Fertility and reproduction treatments are designed to help couples suffering from sub-fertility or fertility disorders due to ovulation issues, sperm problems or an unexplained disorder.
Different treatments are available and tailored according to the couple’s needs.
Ovulation induction - The woman receives oral hormonal treatment designed to stimulate ovulation when she does not ovulate in order to improve the chances of pregnancy.
Daily hormone injections – Hormones are injected daily to increase the number of developing follicles and thus improve the chance for pregnancy. This treatment is monitored carefully by blood tests and ultrasound.
In fertility treatment, intrauterine insemination (IUI) can also be added. This is a procedure in which sperm are injected into the uterus after being properly prepared in the laboratory.
In vitro fertilization (IVF) processes
IVF is a highly effective method for achieving pregnancy in couples with subfertility. The goal of the process is to retrieve eggs from the woman's body and fertilize them with her partner's sperm under laboratory conditions. After fertilization, the embryos are transferred to the uterus, with the woman receiving luteal support.
The treatment comprises five phases:
1. Stimulating the ovaries to develop follicles.
2. Preventing ovulation through hormone suppression of the pituitary gland.
3. Preparing for retrieval.
4. Retrieving eggs.
5. Transferring embryos.
The following are the phases in the IVF process:
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Ultrasound exam during a woman's period to ensure that treatment begins under the right conditions in terms of the thickness of the uterine lining and the number of follicles in the ovaries. Later, treatment including hormones will be given. The entire process will be monitored through ultrasound exams and blood test every few days.
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Hormonal treatment includes a combination of gonadotropic hormones: FSH (Gonal F or Puregon), or a combination of FSH and LH (Menogon or Menopur). These hormones work to stimulate the ovary to develop follicles that contain eggs. At the same time, GnRH anatagonists / agonists are given to prevent natural ovulation.
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When the follicles grow, the hormone Estradiol is secreted from each follicle. The blood tests done throughout the course of treatment measure its level. Thirty-six hours prior to egg retrieval, a hormone with properties similar to LH (Ovitrelle) is injected, causing the eggs in the follicles to mature.
Actions and procedures during IVF treatments
IVF treatment is based on a series of care instructions, known as the treatment protocol. There are combinations of various protocols based on the two principles of treatment described above, and the physician's role is to tailor an ovulation induction protocol that is uniquely suited to the specific woman. To do so, the following factors will always be taken into account: the woman's age, weight, hormone profile, prior response to ovulation induction protocols.
Short treatment protocol with antagonist
Begins on Day 2-3 of the cycle, with the daily administration of a drug used to stimulate the ovaries. After 5-6 days, the GnRH antagonist is added. The purpose of the antagonist is to prevent early ovulation which could undermine the success of the treatment. The combined treatment continues until "mature" follicles have developed. When the follicles have matured (generally, with a circumference of over 17 mm), an injection is given to induce maturity of the eggs in the ovarian follicles and to cause progesterone to be produced and secreted into the bloodstream.
Long protocol with agonist
Begins on Day 2 of the cycle or on Day 21 of the previous cycle (about a week prior to intended menstruation), with administration of a GnRH agonist. The role of the agonist is to prevent early ovulation. However, an agonist needs to be administered for about two weeks to achieve the goal (to suppress the pituitary gland and prevent the possibility of early ovulation). When suppression has been achieved, as seen by ultrasound of the uterus and follicles and in blood tests for hormones, we begin stimulating the ovaries.
In vitro maturation (IVM)
In vitro maturation uses technology developed at the beginning of the century and is designed for women with many follicles in the ovary. When this method is used, the woman receives minimal hormone treatment, and the advantage is that the eggs are removed from the ovary when the follicles are small and the level of hormones secreted is still low. They are then matured in the laboratory, before being fertilized and transferred to the uterus.
Natural cycle IVF
This is a good option for women who are poor responders, in other words, women who have undergone a large number of unsuccessful fertility treatments and do not respond to the standard hormone treatment. This method encourages monitoring of a single follicle that develops naturally in the woman, as part of her monthly cycle, without any hormone intervention at all, and timing of collection of one egg from a single follicle. The IVF process, as described, is then conducted. Remember that these are only some of the protocols, and your physician may consider others.
A wide variety of drugs are used in ovulation induction protocols:
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Drugs that stimulate the ovaries to create follicles
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Drugs that prevent early ovulation
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Drugs that trigger ovulation
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Drugs that support the uterine lining prior to implantation.
Egg retrieval
Egg retrieval is a process of removing the eggs from the follicles that developed in the ovaries. In this procedure, a needle is inserted through the vaginal wall into the follicles in both ovaries. It is performed under light and short general anesthetic or local anesthetic. The procedure is done in the hospital as an outpatient procedure.
Instructions for egg retrieval day
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On the day of egg retrieval, the woman and her partner must arrive at the IVF Unit at the designated time.
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The woman begins a complete fast at midnight (refrain from eating, drinking, smoking and chewing gun), and should arrive without jewelry, makeup or nail polish.
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Ensure that the injection of the ovulation inducing drugs (Ovitrelle, Pergonal or sometimes Decapeptyl) is performed exactly on time, according to the orders, about 36 hours prior to the scheduled egg retrieval time.
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Refrain from having sexual relations for two to three days prior to the planned egg retrieval. The man will be requested to provide a sperm sample by masturbating into a sterile cup. If the man knows he will have a hard time providing the sample at the hospital, he can bring a sample from home, but must follow directions he receives in advance and coordinate this with the Unit physician/nurse.
Instructions for patients following egg retrieval
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We recommend total rest and drinking large quantities, at least two liters of fluid (preferably water).
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Women who will be undergoing egg retrieval under general anesthesia are strictly prohibited from driving.
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If there is any change in your condition, if you develop sharp stomach pains, marked weakness or fever, go immediately to the OB/GYN Emergency Room.
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From the day following egg retrieval, you need to take the drugs (pills/suppositories/injections) according to the instructions of the Unit physician, as listed in the discharge letter from the egg retrieval.
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The day following retrieval, you will need to call the Unit to find out the number of fertilizations and the date for the embryo transfer.
Embryo transfer
The fertilized embryos are transferred into the uterus two to three days and up to five days following egg retrieval. To ensure that the embryos are placed correctly into the uterine cavity, the process is performed under abdominal ultrasound guidance. Prior to the transfer, you will be asked to drink three-four glasses of water and to wait until you feel that your bladder is full. This will help us see a clearer picture of the uterine cavity from the abdomen.
Instructions following embryo transfer
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Continue the hormone treatment to support implantation of the embryos in the uterus.
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If you experience strong stomach pain, vaginal bleeding, fever, abdominal swelling or difficulty breathing after the embryo transfer, go to the OB/GYN Emergency Room or consult with the Unit physician.
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About two weeks following the transfer, you will need to take a blood pregnancy test.
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If it is positive, you will need to continue the luteal support. Additionally, you will be asked to take another blood test and then an ultrasound to ensure that the pregnancy is developing normally.
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Prenatal care in the Unit ends in Week 8, and then you will be referred for continued care to your attending OB/GYN.
Side effects and complications
There are side effects and possible complications associated with the IVF process, which are the result of the hormone treatment. It is important to recognize and be aware of these side effects and complications so that you can report them to the physician and check on the appropriateness, continuation, modification and maybe even termination of the treatment.
The following are among the known side effects:
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Appearance of sensitivity to the hormone preparations
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Ovarian hyperstimulation
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Ovarian hyperstimulation syndrome
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Multiple embryos
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Miscarriages and ectopic pregnancies
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Ovarian torsion, tearing or bleeding
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Ovarian cancer
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Birth of a child with a physical deformity
Other treatment
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Surrogacy - The Unit offers IVF treatments for women who require the assistance of a surrogate. These women will undergo hormone treatment, ovarian stimulation and egg retrieval. In the final phase, the embryos will be transferred to the uterus of the surrogate, who will have undergone treatment to prepare the uterus to receive the embryos.
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Egg donation - Our unit was the first in Israel to operate an egg donation system under the Egg Donation Law enacted in 2011. Women interested in donating eggs and women needing donor eggs can contact us to learn about the process and establish whether it is right for them. | 
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