IVF

Now Offered with Blastocyst Transfer

In-Vitro Fertilization and embryo transfer (IVF-ET) is probably the most well known of the Assisted Reproductive Technologies. Initially known as "test tube baby" technique, it has helped infertile couples conceive and bear children .

IVF-ET was originally developed to treat women with tubal factor infertility. However, it is used today to treat infertility problems due to adhesions, endometriosis, sperm antibodies, moderate male factor, failed GIFT cycles and unexplained infertility.

Description of IVF Process

In order for pregnancy to occur, the egg must be released from the ovary and unite with the sperm. Normally this union, called fertilization, followed by development of an embryo, occurs in the fallopian tube which joins the uterus to the ovary. However, in IVF the egg and sperm are collected from each partner and are united in the laboratory to produce an embryo. This embryo is then transferred back to the uterus for continued growth. The process of IVF involves five major steps:

1. Monitoring the development of follicles in the woman’s ovaries.
2. Aspiration of the follicle’s contents and identification of the eggs.
3. Obtaining a semen specimen from the male partner.
4. Processing the eggs and sperm in the laboratory, enabling fertilization and embryo growth to occur.
5. Transferring the embryo(s) into the uterus.

To control the timing of egg release and to increase the number of eggs collected, the woman will receive ovarian stimulating hormones selected for her individual situation. To determine egg development is satisfactory, she will undergo ultrasound scans of the ovaries to see images of the enlarging follicles which contain the eggs. Hormone levels are also checked by taking a series of blood samples. Using the above information the physician determines when to administer an injection to cause final ripening of the eggs and when to schedule the egg retrieval.

The egg retrieval is performed using a needle guided by transvaginal ultrasound. During this procedure the follicles in the ovary are visualized by placing an ultrasound probe into the woman’s vagina. A needle is then guided into the follicle through the vaginal wall. Fluid from the grape size follicle, which presumably contains the egg, is then withdrawn. This is called follicular aspiration. During this procedure, which may take less than 30 minutes, the patient is given sedation intravenously. Timing is very important for this procedure because unripe eggs may not develop in the laboratory if the retrieval is too early. If the retrieval is too late the eggs may also not develop or may be lost because of release from the ovary. After retrieval, the patient is allowed to rest a short time before going home.

The fluid obtained during the egg retrieval is taken to the laboratory where the eggs are isolated and mixed with properly processed sperm. This mixture is placed in incubators to allow fertilization to take place. The eggs are observed for fertilization 12-16 hours later, and placed in fresh culture medium for continued growth. Once cell division occurs in the fertilized egg it is then referred to as an embryo.

Embryos that have developed satisfactorily are placed in the woman’s uterus three to five days after egg retrieval. This procedure requires cleansing of the vagina with a solution and then transferring the embryo(s) into the uterus through a small catheter. This is a short, painless procedure not requiring sedation. The patient must lie down for a period of time after the embryo transfer. Continuous rest for a day after the transfer is recommended.

Risks and Complications with IVF

Complications of a serious nature are quite uncommon in Assisted Reproduction. Multiple pregnancies and ovarian hyper stimulation syndrome are the most common. Reactions to medications and anesthesia, infection, internal bleeding, and injury to internal organs with possible need for surgical correction are all potential complications but happen very infrequently. If pregnancy is established, the multiple pregnancy rate is definitely higher (twins account for approximately 20% of the pregnancies) than natural conception. Fetal reduction is a procedure which is undesirable but sometimes indicated in higher order multiple pregnancies. The risk for this procedure can be decreased through limitation of the number of embryos transferred. The frequency of miscarriages is slightly higher than natural pregnancy but the frequency of congenital abnormalities is comparable. Tubal pregnancies may be slightly higher than the general population but IVF-ET may actually lower the risk quite dramatically in some patients.

Cancellation of an IVF Cycle

Unfortunately not all cycles lead to successful retrievals or a pregnancy. Some of them must be canceled. Some of the reason are:

1. Poor Ovarian Response. The cycle may be canceled if the ovarian response to hormones is poor as indicated by low blood estradiol levels on cycle day-8 of ovarian stimulation or if you have less than 3 preovulatory size follicles on the day of hCG. Most women at risk of poor ovarian response are those in the late 30s or older.
2. High ovarian response. Women who develop many follicles during a stimulation cycle are at risk of suffering the Ovarian Hyper-Stimulation Syndrome (OHSS). High blood estradiol level is an indicator of hyper stimulation. Preventive measures include: decreasing the dosage of gonadotropin or finishing the cycle without transfer of any embryos (as pregnancy will increase the risk) during that cycle. Instead cryopreserve all resultant embryos and transfer them in a latter cycle. The most extreme measure against OHSS is to cancel the cycle.

The Infertility & IVF Center’s policy to decrease the likelihood of a multiple pregnancy

Maximizing your probability of pregnancy while trying to keep the chance of a multiple pregnancy low is our main objective. However, you must realize that this goal can not be reached in all cases. The number of embryos selected for transfer determines your pregnancy rate and the probability of a multiple pregnancy. It is not advisable to match a predetermined number of embryos for transfer, as some have suggested. Number, quality and developmental stage of the embryos in addition to your age and number of times you have been through IVF&ET cycles are some of the factors to consider in order to select the best number of embryos for transfer. Additional embryos may be frozen and stored.

When Male Infertility is present

Male infertility is a factor in about 30-40% of couples suffering from infertility. Since its inception the Infertility & IVF Center has focused on the diagnosis and treatment of infertility as a "couple problem". Therefore, we have incorporated the latest andrology diagnostic modalities and ART treatments to help you achieve pregnancy. We treat moderate to mild cases of male infertility through the conventional IVF alternative. For severe cases of male infertility we offer in-office procedures that a few years ago were confined to expensive operating room settings. Among them are: Percutaneous Epididymal Sperm Aspiration (PESA) or Testicular Sperm Aspiration (TESA) for those that do not produce sperm in the ejaculate. This may be a more viable alternative for those considering vasectomy reversal. The sperm retrieved can be used fresh to fertilize eggs or stored frozen for subsequent cycles. This method allows you to avoid the expense and discomfort of subsequent PESA or TESA procedures. Bear in mind, however, that depending on the quality and number of sperm collected you may need a second procedure. The spermatozoa collected are utilized to fertilize the oocytes by Intra-Cytoplasmic Sperm Injection (ICSI). These technologies have helped couples have children who a few years ago, were considered hopeless. The pregnancy rates with ICSI are encouraging and similar to those cases where conventional IVF is utilized.