ABOUT IVF

In vitro fertilization (IVF) is a treatment option used for couples with infertility that cannot be treated using simpler methods. This procedure has excellent success rate but requires significant effort and can be expensive. For all of these reasons, advanced treatment options can be stressful. These natural stresses can be minimized if you understand the nuances of the various procedures. Understanding the applications for each procedure will help you obtain the appropriate treatment and maximize your chance for success.

Hormone injections are given to stimulate multiple egg production. This is because the normal cycle usually produces one egg only, and pregnancy rates in IVF are better if a number of eggs can be collected. These injections are usually given subcutaneously (under the skin) and are much less uncomfortable than the previous generations of medication. We then monitor the progress of ovulation induction with ultrasounds and blood estrogen levels over several days.

An egg retrieval is performed by placing a special needle into the ovarian follicle and removing the fluid that contains the egg. This is a relatively minor procedure and is performed by visualizing the follicles with a vaginal ultrasound probe. A needle is directed alongside the probe, through the vaginal wall, and into the ovary. To avoid any discomfort, strong, short acting intravenous sedation is provided.

Once the follicular fluid is removed from the follicle, the eggs are identified by the embryologist and placed into an inubator. The eggs are fertilized with sperm later that day by conventional insemination or by Intracytoplasmic Sperm Injection (ICSI).

During conventional insemination approximately 50,000 sperm are placed with each egg in a culture dish and left together overnight to undergo the fertilization process. The ICSI technique is used to fertilize mature eggs in the event of sperm or egg abnormalities. Under the microscope, the embryologist picks up a single sperm and injects it directly into the cytoplasm of the egg using a small glass needle.

ICSI allows couples with very low sperm counts or poor quality sperm to achieve fertilization and pregnancy rates equal to traditional IVF. It is also recommended for couples who have not achieved fertilization in prior IVF attempts. Special urological procedures are available to you for cases where it is difficult to obtain sperm or for men with no sperm in the ejaculate.

The eggs will be checked the following day to document fertilization and again the next day to evaluate for early cell division. They are now called embryos and are placed in a solution called media to promote growth. Until recently, embryos were cultured for three days and then transferred to the uterus and/or cryopreserved (frozen). We now have the ability to grow the embryos for five or six days until they reach the blastocyst stage. For some couples these blastocysts may have a greater chance of implantation, allowing us to transfer fewer embryos and lower the risk of multiple birth while increasing the chance of pregnancy.

On day two or three after fertilization, the embryos will be evaluated for blastocyst culture. If there is a sufficient number of dividing embryos they will be placed in special blastocyst media and grown for two or three additional days.

Embryos may be transferred on day 3, 5, or 6 after egg retrieval. Transfers on day 5 or 6 are called Blastocyst Transfers. They are placed through the cervix into the uterine cavity using a small, soft catheter. This procedure usually requires no anesthesia. It is similar to the Mock Embryo Transfer which will be performed prior to the actual IVF cycle.