In vitro fertilization (IVF) treatment is usually recommended after other simpler methods of treatment have been tried and failed. However, based on the individual patient’s age and medical circumstances, IVF may be recommended as a first step in treatment. Thankfully, IVF methods and success have improved dramatically over the last 10 years and continue to improve with every year.
IVF is a complex and expensive process requiring the patients, physician, nurses and laboratory to communicate and work as a team toward a successful outcome.
Initially patients, with their physician, undergo an evaluation of their medical and family history and initiate any testing that may be required to more clearly define the couple’s fertility status. Next, a treatment plan is developed by the physician for the couple with specific protocols assigned to best provide for their success.
Oral and or injectable medications are administered over 10 – 12 days to stimulate ovarian follicle development. Simultaneously, ovarian response to the medication will be monitored by ultrasound and blood hormone levels. Finally, when the follicles are mature and ready for egg retrieval, a single injection of medication is given to complete egg maturation and ready the follicles for egg retrieval.
Following appropriate preparation of the ovarian follicles the patient is ready for egg retrieval. Egg retrieval is a safe and routine procedure requiring light sedation and constant monitoring by an anesthesiologist. Once sedated the physician is given the okay to begin an ultrasound guided egg retrieval. Eggs are aspirated from each follicle and immediately transferred to the adjacent IVF laboratory where an embryologist washes the eggs and prepares them for fertilization and embryo culture. The entire procedure occurs in our outpatient setting and is completed within 30 minutes or less.
While the woman is undergoing egg retrieval, the male partner is asked to collect a fresh semen sample, which is immediately analyzed and prepared for insemination. In some cases, frozen partner semen or donor sperm is used.
After the eggs and sperm have completed processing in the embryology laboratory, mature eggs are inseminated. Most commonly, eggs are inseminated by the ICSI method in which a single sperm is injected into each mature egg. Conventional insemination is occasionally used and involves placing several thousand live sperm around each mature egg. Following either method of insemination, the eggs are evaluated for normal fertilization after 16-18 hours in culture.
After normal fertilization is confirmed, all embryos are placed into growth medium for 3 to 6 days. Embryo development is evaluated on day 3 post-fertilization, day 5 and day 6. One or two embryos are usually either transferred to the patient’s uterus on day 5 and/or cryopreserved on days 5 and 6 for later frozen embryo transfer (FET) cycles. All embryos are transferred and cryopreserved at the blastocyst-stage.
Embryo transfer is a simple procedure, similar to intrauterine insemination, and does not require sedation or anesthesia. Under ultrasound guidance, a thin catheter containing the embryo(s) is passed through the cervix and into the uterus where the embryos are deposited. The catheter is flushed in the Embryology Laboratory to confirm embryo deposition into the uterus. After the embryo transfer, nurses will review instructions with the patient and schedule a date for pregnancy testing (usually 12 days after transfer).
If there are any remaining embryos of acceptable quality after transfer, the couple is given the option to cryopreserve and store these embryos for future use. Embryo cryopreservation is performed using a very effective procedure called Vitrification. Over 95% of embryos that are vitrified and later warmed for FET survive and provide exceptional pregnancy rates.
IVF success is dependent on multiple factors including age, egg quality, duration of infertility, ovarian reserve, infertility diagnosis, embryo genetics, body mass index, some medications, lifestyle choices (smoking, recreational drugs, alcohol use).