Invitro fertilization (IVF) is an assisted reproduction technique in which a man’s sperm is combined with a woman’s egg in the fertility laboratory. The resulting embryos are allowed to develop before one or more of them are transferred into the woman’s uterus for implantation and subsequent pregnancy. Any additional embryos created during the IVF process may be frozen through cryopreservation for future use.
IVF is used for almost any infertility cause that fails to naturally create a viable pregnancy.
IVF is used in cases of:
- Age-Related Infertility
- Male Factor Infertility
- Endometriosis or Tubal Factors
- Uterine Factors
- Unexplained Infertility
- Recurrent Pregnancy Loss (Miscarriage) when used with PGS
IVF also assists people who are not infertile, but who have a cancer diagnosis and may become infertile or sterile from their cancer treatment as well as women who may want to bank their eggs while they are younger and more fertile.
The first in vitro fertilization (IVF) baby was born in 1978, and since then millions of babies around the world have been born using IVF.
Our 10 Step IVF Process
Pre-Treatment Testing. Various tests are conducted to determine the patient’s specific infertility and to create a treatment plan that has the best possibility for success. Blood tests may reveal any hormonal problems and determine the amount of hormones needed to produce the optimum numbers of eggs.
Other tests, such as a sonohysterogram are done to ensure that the uterus is normal and that no untreated problems exist. A semen analysis is often performed to determine whether the amount and quality of sperm are sufficient for the IVF process.
We need to understand the medical situation to optimize the IVF stimulation and to provide a realistic prognosis for success.
Most cycles require one to four (1-4) weeks of OCP (oral contraceptive pills) to prepare the ovaries for IVF stimulation. We find improved outcomes with OCP preparation. Some stimulation protocols do not use OCP, but still have suppression of ovarian hormones using other medications.
We use the hormones (FSH/LH) by injection to stimulate the ovary to mature a large number of eggs. Normally, one egg ovulates from the ovary each month but as many as 500-1000 eggs begin development and die. We rescue some of these eggs with FSH/LH stimulation.
IVF stimulation must be carefully controlled to allow the healthiest maturation of the eggs. We work as a team (both clinical and laboratory staff) to carefully adjust medication dosing for optimal length of stimulation and number of eggs for retrieval.
We retrieve eggs in our procedure room under anesthesia. You are completely comfortable and asleep. Most women did not require pain medication after retrieval. The eggs are covered with cells called cumulus cells, which help the sperm fertilize the egg. We sometimes remove the cumulus cells if we need to insert the sperm into the egg (see step 6).
On the day of egg retrieval, the male partner produces a sperm sample which the embryology team processes before inseminating the eggs.
We inseminate eggs using two techniques: conventional insemination and ICSI. Conventional insemination involves placing 100,000-200,000 sperm per egg. The sperm then enter the egg naturally. ICSI involves the embryologist selecting a single sperm, presumably the most normal sperm they can find, and injecting the sperm into the egg.
The day after retrieval and insemination, we find the eggs that fertilize into zygotes and we then track the growth and development of the embryos for three to five (3-5) days. In nature, the embryo enters the uterus approximately three to four (3-4) days after ovulation and begins implantation into the endometrium five to six (5-6) days after ovulation. We transfer embryos into the uterus three to five (3-5) days after egg retrieval, which is similar to a natural cycle.
We decide when to transfer the embryos based on the number and quality of embryos available. Embryo quality is similar to a beauty contest, in which the previous embryos are most likely to create a baby. If we have more good quality embryos then we are willing to transfer on day three (3), then delay and transfer until day five (5) improves our chances of selecting the correct embryo or embryos for transfer.
Day five (5) transfer provides a selection tool such that we are more and more able to choose the single best embryo that will create a single baby. Singleton pregnancies create the healthiest births and the healthiest children.
Importantly, we must transfer the embryo before noon on the 6th day after retrieval for normal IVF implantation, which is important to understand after embryo biopsy for genetic screening.
On the day of the embryo transfer, we meet and review the number and quality of embryos available for transfer. Our final decision about the number of embryos to transfer fine-tunes the previously agreed embryo transfer number to achieve the highest possible pregnancy rate with the lowest risk of multiple births.
Embryo transfer requires the physician to place a very fine, soft and flexible catheter through the cervix and into the midportion of the uterine cavity. We perform embryo transfer with ultrasound guidance to ensure that the catheter is in the correct location. The procedure should be painless and requires approximately 15 minutes of preparation and transfer.
We ask our patients to remain off their feet for 18-24 hours after embryo transfer. The woman they have been return to normal activities but we discourage strenuous exercise or physical activity until the pregnancy test 2 weeks from egg retrieval. Post transfer instructions vary from clinic to clinic.
We obtain a blood pregnancy test 2 weeks after egg retrieval. Beginning 11-12 days after egg retrieval, a sensitive blood test can determine if pregnancy occurred. We choose to test 14 days later to minimize the diagnosis of a biochemical pregnancy.
Two weeks after the pregnancy test, we can detect a gestational sac in the uterus with an embryonic heart rate. The pregnancy continues to develop normally until 8-10 weeks gestation, then we transfer the patient to her obstetrician for care.
We continue progesterone supplements until 10 weeks of pregnancy. The pregnancy begins producing its own hormones approximately 7-8 weeks gestation and we continue are supplements for about 2 weeks after the luteal-placental shift for safety.
If the pregnancy continues to develop normally until 8-10 weeks gestation, then we transfer the patient to her obstetrician for care.
The pregnancy begins producing its own hormones approximately 7-8 weeks gestation but we continue the supplements for about 2 weeks after the luteal-placental shift for safety.