training by an approved acupuncture program and be licensed.

The general theory of acupuncture is based on the premise that there are patterns of energy flow (Qi) through the body, which are essential for health. Disruption of this flow is believed to be responsible for the disease. Acupuncture can correct imbalances of flow at identifiable points close to the skin. These acupuncture points correspond to specific areas on the surface of the body. Attempts to study these areas have found that they do have unique identifiable properties such as temperature and electrical conductance.

Some studies have shown that acupuncture has an effect on brain chemicals called endorphins. Endorphins, in turn, can affect the levels of the pituitary hormones which control the function of the ovaries. It is possible, therefore, that acupuncture may be used to influence ovulation and fertility.
Several studies have shown that acupuncture apparently affected the levels of these hormones in the blood as well as the levels of estrogen and progesterone from the ovaries.

A small series of women who had problems with ovulation found that that about half of them responded to acupuncture treatment.

A larger group of patients was studied by a German group. These women had various types of ovulation problems. They were divided into two groups. One group received medical fertility treatments and the other group had acupuncture. Although the investigators concluded that the acupuncture group had better results, the actual data is not that clear. For example, seven pregnancies in the acupuncture group were actually achieved with hormone treatment 6 months after acupuncture was stopped. Another study used electro-acupuncture in PCOS patients in an attempt to induce ovulation. Before treatment, about 15% of menstrual cycles were associated with ovulation. After treatment, about 66% of the cycles were ovulatory.

The objective of infertility treatment should be the birth of a single, healthy child. Many of the treatment options presented to infertile couples, however, are associated with high risks of multiple gestations. Moreover, many couples view multiple gestations (twins) as desirable and are unaware of the risks they pose to both mother and babies. Couples should understand these potential risks before starting treatment.
The ability to limit the number of embryos or eggs transferred is an effective approach to limit multiple pregnancies. The Society for Assisted Reproductive Technology (SART) and the American Society for Reproductive Medicine (ASRM) have published guidelines recommending an optimal number of embryos for transfer based on patient age, embryo quality, and other criteria.

In the United States, the decision regarding the number of embryos to transfer is made jointly by the physician and the patients. This decision should be based upon the best interests of the patient and the future offspring. However, ART is centrally regulated in England, and no more than three embryos on Day 3, or two on Day 5, may be transferred in most circumstances.

The ultimate goal is to achieve a high pregnancy rate while transferring a single embryo. Recent laboratory improvements have allowed programs to transfer two embryos while maintaining acceptable pregnancy rates. Eventually, the transfer of one embryo will resolve the issues surrounding multiple pregnancies.

At IVF Phoenix™, we see more than the average number of patients with difficult infertility problems, such as advanced maternal age or low AMH (<1.0). Some clinics are not willing to offer ART to those who have a low probability of success and encourage them to use donor eggs, a practice that results in higher success rates among older women. At IVF Phoenix, we have been focusing on low AMH patients and are seeing a 30% on-going pregnancy rate in low AMH patients, (<0.5) under age 40. Unfortunately, this does not apply to a woman 40 and older with low AMH.

In vivo hatching of the blastocyst is a critical component of the physiologic events culminating in implantation. Conversely, the failure to hatch may be one of the many factors limiting human reproductive efficiency. The clinical application of assisted hatching has been proposed as one approach toward the enhancement of implantation and pregnancy rates following in vitro fertilization.  The assisted hatching procedure entails the creation of a gap in the outer area of the embryo called the zona. In the past, this was done either by drilling with an acid medium or by using a piezomicromanipulator, but currently we and most other centers are using laser vaporization of a portion of the egg shell.  Success rates following the use of assisted hatching in different ART programs have varied considerably. Well-designed studies suggest that assisted hatching might best be used in patients > 38 years old or with multiple prior failed IVF cycles.  Please note that assisted hatching with laser is the safest way to promote hatching, and this is needed if the lab is planning on doing embryo biopsy at Day 5-7.

A principal limitation to human reproduction is the natural loss of healthy eggs as a woman ages. At birth, a woman is born with her total reserve of eggs. Over her lifetime, waves of them degenerate through a natural process called atresia so that by her mid thirties, we begin to see a greater difficulty to achieve a pregnancy and a higher chance of chromosomally affected children. By her early forties, the majority of women experience infertility and eventually a loss of reproductive capacity. This is due to the eventual loss of her remaining healthy eggs. Egg donation, like sperm donation, is a means to realize parenthood when the loss of gametes (i.e., egg or sperm) occurs. This may be due to the natural process of aging or may occur prematurely from other disease states or because of medical treatments for cancer, for example. When gametes are depleted, replacement by egg donation is an exceptional option to enable one to become a parent. There are many young women who want to help others overcome infertility. They serve as egg donors by expressing interest and then going through a rigorous screening process to ensure they are appropriate candidates. Typically, they provide a detailed health history of themselves and genetic history of their ancestors. Medical and psychological evaluations are performed, in addition to FDA mandated infectious disease testing. Once a patient has chosen to pursue egg donation, the process typically involves coordination of their two menstrual cycles so that the eggs may be retrieved, fertilization by the sperm of the patient’s partner and transfer into the patient’s womb can occur during the same month, or at a later time with frozen embryo transfer. The egg donor treatment cycles rate among the highest success in assisted reproduction.

The purpose of ICSI is to assist the fertilization process when a man’s sperm count is abnormal. Whether it is because the number of motile sperm is very low or the morphology is excessively poor, the technique involves the delivery of a single sperm into a single egg. Since 1991, when it was first described, it has revolutionized the treatment of male infertility. Most clinics started out recommending ICSI if there is a fear that poor fertilization may occur by traditional IVF where sperm are merely added to the egg culture dish.   Currently with most IVF, ICSI is utilized to obtain the highest likelihood of fertilization, and to reduce the risk of polyspermia, (more than one sperm fertilizing the egg).  Accordingly, efforts are made to assess sperm by function or morphology to help determine those most likely to require ICSI, and at IVF Phoenix, we use a more physiological approach to selecting sperm for ICSI called PICSI. This involves having sperm bind to hyaluronic acid, then selecting those sperm for ICSI.  The egg shell is made of hyaluronic acid, and it is show that sperm which bind to HA, have higher intact DNA and less DNA fragmentation.   It is best to discuss this option with Dr Couvaras and our Embryologist prior to treatment.

The first and second parties involved in a pregnancy are the male and female couple wishing to become parents. The three principal components required to achieve a successful pregnancy are a healthy egg, sperm and uterus. If any of these components are absent, then an option is to have a third party, or someone besides the couple, become involved. Third-party reproduction is when a couple uses a sperm donor, egg donor or a gestational carrier to help them become parents.

Each third party becomes involved in very distinct and completely different ways. A sperm donor’s involvement, for example, may simply be to produce a semen sample at a sperm bank, while a gestational carrier is committed for at least the nine months of pregnancy. Each has its own intricacies, processes, regulations and procedures that a certified IVF center can help a patient navigate through. It often involves a multi-team approach including the reproductive endocrinologist, the IVF team, an experienced attorney, a psychologist, third-party agencies, etc.

Preimplantation genetic screening (PGS) is a technique in which one or more cells are taken from an egg or embryo (fertilized egg) for testing to provide information about the genetic make-up of the rest of the cells in that embryo. In order to utilize PGS, couples must undergo in vitro fertilization (IVF), where the eggs (oocytes) are removed from a woman’s body and mixed with her partner’s sperm in a laboratory. The embryos which are created can be tested on Day #5-7 after egg harvest. At IVF Phoenix, these embryos will be frozen after the cells are removed for testing and implanted in a subsequent frozen embryo transfer cycle attempts.

Patients with many inherited familial diseases can have their embryos tested with preimplantation genetic diagnosis (PGD) to determine if a specific gene is present or absent. Specifically, this would include patients with a history of single-gene disorders (such as cystic fibrosis or sickle cell anemia) and patients with a history of sex-linked disorders (such as Duchenne muscular dystrophy and Fragile X syndrome). In addition, even families in search of a bone marrow donor may be able to use PGD to bring a child into the world that can provide matching stem cells for an affected sibling.

Other patients may also decide to use genetic screening called PGS. For some patients with recurrent pregnancy loss, severe male factor infertility, advanced reproductive age or recurrent IVF treatment failures, genetic screening may be used. Genetic screening is different than other types of genetic testing because the testing is looking for any gross chromosomal abnormality instead of a specific disease, and as a result is associated with higher rates of false results.  The literature has shown the highest rates of ongoing pregnancy rates for all age groups when transferring a chromosomally normal or euploid embryo with frozen embryo transfer.

If you are uncertain about genetic testing for you, speak with Dr. Couvaras about whether preimplantation genetic testing is right for you.

A response to ovarian stimulation depends on a number of different factors, the most important include available eggs, appropriate hormone levels, proper administration of any medications and lifestyle/environmental factors.
In order to respond to ovarian stimulation, a woman must have eggs available to respond; this is sometimes referred to as ovarian reserve. If a woman has diminished ovarian reserve (identified by high blood levels of follicle stimulation hormone (FSH), low blood levels of Anti Müllerian Hormone (AMH) or a low antral follicle count on ultrasound), she may not have as robust (or any) response to stimulation. For these patients, an alternate stimulation protocol may be tried or donated eggs may be used (from a woman known or unknown to the patient).
It is possible that a woman does have the necessary eggs but lacks the appropriate pituitary hormones to respond. In this case, using a different medication- one which may contain both FSH and luteinizing hormone (LH) may allow for an optimal response.
Lifestyle factors can also affect a woman’s response to stimulation. Optimizing weight, diet and stress and cessation of use of tobacco, alcohol and recreational substances can also improve a response to ovarian stimulation.

In vitro fertilization (IVF) is a treatment for infertility or genetic problems. If IVF is performed to treat infertility, you and your partner might be able to try less invasive treatment options before attempting IVF, including fertility drugs to increase production of eggs or intrauterine insemination — a procedure in which sperm are placed directly in your uterus near the time of ovulation.

Sometimes, IVF is offered as a primary treatment for infertility in women over age 35, and especially 40 or more.  IVF can also be done if you have certain health conditions. For example, IVF may be an option if you or your partner has:

• Fallopian tube damage or blockage. Fallopian tube damage or blockage makes it difficult for an egg to be fertilized or for an embryo to travel to the uterus.
• Ovulation disorders. If ovulation is infrequent or absent, fewer eggs are available for fertilization.
• Premature ovarian failure. Premature ovarian failure is the loss of normal ovarian function before age 40. If your ovaries fail, they don’t produce normal amounts of the hormone estrogen or have eggs to release regularly.
• Endometriosis. Endometriosis occurs when the uterine tissue implants and grows outside of the uterus — often affecting the function of the ovaries, uterus and fallopian tubes.
• Uterine fibroids. Fibroids are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. Fibroids can interfere with implantation of the fertilized egg.
• Previous tubal sterilization or removal. If you’ve had a tubal ligation — a type of sterilization in which your fallopian tubes are cut or blocked to permanently prevent pregnancy — and want to conceive, IVF may be an alternative to tubal ligation reversal.
• Impaired sperm production or function. Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. If semen abnormalities are found, your partner might need to see a specialist determine if there are correctable problems or underlying health concerns.
• Unexplained infertility. Unexplained infertility means no cause of infertility has been found despite evaluation for common causes.
• A genetic disorder. If you or your partner is at risk of passing on a genetic disorder to your child, you may be candidates for preimplantation genetic diagnosis — a procedure that involves IVF. After the eggs are harvested and fertilized, they’re screened for certain genetic problems, although not all genetic problems can be found. Embryos that don’t contain identified problems can be transferred to the uterus.
• Fertility preservation for cancer or other health conditions. If you’re about to start cancer treatment — such as radiation or chemotherapy — that could harm your fertility, IVF for fertility preservation may be an option. Women can have eggs harvested from their ovaries and frozen in an unfertilized state for later use. Or the eggs can be fertilized and frozen as embryos for future use. Women who don’t have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using another person to carry the pregnancy (gestational carrier). In this case, the woman’s eggs are fertilized with sperm, but the resulting embryos are placed in the gestational carrier’s uterus.