In Vitro Fertilization (IVF)
In the United States, infertility affects approximately 10% of men and women during their reproductive years. In vitro fertilization (IVF) is one of the more common procedures used to help infertile couples conceive.
IVF is an example of an Assisted Reproductive Technology (ART) in which a woman’s egg is fertilized with a man’s sperm in a laboratory. The resulting embryo is then transferred to the woman’s uterus to implant and develop naturally.
During the IVF process, female patients receive a course of gonadotropins that stimulate the ovaries to produce several eggs for extraction. Collected eggs are then fertilized in vitro. Successful embryos are incubated and monitored for several days, and are then transferred to the patient. The patient is given additional hormone therapy and monitored for signs that implantation occurred – resulting in pregnancy.
Ovulation Induction at DVIF&G
As our patient you will receive an ultrasound on day 2-5 of your menses to assess the uterus and ovaries. You will also have your blood drawn and meet with our nurse practitioner. The same day in the afternoon, you will receive a phone call with instructions regarding your medication.
Ovulation Induction with Oral Medication
When oral medications are used, such as Clomiphene Citrate, Tamoxifen, or Letrozole, patients will begin taking one of these on days 3-5 of their cycle for 5 days. They will return for ultrasound and blood work to be monitored about ten days after they begin medications. Following this visit, ultrasound may need to be repeated every 2 days until a follicle is mature in the ovary. Once it is determined that the patient has a mature follicle and is nearing ovulation, they are given instruction on performing timed intercourse or intrauterine insemination.
Ovulation Induction with Injectable Medication
Injectable medications can also be used to stimulate the ovaries and are used in conjunction with intrauterine insemination (IUI) or in vitro fertilization (IVF). Please be aware that using injections requires frequent blood work and ultrasound visits. Patients typically begin injections on day 3 or 4 of menses and are seen every 2-3 days in the office. This is necessary so medications can be adjusted appropriately. Trigger shots of HCG or other ovulation induction agents are used to time ovulation. In addition, it is sometimes necessary to use birth control pills prior to beginning a treatment cycle in order to suppress the ovaries.
Patients return to the office during the second portion of their cycle in order to have their progesterone measured and assess their response to treatment. At this time may be started on progesterone supplementation. They will have their pregnancy test in our office approximately 2 weeks after ovulation. In IVF cycles, patients return after retrieval for their embryo transfer. This process is outlined below.
In Vitro Fertilization Step by Step
In Vitro Fertilization, or IVF is a process by which one or more eggs (oocytes) are removed from the ovaries with the assistance of ultrasound and fertilized outside the body.
- Ovarian Stimulation: See Ovulation Induction above for your detailed treatment protocol at DVIF&G.
- Egg Retrieval: Patients undergo egg retrieval following approximately 10 days of ovarian stimulation. This procedure takes place in our Marlton office in the Operative Suite, under unconscious sedation. An ultrasound probe is inserted into the vagina and acts as a guide to the needle that is used to collect the eggs. This process is described below.
- Fertilization of Eggs: Eggs are placed in dishes following retrieval. If the sperm count is normal, then the usual procedure is to place a droplet of washed sperm onto each egg. If the male partner has a very low sperm count, then fertilization is achieved by injecting a single sperm into each egg in a process called Intra-Cytoplasmic Sperm Injection (ICSI).
- Embryo Transfer: Successfully fertilized eggs are called embryos. A finite number of selected embryos are placed into the uterus for implantation and establishment of pregnancy. This process bypasses the fallopian tubes. Our embryologists assess the embryo development at multiple stages and choose the best day for embryos to be transferred. Transfers are commonly scheduled for either 3 or 5 days after egg retrieval.
- Embryo Freezing: After embryos have been selected for transfer, the remaining embryos can be frozen and stored in our laboratory for future use. Frozen embryo transfer cycles do not require ovarian stimulation and can be completed in 5-6 weeks. Embryos can remain in storage until patients have completed their families and no longer desire fertility.
Preparing for Your Egg Retrieval During IVF
After about 8-10 days of injectable hormones, the follicle size and ovarian hormone levels are appropriate for the trigger shot to be administered. The timing of the injection is critically important as your egg retrieval procedure is scheduled at a specified hour following this injection. The day before the retrieval you will be asked to not have anything to eat or drink after midnight, as you will be under anesthesia the following day.
It is recommended that the male partner ejaculates on the date of the trigger shot. This allows for a fresh sample of healthy sperm on the day of egg retrieval.
Before the egg retrieval, one of our experienced nursing staff will take your vital signs and you will be taken back to our OR suite, asked to change into a hospital gown and introduced to one of our Certified Registered Nurse Anesthetists (CRNA). The CRNA will ask you health history questions and an IV will be started. A mixture of different medications will be used to deliver unconscious sedation. This means you will be breathing on your own, but will be unable to feel any discomfort.
The egg retrieval involves a transvaginal ultrasound, almost identical to the one used for scans performed during the monitoring process. A needle guide is attached to the shaft of the vaginal probe. Under ultrasound guidance, the needle is passed through the wall of the vagina into the ovary and the fluid within the visible follicles is removed. This is passed on to the embryologist who identifies the egg from each aspirate of fluid. Prior to discharge, you will be informed regarding the number of oocytes retrieved. The day following retrieval, you will be contacted by our embryologist regarding fertilization outcome.
Embryo Donation at DVIF&G
At DVIF&G, couples that have participated in In Vitro Fertilization and have completed their families can choose to donate their embryos. These embryos are frozen in our lab and remain in storage until they are ready to be used. Embryos are available to couples who are deemed eligible for embryo donation by the physician. Eligibility is based on the patient’s fertility history and evaluation in our office.
Couples interested in adopting embryos can choose from available embryos and this is done on a “first come, first serve” basis. Typically 2 embryos are donated at a time, but at any time single embryos are also available. Information regarding the ethnicity and medical background of the couple that donated the embryos is often limited.
Once embryos are selected, the recipient will be asked to attend a session with a therapist to discuss different aspects of embryo adoption and complete a psychosocial evaluation.
A mock embryo transfer and hysteroscopy is performed to assess the uterine cavity. The patient is then prepared for the embryo transfer using oral medications and injections. This takes place over 5-6 weeks and requires the patient to come into the office for approximately 4-5 visits prior to embryo transfer. These visits consist of ultrasounds and blood work. When it is determined that the uterus is ready to receive the embryo, the embryo transfer will take place.
History and Statistics
Since the first successful In Vitro Fertilization (IVF) birth in 1978, the technology has been continually refined by physicians and embryologists, increasing success rates at IVF centers all over the world. Today, the possibility of an IVF pregnancy being achieved has improved from practically nil to a national average of approximately 40%, depending on a patient’s age and medical history.