In Vitro Fertilization (IVF) became a reality when the baby, Louise Brown, was born on July 25, 1978 in England. Over the last 32 years, we have seen IVF has become not only incredibly successful but the most successful infertility treatment available today. IVF has become so successful that it is considered a first line treatment for many infertility conditions.
IVF is the process of fertilization by manually combining an egg and sperm in a fertility laboratory. After the newly fertilized embryos begin developing, one or more of the best quality embryos are carefully selected and then placed into the woman’s uterus. The embryo(s) will then implant in the uterus and begin to grow resulting in pregnancy.
IVF has a very high success rate and is effectively used to treat many fertility problems. Any excess embryos created in the fertility laboratory may be frozen through cryopreservation for future use.
1. Monitor and stimulate the development of healthy egg(s) in the ovaries.
Fertility medications are prescribed to control the timing of the egg ripening and to increase the chance of collecting multiple eggs during one of the woman’s cycles. This is often referred to as ovulation induction.
2. Collect the eggs.
Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity.
3. Secure the sperm.
Sperm, usually obtained by ejaculation is prepared for combining with the eggs.
4. Combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and early embryo growth.
The sperm and eggs are placed in incubators located in the laboratory. The incubators enable fertilization to occur. In some cases where there is a lower probability of fertilization, intracytoplasmic sperm injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization.
5. Transfer one or more selected embryos into the uterus.
The embryos are usually transferred into the woman’s uterus from one to six days later, but in most cases the transfer occurs between two to three days following egg retrieval. At this stage, the fertilized egg has developed into a two-to-four cell embryo.
These steps are followed by rest and watching for early signs of pregnancy. A blood test and potentially an ultrasound will be used to determine if successful implantation and pregnancy have occurred.
IVF may be done with a couple’s own eggs and sperm or with donor eggs, sperm, or embryos. Some couples choose to use donor eggs, sperm, or embryos because of genetic concerns. Donor eggs are used in approximately 10% of all assisted reproductive technology (ART) cycles.
The success rate of IVF clinics depends on a number of factors including the patient’s medical history and the treatment approaches used. It is also important to understand that pregnancy rates are not the same as live birth rates.
Thorough evaluation is necessary to ensure the proper preparation for IVF. If a patient has undiagnosed and untreated issues, such as endometrial polyps, uterine myomas, hydrosalpinx (dilated blocked fallopian tubes) or poor quality sperm, then the likelihood of a successful IVF cycle drops dramatically.
Choosing the correct stimulation protocol is critical to ensuring that the eggs will be mature at the time of retrieval. The number of days for optimal stimulation varies by the stimulation protocol.
Perhaps the easiest part of the IVF process, most physicians are very capable of retrieving all the eggs. Doctors must be careful to ensure that the pressure of the suction machine is monitored to get the eggs without using excessive pressure which can increase the rate of damaged eggs (fractured zones).
This is a very critical component to the IVF process. The Poma Fertility laboratory has extensive air filtration and positive pressure to maintain a biological clean room. The particulate matter in the air is less important than the concentration of volatile organic compounds (VOCs). Our lab has regular tests for VOC levels.
The embryo transfer part of the IVF process is a critical procedure. The embryology team also plays a significant role by selecting the best embryos for transfer. The embryologist’s grading of the embryos influences our recommendations for the number of embryos to transfer, which can increase the probability of pregnancy.
Another issue is that not all patients have the same chance of succeeding based on their medical condition. If a clinic has more poor prognosis patients then they will have poorer success rates. Some clinics choose only the best prognosis patients, refusing to treat poorer prognosis patients, in order to keep their success rates inflated. Poma Fertility has developed a clinical scoring system to segregate patients into GOOD and IDEAL prognosis categories. This scoring system helps us to give patients realistic expectations before we start the IVF cycle and to inform patients of our success rates depending on how complicated their medical condition is.