In Vitro Fertilization
In vitro fertilization (IVF) involves harvesting eggs, inseminating them with sperm, and implanting the resulting embryo(s) into the woman’s uterus to achieve pregnancy. IVF was first introduced as an experimental procedure, and the first successful pregnancy in the United States occurred in 1981. Since that time, thousands of healthy babies have been born, and IVF success rates have increased dramatically, with the procedure no longer considered experimental.
Patients undergoing IVF receive daily injections of Follicle Stimulating Hormone (FSH), which causes the ovaries to recruit additional follicles. Depending upon a patient’s specific protocol, she will also administer Lupron or Antagon to prevent premature ovulation (before egg retrieval), which can cause the “loss” of the IVF cycle.
During this medication process, patients will visit the fertility clinic several times for estradiol hormone level measurements and vaginal probe ultrasound. Monitoring is extremely important, and the measurements are used to “adjust” the FSH doses and prevent serious side effects.
Rising estradiol measurements indicate that healthy follicles are developing. Ultrasound is used to visualize and measure the follicles as they develop. It is also used to measure the thickness of the endometrium (the lining of the uterus), which signifies a healthy environment for the developing fetus.
Once the physician judges that the follicles are mature, an injection of human chorionic gonadotrophin (hCG) is given, which signals to the body that ovulation is eminent. The patient will then be scheduled for egg retrieval.
Egg retrieval is accomplished using ultrasound-guided transvaginal egg retrieval under conscious sedation anesthesia. This is an outpatient procedure that is accompanied by minor discomfort. A small needle is passed through the back of the vagina into the follicles located on the ovaries. Each egg is withdrawn from its follicle and passed to the embryologist.
The eggs are washed in special solutions to prepare them for exposure to the partner’s sperm. He provides a semen sample on the day of the retrieval that is prepared for introduction into the culture dishes containing the eggs. For patients who are scheduled for intracytoplasmic sperm injection, each egg will be individually injected with a single sperm.
After exposure to sperm, the fertilized eggs are transferred to incubators that control temperature, gases, and other environmental variables. The resultant embryos remain in the incubators until the embryologist and physician judge that they are mature, usually in three days.
Once the embryos mature, the patient will be scheduled for embryo transfer. If the embryos require procedures such as assisted hatching or preimplantation genetic diagnosis
(PGD), they will be performed prior to inserting the embryos. The embryos are inserted directly into your uterus using a small catheter in a painless procedure.