In-Vitro Fertilization (IVF)
The medical treatment designated as In-vitro fertilization (IVF) is an assisted reproductive technique that both diagnoses and treats many infertility conditions in both men and women. The first IVF baby in the world was born in 1978. The first IVF baby in the United States was born in 1981. This innovative field of medicine has undergone a fast paced evolution over the past 30 years.
The process of IVF involves the stimulation of the ovaries of a woman with injectable fertility medications, allowing the development of multiple eggs (oocytes). The oocytes are retrieved outside of a woman’s body and cultured with a man’s sperm in the laboratory on a petri dish, from there the word “in-vitro” (Latin for glass) comes from. The resulting embryos (usually 2 to 3) are placed back into the womb (uterus) between 3 to 5 days after the oocytes retrieval, in an attempt to establish a healthy pregnancy. IVF is the most commonly used form of assisted reproductive technique around the world.
IVF is usually used to treat infertility caused by fallopian tube occlusion, pelvic adhesions, endometriosis, presence of sperm antibodies, low or absent sperm counts and unexplained infertility. Prior to beginning the IVF treatment, the couple undergo an infertility workup to determine if they are fit candidates for the procedure. The testing includes blood work for hormones/infectious diseases and a hysterosalpingogram or hysteroscopy in the woman. For men, a semen analysis and infectious disease screening are obtained. The traditional IVF treatment protocol consists of several phases which include the suppression phase, the stimulation phase, the egg retrieval phase, the embryo transfer phase and the confirmation of pregnancy. Even though this treatment includes a few steps, the whole treatment is a rather quick process that is usually completed in 6-8 weeks.
The suppression phase
This phase of therapy usually begins the month before the actual egg retrieval. During this phase your ovaries are suppressed in preparation to their stimulation to produce many eggs at once. The suppression of the ovaries is usually achieved by using oral contraceptives and a medication called leuprolide (Lupron). This particular phase of treatment is not used in patients with either advanced reproductive age or low ovarian reserve. For these patients, a different treatment protocol involving microdose leuprolide or a gonadotropin releasing hormone antagonist (ganarelix or cetrorelix) is commonly used.
The stimulation phase
A woman typically produces one matured egg per menstrual cycle. However, in order to optimize the success of the IVF treatment, it is important to obtain many matured eggs. The production of multiple oocytes is achieved by using injectable fertility medications, containing both follicle stimulating hormone (FSH) and luteinizing hormone (LH). These injectable medications are taken once or twice a day for about 10-12 days. The final maturation of the oocytes is induced by taking human chorionic gonadotropin (HCG) prior to oocyte retrieval. In fact, the egg retrieval occurs approximately 36 hours after the HCG injection. The use of these powerful injectable hormones requires careful monitoring of both the follicular sizes (assessed by transvaginal sonogram) and blood tests (to measure the estradiol production). The follicular size and level of estradiol help to assess the development of the eggs. Please note that eggs can not be seen in ultrasounds because they are microscopic cells.
The Egg Retrieval/Embryo Culture Phase
The egg retrieval is a short surgical procedure done under intravenous sedation. Intravenous sedation is administered by an anesthesiologist, to prevent any pain or discomfort. The egg retrieval consists of the introduction of a small caliber needle through the vaginal walls into the ovarian follicles under ultrasound guidance. Every stimulated follicle is usually aspirated. The follicular fluid is then given to the embryologist, who under the microscope, confirms the presence of an oocyte. In a few hours after the retrieval, the oocytes are inseminated or injected with the prepared sperm sample from the male partner. Both oocytes and sperm are then placed in a special culture media that allows the development of the fertilized oocytes into embryos inside of an incubator.
The development of the resulting embryos is monitored closely for the next 2 to 6 days. The healthy embryos will subsequently be transferred to the woman’s uterus or frozen (cryopreserved) for future use, according to the couple’s preference. It is extremely important to start using the progesterone hormone on the day of the egg retrieval in order to prepare the endometrial lining to accept the transferred embryos. The implantation of the embryos into the endometrial lining is what establishes an intrauterine pregnancy, that will ultimately will result in a viable infant.
Exciting changes in the methods of growing and selecting the best embryos have recently been developed. Thus, allowing Dr. Gomez to transfer the best possible embryos back to the uterus, maximizing your chances for a viable pregnancy.
The Embryo Transfer Phase
The embryos will be returned to the uterus between 3 days to 5 days after retrieval. Ideally, if the patient has more than 4 normally dividing embryos on day 3 after retrieval, the embryo culture is extended for 2 days until the embryos reach the blastocyst stage. The blastocyst is an advanced stage of development in which the embryo is more able to implant into the uterus. The embryologist will be providing you with reports on embryo development on a daily basis.
During the embryo transfer, a small, special plastic catheter is passed through the uterine cervix into the endometrial cavity. The transfer usually happens under ultrasound guidance. The transfer does not require any anesthesia. After the embryo transfer takes place, you will rest for a brief period of time in the clinic. Subsequently, patients are advised to take a few days of bed rest after the transfer has taken place. Thereafter, the patient may resume her usual daily activities.
The Confirmation of Pregnancy Phase
During the days that follow the embryo transfer, the patient will be using progesterone. The progesterone hormone will help the developing embryos to implant into the endometrial lining. The pregnancy test in blood is done usually 16-18 days after egg retrieval. If your blood pregnancy test is positive, you will continue using progesterone for about 8 more weeks until the placenta is fully developed. A transvaginal ultrasound is done to confirm the presence of a healthy pregnancy in about 2 weeks after your positive blood test. Pregnancies achieved through IVF usually progress like any other naturally conceived pregnancy, once the pregnancy is well established. Once a viable pregnancy is confirmed, your care will be transferred to the obstetrician of your choice for your routine prenatal care.
In vitro fertilization can be a very successful option for those couples who cannot conceive by means of other infertility therapies. Both Dr. Gomez and our laboratory personnel play a key role in the success of your IVF treatment. Dr. Gomez and the embryology laboratory at Reproductive Medicine Institute specialize in the field of advanced reproductive techniques. Our staff is a team of experienced and highly trained professionals in the latest technologies of assisted reproduction.
Patients that are contemplating this kind of therapy are highly encouraged to attend our monthly IVF seminar, in which all aspects of IVF are discussed in great detail. Please, You can use IVF success rate calculator to predict success rate. We look forward to addressing any concerns or questions that you may have! We are here to help you materialize your desires to build up a family!