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DR. HEBER DUNAWAY: Once the decision has been made to turn to in vitro fertilization for conception purposes, it's a process that's been partially discussed among my partners. Ovulation induction is key to make healthy eggs. Once the eggs are developed and patients are monitored by ultrasound and follicular measurements, then we go on to the actual egg retrieval itself. Once patients get to their right size follicle a trigger is given, an injection is given, 8CG, and approximately 36 hours from that injection you're brought to surgery. Surgery is performed in a sterile environment under what we call conscious sedation. IV medications are given. The patient does not feel anything, but it is given without general anesthesia as far as intubation is concerned. We actually tube in the throat, which may be more commonly associated with surgical procedures.

Once the eggs are retrieved, and the process takes generally anywhere from let's say 10 to 15 minutes. It's a very fast procedure. All of the eggs are retrieved transvaginal, to the vagina. When you had ultrasounds during the process of egg development, a vaginal probe was used. The only difference at this point is that the probe has a needle guy attached to it and we pass a needle into the egg and—I mean into the ovary, and retrieve the egg.

Once the eggs are retrieved they are passed to the embryologist who cleans the eggs up, examines the eggs and grades the eggs. We grade the eggs on a one to four scale, one being immature, four being over-ripe. Grade three eggs are the ideal eggs although grade two eggs produce pregnancies as well.

Once these eggs are cleaned, insemination of the eggs by sperm is performed. In special cases where husband's sperm cannot penetrate the egg a technique called intracytoplasmic sperm injection or ICSI is utilized. Once the eggs are fertilized we check for fertilization the next day, the day after the egg retrieval. At this point we have what we call a pronuclear stage where we just see signs of fertilization. An embryo is yet to develop.

The second day after retrieval we see a two-cell to four-celled embryo and we follow this development to Day 5, when you have what is called a blastocyst, that's a very highly developed embryo. If the embryo survived to this stage, then we choose based on the patient's age anywhere from two or more embryos to be placed back into the uterus.

The transfer or placement of the embryos is very simple. We bring the patient into the operating suite. While she's awake we generally ask the husband to be with us. We put a speculum in the vagina like you're having a Pap test. We pass a very tiny tube with the embryos into the uterine cavity and we inject under ultrasound guidance. We want to know exactly where to place the embryos. Then the patient is taken out of position and brought back into recovery. Approximately ten days after transfer we check for pregnancy.