IVF Services

USF IVF offers the following services:

A saline ultrasound (SIS) or sonohysterogram is a commonly performed test. The test is a specialized transvaginal ultrasound, in which a catheter is placed in the cavity of the uterus where a pregnancy implants, called the endometrial cavity. The catheter is used to fill the endometrial cavity with saline. Ultrasound images depend on sound waves put out by the ultrasound probe, with echoes from the sound waves returning to the ultrasound probe to create an image. Since fluid does not echo sound, fluid filled areas are seen as black cavities with ultrasound. Filling the uterus with saline creates a black background, in which abnormalities in the endometrial cavity such as polyps or fibroids can be seen in detail. Polyps and fibroids are almost never cancerous in the reproductive age group, but are common and can lead to infertility or to miscarriages.

A hysterosalpingogram, often called an HSG, is a test performed in radiology to determine whether or not the fallopian tubes are healthy. The HSG is an important test. Healthy fallopian tubes are essential to becoming pregnant, as they serve as a pathway between the uterus (where a pregnancy implants), and the ovary (where the eggs are located). Shortly after ovulation, the fallopian tube will pick up the newly released egg from the ovary, and provide a pathway through which sperm swimming through the uterus from the vagina can reach the egg. Fertilization of the egg by the sperm occurs at the far end of the fallopian tube closest to the ovary, called the ampulla. After egg fertilization by sperm, the fallopian tube pushes the fertilized egg towards the uterus in a journey that takes 3-4 days. Infections, inflammation, and sometimes endometriosis can lead to blocked or damaged fallopian tubes, preventing the tube from picking up the egg and causing infertility. If the tube is open but damaged then a pregnancy in the fallopian tube, called an ectopic pregnancy, can occur. The HSG involves placing a catheter in the uterus, and filling the uterus with a special liquid called radio-opaque contrast, which can be seen on a radiograph to give a picture of the uterus. Once the uterus is filled with contrast, the contrast will migrate down the fallopian tubes to give an outline of the tubes as well. In this way we can determine if the tubes are open. There are many comments on the internet about discomfort during the HSG test, but the test need not be difficult. With proper preparation including pre-treatment with a non-steroidal anti-inflammatory medicine, the test is tolerable, and should in most instances only take a few minutes.

Egg freezing is also referred to as oocyte cryopreservation or egg cryopreservation. Egg freezing involves freezing unfertilized eggs, with the intent to thaw them in the future, inseminate or fertilize them with sperm after thawing, and then do an embryo transfer of the fertilized ages to achieve pregnancy. The first successful birth after egg freezing occurred in South Korea over twenty years ago, but until recently successful egg thawing was a rare occurrence and pregnancies were sporadic. Egg freezing was considered experimental by the American Society for Reproductive Medicine until 2013, but is now considered as an acceptable treatment. The egg is the largest cell in the human body, making freezing difficult. The original technology used for egg freezing is called “slow freezing” Over the past decade, a newer process called “vitrification” has been developed, and research studies are showing that egg survival and pregnancy rates are better when the eggs have been vitrified compared to slow freezing. USF IVF uses vitrification technology exclusively. Pregnancy rates after thawing frozen eggs depend on the number of eggs that survive the thaw, and the age of the patient when her eggs were frozen. Egg freezing is carried out most commonly for cancer patients who will be undergoing chemotherapy or radiation as part of their cancer treatment, through our Center for Fertility Preservation. Since chemotherapy or radiation can affect ovarian function, freezing eggs prior to starting chemotherapy or radiation provides a way for the cancer patient to become pregnant after she is cured. With increasing frequency, healthy reproductive age women who are not in a situation to get pregnant, or are not yet ready to get pregnant, are choosing to freeze their eggs. Fertility declines with age, and the decision to freeze eggs when younger is made so that the woman will have choices available as she gets older. Finally, there are several donor egg banks using frozen eggs to be donated to couples who require donor egg IVF.

Embryo freezing, or embryo cryopreservation, involves freezing fertilized eggs, or embryos, with the intent to thaw them in the future and do an embryo transfer to achieve a pregnancy. At USF IVF, we freeze embryos that reach the blastocyst stage of development by the 5th or 6th day after egg retrieval during an IVF treatment. Embryo freezing is an established technology that has been carried out since the 1980s. The original technology used for embryo freezing is called “slow freezing”. Over the past decade, a newer process called “vitrification” has been developed. USF IVF uses vitrification technology exclusively. Historically, pregnancy rates with frozen embryos were lower than with fresh embryos, but with improved technology including vitrification this is no longer true and pregnancy rates rival, or exceed, those with fresh IVF. Embryo freezing most commonly occurs when there are additional embryos available after embryo transfer during a fresh IVF cycle. Embryo freezing also occurs when we perform trophectoderm biopsy for preimplantation genetic diagnosis, while awaiting the results of the genetic analysis. Another indication for embryo freezing is for cancer patients, through our Center for Fertility Preservation, who will be undergoing chemotherapy or radiation as part of their cancer treatment. Since chemotherapy or radiation can affect ovarian function, freezing embryos prior to starting chemotherapy or radiation provides a way for the cancer patient to become pregnant after she is cured.

Sperm washing and intratuerine insemination, or IUI, is a procedure where sperm is processed in our andrology lab so that it can be safely introduced into the uterus with a special catheter called an insemination catheter. With intercourse, the majority of sperm in the ejaculate leak out of the vagina and only a few sperm are able to swim through the cervical canal into the uterus. Theoretical reasons why IUI is effective include the availability of more sperm in the uterus, the fact that sperm placed in the uterus have a shorter distance to travel to reach the egg in the fallopian tube, and bypassing the cervix which serves as a barrier to sperm. IUI is typically used in conjunction with fertility pills such as letrozole (femara) or clomiphene citrate (clomid) to treat couples with unexplained infertility or with mild sperm deficits. IUI is also used with donor sperm.

Since the birth of the first IVF baby in England 1978, In vitro fertilization (IVF) has revolutionized our ability to treat infertility. IVF is in most instances the most effective fertility treatment we have. IVF treatment involves several steps. Powerful injection fertility medicines are taken daily for 10-13 days, in order to produce many eggs during treatment, rather than the typical one egg a month that women release naturally. The response of the ovaries is monitored using intravaginal ultrasound, and hormone levels in the blood are monitored. When the eggs are mature, a 15-30 minute procedure called an egg retrieval is undertaken. While the IVF doctor is retrieving the eggs using an ultrasound, an anesthesia provider gives intravenous sedation. Embryologists from the IVF lab are present in the retrieval room to identify the eggs using a microscope. The eggs are maintained at body temperature, strict oxygen tension, and strict pH to insure their health. A few hours after the egg retrieval, the eggs are fertilized with sperm, and the fertilized eggs are cultured in an incubator for 3-5 days. The procedure whereby the fertilized eggs are put into the uterus is called an embryo transfer, which occurs 3-5 days after the egg retrieval. Any additional fertilized eggs that reach a developmental stage called the blastocyst stage by the 5th or 6th day after the egg retrieval are cryopreserved, or frozen, and can be used in the future to try to achieve another pregnancy.

Fertility medicines come in two forms, as pills taken orally and as injections. Fertility pills are not as powerful as fertility injections, and are the first choice of treatment for women who do not ovulate regularly. Fertility pills are also given to women who ovulate regularly where we want to increase egg numbers modestly from the usual one egg a month to two or three eggs, such as when we treat with intrauterine insemination. Typical fertility pills are clomiphene citrate (clomid) and letrozole (femara). Fertility injection medicines are much more powerful than pills, and are most often used with IVF, where we want to increase egg numbers substantially. Fertility injections are less commonly used to treat women who do not ovulate regularly, usually when fertility pills have not been successful, or in conjunction with intrauterine insemination. Fertility injections include pure FSH preparations (Gonal-F, follistim, bravelle) and a combination FSH-LH preparation (Menopur).

Preimplantation genetic diagnosis (PGD)/Preimplantation genetic screening (PGS), is a procedure carried out on embryos as part of some IVF cycles, before choosing which embryos to transfer into the mother’s uterus. With PGD/PGS, cells from the embryo, called blastomeres, are removed, or biopsied, on the third, fifth, or sixth day after egg retrieval. Day 5 and day 6 biopsies are called trophectoderm biopsies. The biopsied cells from the embryos are dissolved in a lysis buffer, and transferred to a specialized genetics lab where DNA from the cells can be analyzed for genetic abnormalities, or for sex determination. Embryo biopsy is a highly skilled procedure performed by our embryology team. The entire process of embryo biopsy, transport to the genetics lab, and testing by the genetics lab takes two days. Once we have the report from the genetics lab, we can determine which embryo(s) to transfer back into the mother’s uterus. PGD is especially useful for patients with inherited genetic disorders, such as cystic fibrosis, hereditary breast and ovarian cancer, sickle cell anemia, muscular dystrophy, and many others. The role for PGS is evolving. This technology allows for exclusion of embryos with disorders such as trisomies (e.g. Down’s syndrome) and other embryos that have no potential for implantation and delivery (e.g. triploidies, monosomies, etc.), and it also can be used for sex selection. It may prove to be useful in improving pregnancy rates and decreasing multiple pregnancy risks, by identifying embryos with normal chromosome structure.

Many couples with infertility have been told that they have polycystic ovary syndrome (PCOS). Women with PCOS often have irregular or no periods, bothersome hair growth on the face and elsewhere, acne, and may be overweight. The condition is called PCOS because the ovaries, when ultrasounded, demonstrate many small cysts (see photograph). These cysts are not bad, are not large, will not lead to cancer of the ovary, and do not require surgery.

But what is PCOS? Although physicians do not all agree on the fine points of diagnosis, we are in agreement that an excessive amount of male hormone production by the ovary is the main feature of PCOS, and leads to many of the findings that women with PCOS experience. Another important feature is that women with PCOS often have a pre-diabetic condition called insulin esistance, abnormal cholesterol and triglyceride levels, and even diabetes.

Most of us are aware that the ovary produces estrogen, which is traditionally thought of as "the female hormone". Fewer people are aware that the ovary also makes testosterone, which is traditionally thought of as a "male hormone", and progesterone. In fact, estrogen is produced from testosterone. If the ovary is not producing enough testosterone, estrogen levels will be low, eggs will not mature, and ovulation will not occur. If the ovary is making the right amount of testosterone, the right amount of estrogen can be made, the egg can mature, and vulation will occur. However, if the ovary is making too much testosterone, even just a slightly excessive amount, eggs do not mature and ovulation does not occur. In other words, the amount of testosterone being produced in the ovary needs to be just right. Women with PCOS have ovaries that are producing too much testosterone. The amount of testosterone produced by PCOS ovaries is only slightly excessive, still only 1/5th that produced by the average man, but is high enough to prevent ovulation, and high enough to cause excessive hair growth and acne, which are common complaints of many women with PCOS.

The third hormone that ovaries produce, progesterone, is also important for two reasons. First, progesterone acts with estrogen to prepare the inner lining of the uterus, the endometrium, to support a pregnancy. Second, although estrogen is vitally important as the fundamental female hormone, too much estrogen can lead to irregular and heavy vaginal bleeding, and to cancer of the endometrium. Progesterone not only works with estrogen to support pregnancy, but counteracts, or cancels out, the cancer and irregular bleeding risks of estrogen. Progesterone is only made by the ovary after ovulation. Therefore, the ovaries of women who ovulate every 28-30 days and have regular periods are making progesterone half of the time. This is more than enough progesterone to cancel out the negative effects of estrogen. Since most women with PCOS do not ovulate, their ovaries do not make progesterone, and they are at higher risk of getting cancer of the endometrium or heavy, irregular bleeding.

You and your provider should design the treatment of your PCOS to fit your goals. For example, if your goal is to get pregnant, then your treatment will require medications to help you ovulate. These medications will solve two problems. First, you will ovulate, which is required if you are going to get pregnant. Second, after you ovulate, your ovaries will produce progesterone, which will protect your endometrium.

On the other hand, if your goal is to treat bothersome excessive hair growth, you might want to consider the birth control pill. The birth control pill works to prevent pregnancy by turning off the signals from your brain to your ovaries. If the ovaries of women with PCOS do not receive a signal from the brain, they stop making excessive amounts of male hormone, and also stop making estrogen. Fortunately, the pill has estrogen in it to replace the estrogen that the ovary is no longer making, and also has a progestin (a type of progesterone) to protect the endometrium. With no male hormone coming from the ovaries after starting the birth control pill, bothersome hair growth will slow down. You may also want to consider adding a medicine called spironolactone, which works directly at the skin to inhibit the stimulating effects of male hormone on hair follicles. The birth control pill and spironolactone work very well together, and often work very well in conjunction with laser hair removal or electrolysis.

If you neither want to have a baby, nor consider excessive hair growth a problem, but have irregular periods, you might still want to consider the birth control pill because it contains a progestin, but many other progestin-containing medications are also options to protect against endometrial cancer.

The relationship between PCOS and diabetes is very important, since diabetes is a major health problem. Insulin resistance and diabetes are risk factors for cardiovascular and peripheral vascular disease, stroke, kidney disease, blindness, and other conditions. Women with PCOS, particularly if overweight, should be tested for diabetes. Diabetes drugs, such as metformin (glucophage), often help women with PCOS to ovulate, even if they are not diabetic. Metformin may also prevent women with insulin resistance from progressing to diabetes.

Although most of our patients are seeing us in order to get pregnant, all women with PCOS will spend most of their lives not being actively treated for infertility. It is important not to ignore PCOS once you move on (hopefully successfully) from infertility treatment. Diabetes is a serious health problem, but it is a preventable health problem most of the time. Exercise, nutrition, and lifestyle modifications should be tackled seriously. These are big changes that do not happen overnight, but they are the key to diabetes prevention. Furthermore, often a small 5%-10% weight loss will restore regular menstrual cycles, which is a big plus when trying to get pregnant and when trying to prevent endometrial cancer. Beyond infertility therapy, irregular periods should be addressed if they continue. The good news is that lack of ovulation because of PCOS is treatable, and the chances of a successful pregnancy very good.

Typical surgical procedures performed by USF IVF physicians include hysteroscopy, laparoscopy, and laparotomy. Hysteroscopy involves inserting a narrow telescope through the vagina and cervix into the uterus. Hysteroscopy can be carried out to diagnose and surgically treat abnormalities such as polyps, fibroids, intrauterine scar tissue, or abnormalities that some women are born with (congenital abnormalities) such as a uterine septum. Laparoscopy involves inserting a telescope through the abdomen, most often the belly button, to look at the outside of the uterus, the fallopian tubes, and the ovaries. Removal of fibroids, endometriosis, ovarian cysts, and severely damaged fallopian tubes can be carried out using a laparoscope. Repair of damaged fallopian tubes can also be carried out. A laparotomy incision is a bigger abdominal incision, reserved for the removal of large fibroids, or multiple fibroids. Use of an operating microscope through a mini-laparotomy is a procedure used to reconnect fallopian tubes that were previously ligated or tied. Surgery that is carried out using a hysteroscope or a laparoscope is call minimally invasive surgery.

Typical surgical procedures performed by USF IVF physicians include hysteroscopy, laparoscopy, and laparotomy. Hysteroscopy involves inserting a narrow telescope through the vagina and cervix into the uterus. Hysteroscopy can be carried out to diagnose and surgically treat abnormalities such as polyps, fibroids, intrauterine scar tissue, or abnormalities that some women are born with (congenital abnormalities) such as a uterine septum. Laparoscopy involves inserting a telescope through the abdomen, most often the belly button, to look at the outside of the uterus, the fallopian tubes, and the ovaries. Removal of fibroids, endometriosis, ovarian cysts, and severely damaged fallopian tubes can be carried out using a laparoscope. Repair of damaged fallopian tubes can also be carried out. A laparotomy incision is a bigger abdominal incision, reserved for the removal of large fibroids, or multiple fibroids. Use of an operating microscope through a mini-laparotomy is a procedure used to reconnect fallopian tubes that were previously ligated or tied. Surgery that is carried out using a hysteroscope or a laparoscope is call minimally invasive surgery.

Typical surgical procedures performed by USF IVF physicians include hysteroscopy, laparoscopy, and laparotomy. Hysteroscopy involves inserting a narrow telescope through the vagina and cervix into the uterus. Hysteroscopy can be carried out to diagnose and surgically treat abnormalities such as polyps, fibroids, intrauterine scar tissue, or abnormalities that some women are born with (congenital abnormalities) such as a uterine septum. Laparoscopy involves inserting a telescope through the abdomen, most often the belly button, to look at the outside of the uterus, the fallopian tubes, and the ovaries. Removal of fibroids, endometriosis, ovarian cysts, and severely damaged fallopian tubes can be carried out using a laparoscope. Repair of damaged fallopian tubes can also be carried out. A laparotomy incision is a bigger abdominal incision, reserved for the removal of large fibroids, or multiple fibroids. Use of an operating microscope through a mini-laparotomy is a procedure used to reconnect fallopian tubes that were previously ligated or tied. Surgery that is carried out using a hysteroscope or a laparoscope is call minimally invasive surgery.

Typical surgical procedures performed by USF IVF physicians include hysteroscopy, laparoscopy, and laparotomy. Hysteroscopy involves inserting a narrow telescope through the vagina and cervix into the uterus. Hysteroscopy can be carried out to diagnose and surgically treat abnormalities such as polyps, fibroids, intrauterine scar tissue, or abnormalities that some women are born with (congenital abnormalities) such as a uterine septum. Laparoscopy involves inserting a telescope through the abdomen, most often the belly button, to look at the outside of the uterus, the fallopian tubes, and the ovaries. Removal of fibroids, endometriosis, ovarian cysts, and severely damaged fallopian tubes can be carried out using a laparoscope. Repair of damaged fallopian tubes can also be carried out. A laparotomy incision is a bigger abdominal incision, reserved for the removal of large fibroids, or multiple fibroids. Use of an operating microscope through a mini-laparotomy is a procedure used to reconnect fallopian tubes that were previously ligated or tied. Surgery that is carried out using a hysteroscope or a laparoscope is call minimally invasive surgery.

Fibroids, also called leiomyomata, are growths that arise in the muscle of the uterus. Fibroids are almost always benign (not cancerous) but rarely can be malignant (cancerous). Fibroids are very common, and more often than not are asymptomatic and do not prevent women from getting pregnant. Sometimes, however, fibroids require treatment because of growth, heavy bleeding, bladder pressure, pelvic pressure, pain, infertility, or recurrent miscarriages. There are many ways to treat fibroids, including hormones and other medications to control bleeding, surgery, uterine fibroid embolization by interventional radiologists, or ultrasound sound energy. Women with recurrent miscarriages or infertility and fibroids sometimes, but not always, require treatment. Surgery to remove the fibroids is the first choice of treatment for women with infertility. Depending upon the size, location, and number of fibroids, surgery can be carried out by hysteroscopy, by laparoscopy with or without a robot, or by a larger abdominal incision called a laparotomy.

Endometriosis is a condition where the tissue that normally coats the uterine lining, or endometrium (where pregnancies implant), starts to grow on the bladder, pelvic sidewalls, ovaries, and elsewhere besides the uterus. Endometriosis is present in up to 30% of women with infertility, and commonly is a cause of pelvic pain, painful periods, and infertility. Endometriosis can be treated hormonally, or with surgery. Women with endometriosis and infertility or pain sometimes require surgery, which is almost always carried out by laparoscopy.

The Donation and Surrogacy Program offers sperm donation, egg donation and surrogacy options, including gestational carriers, for patients struggling to conceive.
Saline Ultrasound (SIS) or sonohysterogram is a commonly performed test. The test is a specialized transvaginal ultrasound, in which a catheter is placed in the cavity of the uterus where a pregnancy implants, called the endometrial cavity. The catheter is used to fill the endometrial cavity with saline. Ultrasound images depend on sound waves put out by the ultrasound probe, with echoes from the sound waves returning to the ultrasound probe to create an image. Since fluid does not echo sound, fluid filled areas are seen as black cavities with ultrasound. Filling the uterus with saline creates a black background, in which abnormalities in the endometrial cavity such as polyps or fibroids can be seen in detail. Polyps and fibroids are almost never cancerous in the reproductive age group, but are common and can lead to infertility or to miscarriages.

The Center for Fertility Preservation at USF IVF is committed to offering young adults with cancer with the most current and comprehensive fertility preservation opportunities.

  • Every year, 55,000 young adults, adolescents, and children are diagnosed with cancer in the United States. Most young men and women dream of having children and a family, and cancer patients are no different in this desire. Many chemotherapy drugs, and even some surgeries and radiation treatments, permanently destroy eggs and sperm. As cancer treatment has improved and advanced, so too have reproductive options. It is important that young cancer patients have the knowledge and the opportunity to make reproductive choices.
  • Reproductive considerations in cancer patients include:
  • Will cancer treatment destroy gonadal function?
  • What fertility preservation treatment choices are available, and when are they indicated?
  • If cancer treatment is delayed to make time for fertility preservation, will survival be affected?
  • What options are there to shorten the time required for fertility preservation treatment?
  • Will pregnancy alter the likelihood of survival?
  • Are there ways to prevent genetic transmission of genes that could predispose children of parents with familial cancers to cancer?

Treatment choices can include

  • Sperm freezing and banking
  • Freezing unfertilized eggs
  • Feezing embryos (fertilized eggs)
  • Some gynecologic cancer surgeries can be modified in reproductive age women to conserve reproductive organs
  • Ovarian transposition surgery is a procedure where ovaries are moved away from a radiation field when radiation therapy is being used that may affect the ovaries.
  • Hormonal treatment with drugs called GnRH agonists during chemotherapy may offer partial protection to the ovary
  • Ovarian tissue cryopreservation (investigational)

Collaboration and discussion between the patient, her/his oncologist and the Center for Fertility Preservation team is important to develop an approach that will give the best opportunity for future fertility, and not delay cancer treatment.

Semen analysis, also known as a sperm count test, analyzes the health and viability of a man’s sperm. Semen is the fluid containing sperm (plus other sugar and protein substances) that’s released during ejaculation. A semen analysis measures three major factors of sperm health:

  1. The number of sperm
  2. The shape of the sperm
  3. The movement of the sperm, also known as “sperm motility”