In Vitro Fertilization

In Vitro Fertilization (IVF) is a procedure that has been used for more than 30 years to help tens of thousands of couples have babies. IVF is used for couples who have medical or fertility conditions that require IVF or who have not become pregnant using other fertility treatments.

Some of the common reasons patients undergo IVF include:

• Blocked tubes
• Male Causes
• Endometriosis
• Unexplained Infertility
• Preimplantation Genetic Diagnosis (PGD)
• ICSI
• Advanced female age
• Donor egg cycles

In general, female patients should be 44 years of age or younger (except in donor cycles), have at least one normal ovary and a normal uterus and must be in good health. After the patient and physician decide that IVF is the appropriate treatment, patients are pretreated with oral contraceptive medication (birth control pills) for several weeks. On the first day of their menstrual cycle, patients then come in to the office to have an ultrasound and laboratory work performed. Patients then receive daily injections of follicle stimulating hormone (FSH) which stimulates the development of multiple follicles in the ovary. Each follicle contains one egg. Patients undergoing IVF will typically come to the office 3 to 5 times for ultrasounds and laboratory work (measurement of estradiol levels) during a 10-14 day period.

The ultrasounds and estradiol levels allow the physician to determine when the follicles have grown large enough to contain the optimal (highest) number of mature eggs. Once the follicles have grown enough, an injection of hCG (human chorionic gonadotropin) is given to allow the physician to time the removal of the eggs from the ovary. The egg retrieval is usually conducted 35 hours after the hCG injection at our clinic as an outpatient procedure.

IVF Egg Retrieval

The patient receives intravenous sedation (through an IV needle) prior to the procedure. The egg retrieval is performed by placing a long needle through the wall of the vagina and into the ovaries under ultrasound visualization. The eggs are then withdrawn from the follicles through the needle and given to the embryologist in tubes containing culture media. The procedure requires approximately 15 to 30 minutes and patients are monitored for approximately two hours afterwards.

IVF Laboratory

Once the embryologist receives the eggs, the eggs are removed from the follicular fluid and placed in the appropriate media to promote their growth. After several hours, they are exposed to sperm and fertilization is allowed to occur after which the eggs are placed in an incubator. If ICSI (injection of the sperm into the egg) is indicated, it will be performed at this stage.

The following day the eggs are checked to see if they were fertilized. The fertilized eggs are called embryos and are allowed to develop inside of the incubator for 3-5 days after the retrieval. Incubators control environmental conditions including temperature, air quality, acidity, and several other factors that may influence the embryos’ development.

Embryo Transfer

The embryo transfer typically occurs on day 3 or 5 after the egg retrieval and depends on the number and quality of embryos, and plan decided upon between the patient and physician. Embryos on Day 3 are called cleavage-stage embryos and Embryos grown to Day 5 are called Blastocysts. The number of embryos transferred depends upon many factors including patient’s age, embryo quality, cause of infertility, previous IVF history, and other factors unique to each patient’s situation. Any extra embryos can be frozen (cryopreservation) and used for an embryo transfer at a later date.

The embryo transfer takes approximately 15 to 20 minutes. During this procedure, a speculum is placed in the vagina, the cervix is washed and a catheter containing the embryos is placed inside the uterus under ultrasound guidance. After placement of the embryos, patients will return the recovery area briefly, and then sent home to rest. Patients should avoid strenuous exercise or heavy lifting for several days after the procedure.