In Vitro Fertilization

In vitro fertilization is an option for many people who cannot conceive naturally or who have failed to conceive after attempting ovulation induction therapy.  IVF in its simplest terms is the process of stimulating the ovaries into producing multiple mature eggs, retrieving them from the ovaries, combining the eggs with sperm in the laboratory and once fertilization occurs, transferring the early embryos back into to the woman's uterus.  Recently the American Society of Reproductive Medicine has recommended IVF as the first line of therapy for several types of infertility patients.  The patient's diagnosis and history are the primary determining factors in choosing the appropriate course of treatment.

Various medications are given during an IVF cycle, and your own drug protocol will be highly individualized based on your unique medical history.

The IVF cycle consists of the following five stages:

  1. Suppression
  2. Stimulation
  3. Retrieval
  4. Transfer
  5. Post-transfer

During the suppression stage, you will be given medications that shut down or "quiet" the ovaries.  This induced rest period allows the ovaries to respond better to hormonal stimulation.  Also, suppressing the natural ovulatory cycle keeps the body from recruiting a single dominant follicle during the induced cycle, allowing for the maturation of multiple eggs.  The suppression drugs you will be prescribed may include: oral contraceptives or Aygestin and Lupron or a GnRH Antagonist.

Next you will begin the stimulation phase of the IVF cycle, during which you will take injectable hormones (FSH and/or hMG) to stimulate egg maturation, along with suppression drugs (Lupron or GnRH Antagonist) to keep your natural ovulatory cycle from interfering with the recruitment of multiple eggs.  During this stage, you will be monitored regularly with blood tests and ultrasounds, and when the eggs are on the verge of maturation, as determined by the size of the follicles, you will be given an exact time to administer a single dose of hCG, which completes the maturation of the eggs and readies them for retrieval.

Egg retrieval, also known as follicle aspiration, is scheduled to take place about 35 hours after the hCG is administered. By this time, the eggs have separated and are floating in their follicles.  A needle is passed through the upper vaginal wall, and with the aid of vaginal ultrasound, fluid is removed from the follicles under gentle suction.  The procedure generally lasts from 10 to 30 minutes. During the retrieval, an anesthesiologist will administer light anesthesia (conscious sedation) through an intravenous drip (IV).  After the egg retrieval, you may experience light to moderately severe pain, although most patients tolerate the procedure very well.

** You should not eat or drink for at least 8 hours prior to an egg retrieval**

The eggs are then examined microscopically by one of our embryologists.  Next, the eggs are inseminated with sperm and then placed in an incubator.  Often insemination involves ICSI (intracytoplasmic sperm injection), especially in cases of Male Factor Infertility.  In ICSI, a single sperm is injected, using a tiny needle, directly into the egg to increase the odds of fertilization.  The eggs are closely monitored during this time to see whether fertilization occurs.  If an embryo develops, it is then closely monitored by the embryologist for cell division.  A healthy embryo should divide to form 2 cells, then divide again to form 4 cells and again to form 8 cells.  This division of the cells to an 8-celled embryo usually occurs on the 3rd day after egg retrieval, if the embryo is healthy.

The next stage of treatment is the transfer stage.  Three to five days after the egg retrieval, the embryos are returned to the uterine cavity via a soft, thin catheter in a procedure known as embryo transfer.  Healthy unused embryos can be frozen through a process known as cryopreservation and used for future attempts.  Cryopreserved embryos can be stored for years and still remain viable.

The final stage of IVF is the post-transfer stage, during which the woman waits 11 days to find out whether the transfer has led to a pregnancy.  Once the embryo transfer has taken place you should stay away from alcohol, greatly limit your caffeine consumption, and not smoke cigarettes or use recreational drugs.  You should also avoid the following activities: heavy lifting; strenuous exercise and housework, including vacuuming; bouncing activities such as aerobics or horseback riding; hot tubs, saunas, and Jacuzzis; swimming and baths; and sexual intercourse.  You will most likely be prescribed some form of progesterone to help maintain a rich endometrial lining during this time, and may be prescribed baby aspirin and/or Prednisone.  If your first pregnancy test is positive, you will be scheduled to take a second blood test in two days; if that pregnancy test is also positive you will be scheduled for an ultrasound on the following week so that we can monitor your pregnancy.

 


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