Conventional In-Vitro Fertilization & Embryo Transfer (IVF/ET)
When less aggressive or simpler methods of infertility treatments have failed, in vitro fertilization (IVF) may be an option that may provide you with a better chance of success (pregnancy). In some couples with certain medical conditions, IVF may be the first step in the treatment of infertility. These conditions include blocked fallopian tubes, severe endometriosis, male infertility and unexplained infertility.
IVF is a complex and expensive procedure and involves combining a sperm and an egg outside the body in the laboratory and transferring the resulting embryo(s) back into the uterus.
There is a basic evaluation that couples have to undergo before they are considered for IVF. If eligible, a treatment plan is selected by the physician. The specific protocol assigned takes into consideration each couples unique circumstances with the hopes of providing the best outcomes.
IVF involves a series of coordinated steps and they are as follows:
- Ovarian stimulation – Injectable medications are provided daily for an average of 10 – 12 days to stimulate the woman’s ovaries to produce multiple eggs. The ovarian response to the medications are monitored with the help of ultrasound and blood work and medication dosing is adjusted accordingly.
- Egg retrieval – When the physician determines that the eggs are mature and ready, the woman undergoes an ultrasound guided egg retrieval procedure under light sedation in an outpatient setting. During this approximately 30 min. procedure, a needle is placed through the vagina into the ovaries and all follicles (eggs) are aspirated and immediately evaluated by our laboratory personel.
- Sperm collection – 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 or donor sperm is used.
- Fertilization in the laboratory – After the eggs and sperm have been analyzed and prepared, the eggs are then inseminated and fertilization determined 16-18 hours later. The eggs are Inseminated in one of two ways:
- Conventional insemination – a specific amount of prepared sperm is mixed with each egg in a culture dish
- Intracytoplasmic sperm injection (ICSI) – a normal sperm is directly injected into an egg in a culture dish
- Embryo culture – After fertilization, the embryos are allowed to grow in special media for 3 – 5 days until they have reached optimal growth.
- Embryo transfer – Based on number of embryos available and their quality, 1-3 embryos are then transferred into the uterus 3-5 days after egg retrieval. A day 5 blastocyst transfer is recommended when more than 5 embryos are available because it allows the embryologist to select the better embryos. Embryo transfer is a simple procedure, similar to an intrauterine insemination, and does not require sedation or anesthesia. Under ultrasound guidance, a thin long catheter containing the embryos is passed through the cervix into the uterus where the embryos are placed. After embryo transfer, 3-5 days of pelvic rest is recommended. A pregnancy test is scheduled 12 days later.
- Embryo cryopreservation – If there are any remaining embryos of acceptable quality after transfer, the couple is given the option to freeze and store the excess embryos for future use.
IVF success is dependent on multiple factors including woman’s age, duration of infertility, eqq quality (ovarian reserve), diagnosis, embryo quality, tobacco smoking and body mass index.
Complications of IVF:
- Multiple pregnancy – up to 30%, mostly twins.
- Ovarian hyperstimulation syndrome (OHSS) – ovarian enlargement with multiple cysts in association with other symptoms such as nausea, vomiting, diarrhea, weight gain, bloating and abdominal pain. Mild OHSS occurs in up to 20%, severe OHSS 1-2%.
- Ovarian torsion –twisting of ovaries, may require surgery.