In Vitro Fertilization (IVF) is a method of assisted reproduction in which the man’s sperm and the woman’s egg are combined in a laboratory. Following fertilization and early embryo development in the laboratory, an appropriate number of embryos are transferred to the woman’s uterus.
Natural conception begins with the release of a single ovum (egg) from the woman’s ovaries. The fallopian tube picks up the egg, and it is within the fallopian tube that the sperm will fertilize the egg. Following fertilization, the zygote, or early embryo, stays in the tube for about three days while it divides into more and more cells. The embryo is then transported to the uterus where it will “float” for approximately three days until it implants into the wall of the uterus.
IVF was originally designed for couples in which the woman’s fallopian tubes were absent or damaged. The events normally occurring in the fallopian tubes, including fertilization and early embryo development, occur in the laboratory instead. Success with IVF has progressed to the point where it is now an alternative, if not the treatment of choice, for many couples with impaired fertility. IVF has revolutionized the approach to infertility.
What is the Basic IVF Process?
IVF involves the following steps:
1. Ovarian Stimulation and Egg Development
During the first half of a normal cycle, follicles (the fluid-filled sacs that contain the eggs) develop, and a single egg is released. There is no question that the chances of success with IVF increase if there is more than one oocyte (immature egg) available for use in the laboratory. A combination of medications and hormones is routinely utilized during the early part of an IVF cycle. The goal is the synchronous development of multiple follicles and eggs. The most commonly used combinations are Lupron and FSH or Ganirelix and FSH.
The response to the medications is monitored through a combination of blood tests and pelvic ultrasounds. Once this monitoring suggests that the eggs have reached maturity, human chorionic gonadotropin (hCG) is administered. The egg retrieval is scheduled 36 hours after hCG administration.
2. The Egg Retrieval
The mature eggs are removed from the ovaries with a needle that is inserted through the vagina. This procedure is performed using ultrasound guidance, which allows precise placement of the needle into each follicle. Intravenous sedation makes this a painless procedure – general anesthesia is not required. The contents of each follicle are collected into a test tube and immediately transferred into the laboratory, where the eggs are identified, isolated, evaluated and placed into an incubator in less then two minutes.
3. The Laboratory
The eggs, sperm and embryos are handled under sterile conditions at all times. Once an egg is identified, it is placed into a special culture medium for two to six hours before it is inseminated. After the egg retrieval, the man will be asked to obtain a sperm sample. The sperm are then isolated from the remainder of the ejaculate and added to the eggs to allow fertilization to occur. After 18 to 24 hours, the first signs of fertilization occur. The laboratory personnel will notify you at this time as to how many of the eggs successfully fertilized. The embryos are incubated in the laboratory for an additional 48 to 96 hours, depending on the stage of embryo your doctor is recommending for transfer.
4. The Embryo Transfer
The embryo transfer is performed in a small room adjacent to the laboratory. It is an essentially painless procedure. During the procedure, an appropriate number of embryos are loaded into a small catheter. This catheter is then introduced through the cervix and into the uterus. A physician will use ultrasound guidance to check the placement of the catheter. Once the catheter is placed, the embryos are gently deposited into the uterus. You will be released to go home right after your transfer. After you return home, we suggest very minimal activity for the first 24 to 48 hours.
5. After the Transfer
Progesterone, the hormone responsible for preparing the lining of the uterus to accept a pregnancy, is administered for several weeks following the transfer.
The first pregnancy test can be done as soon as 15 days after the retrieval. If the results are positive, a pregnancy test is repeated two days later. If the tests are positive, we will continue to provide your care, including ultrasounds for the next several months and then refer you back to your obstetrician.
If the tests are negative, we will arrange a post-cycle consultation, at which time the events of the cycle will be analyzed and plans made for the future. If unsuccessful, an attempt may be repeated in two to three months.
Your participation in this program will remain strictly confidential.
Expectations from the IVF Cycle
Midwest Fertility’s pregnancy and delivery rates are among the best in the country. Unfortunately, there are many reasons IVF procedures may be unsuccessful. Reasons may include:
The attempt may be cancelled prior to egg retrieval if an adequate ovarian response is not achieved.
- Not all follicles contain an egg.
- Not all eggs will fertilize.
- Not all embryos will develop normally.
We try very hard to minimize a couple’s risk of higher-order multiple pregnancies while maximizing their chances of achieving a pregnancy. For most couples under age 38, we will transfer one to two embryos, depending on their stage of development.