In Vitro Fertilization (IVF)
In vitro fertilization (IVF) is a procedure designed to improve fertilization. An egg, or several eggs, are surgically removed from the ovary and are fertilized within a laboratory environment. The fertilized egg, now considered an embryo, is then implanted into the uterus.
IVF is appropriate for:
- Women who have absent or non-surgically repairable fallopian tubes
- Women who have endometriosis and haven’t been able to achieve pregnancy after medical or surgical treatment
- Women who have ovulatory dysfunction who haven’t been able to achieve pregnancy after regular ovulation induction
- Women with a history of DES exposure during pregnancy (T-shaped uterus)
- Couples experiencing unexplained infertility
- Couples for whom the husband has severe low sperm count, was born with congenital absence of the vas deferens (the tube that carries sperm from the testicles to outside the penis), has failed vasectomy reversal or has a history of anti-sperm antibodies
The IVF procedure includes the following:
- Follicular development. In order to stimulate follicles in the ovaries to produce healthy, mature eggs, a woman will receive injectable hormones administered at home for a period of ten to twenty days. The Fertility Center provides free orientation classes to help couples become comfortable with this process.
Intensive follow up every three to four days by blood test and ultrasound are important for the appropriate medical treatment. The eggs develop inside fluid-filled cysts called follicles. Once the follicles reach 18 millimeters in diameter, the patient will receive a different hormone to complete the maturation of the eggs. This is also administered at home by injection.
- Egg Retrieval. The egg retrieval can be performed on an outpatient basis, while the patient is under IV sedation. Using ultrasound guidance, the follicle will be aspirated through the vagina, to check for mature eggs. After looking at the fluid under a microscope in an adjacent lab, your doctor will determine if there are enough eggs to proceed.
- Preparation of sperm and insemination of the eggs. After the collection and classification of the eggs, the insemination takes place. A semen sample will be provided by the partner/husband. The sperm will be processed in the lab to prepare it for egg insemination. The insemination will be carried out by conventional IVF (sperm and egg unite in a plastic dish in the lab using a special culture medium) providing that semen parameters are normal.
If there are not enough sperm, or if the sperm is of poor quality, intracytoplasmic sperm injection (ICSI) will be used. In ICSI, a single sperm is injected into the egg using a micropipette under a special microscope. Inseminated eggs are cultured in an incubator with proper temperature, humidity and air control conducive to fertilization and embryo development.
If the embryos have a thick membrane, your doctors may recommend assisted hatching. At the appropriate stage of embryo development, usually on the morning of embryo transfer, an embryologist in the lab thins the outer layer of the embryos that have been chosen to be transferred. This makes it easier for the embryos to attach to the lining of the uterus for implantation. A thick membrane is more commonly identified in:
- patients over the age of 38
- embryos that have been previously cryopreserved (frozen)
- patients who have multiple IVF attempts without a successful pregnancy
- Transfer of the embryos. In IVF procedures, after fertilization and embryo development, the next step is an embryo transfer. Embryo transfer is a process to deposit embryos into the endometrial cavity by using a fine catheter that is passed through the cervix.
In general, the procedure is monitored by a trans-abdominal ultrasound. The embryos can be transferred three days after the insemination, called the cleavage stage. Some are transferred five to six days after the insemination, called the blastocyst stage. The number of embryos to be transferred is determined by the age of the patient, the quality of the embryos and other related factors. A pregnancy test is administered two weeks after embryo transfer. Any remaining embryos can be cryopreserved (frozen) in the lab for a future use, if desired. The recommended timeline for embryo and sperm cryopreservation is 5 years.
The policy at the Fertility Centers is to transfer only two embryos in patients under the age of 35, two-to-three embryos in patients under the age of 39, four-to-five embryos in patients older than 40. If the embryos are transferred at the blastocyst stage, your doctors will recommend one or two embryos in patients younger than age 40.
- Pregnancy testing. Pregnancy tests are usually performed approximately two weeks after embryo transfer by blood and urine testing. After pregnancy is determined, your doctors will follow you during the early stages of pregnancy until the presence of the heartbeat has been documented in the fetus. A blood pregnancy test is required every three days during the first week, and then once a week until the patient is referred to an obstetrician.
Our IVF program serves a variety of patients. Due to our vast experience in treating patients who have had multiple IVF failures, we provide individualized protocols according to the patient’s response. At the Fertility Center, our doctors have a particular interest in “poor responder” patients and in patients with base-line elevation of the FSH. Many fertility centers refer those patients to donor egg programs. Our doctors consider that the last resort once we have exhausted all our efforts to assist these couples in having their own biological child.