The IVF Procedure
In vitro fertilization has enabled thousands of couples to have children and is routinely used by infertility clinics. "In vitro" means "fertilization outside of the body", which is where fertilization occurs in an IVF cycle. Eggs are retrieved from the ovaries and combined with sperm in a Petri dish.
IVF may be a first line treatment for women with tubal disease, those of advanced age, ovarian failure (using a donor’s eggs), unexplained infertility or other conditions. IVF is also used to treat moderate to severe male infertility often using intracytoplasmic sperm injection (ICSI). Most couples won't need IVF and will become pregnant using oral medications such as Clomid or intrauterine insemination (IUI) in combination with fertility drugs.
IVF cycles are managed by the infertility specialist using various fertility drugs such as follicle stimulating hormone (FSH), Lupron/Antagon/Ganirelix, hCG, and others. Many eggs are needed in an IVF cycle and FSH is given by injection to stimulate follicular recruitment (each follicle contains an egg). Patients are monitored using ultrasound and estradiol hormone measurements to confirm egg development and reduce the chance of side effects.
Lupron/Antagon/Cetrotide or Ganirelix is used to control the IVF stimulation cycle (a process called downregulation) to insure optimal egg development and prevent premature ovulation. Downregulation prevents the eggs from being ovulated before the retrieval.
Healthy follicles produce estrogen as they mature, and along with progesterone, these hormones cause the endometrium (lining of the uterus) to thicken and become more vascular. This development is needed to support a developing embryo.
Ovulation is stimulated by a surge of luteinizing hormone (LH) in a natural cycle but in an IVF cycle this surge is blocked by the drug used for downregulation. Human chorionic gonadotropin (hCG) mimics the LH surge and is given by injection before retrieval causing final egg maturation.
The eggs are retrieved from the ovaries using transvaginal guided ultrasound under light sedation. The retrieval involves passing a small “needle” through the back of the vagina into the follicle. The egg is gently “suctioned” from the follicle and passed to the embryologist who identifies the eggs and separates them from the follicular fluid before transfer to specially prepared media. The eggs are combined with the husband’s sperm and fertilization occurs.
Sometimes a woman's eggs can't be fertilized due to low ovarian reserve or menopause. An egg donor can be used in these cases.
The male usually provides sperm by masturbation and it is washed and prepared for exposure to the eggs. Intracytoplasmic sperm injection (ICSI) may be needed when male infertility, or other conditions, are present. In the ICSI procedure, a single sperm is injected directly into the egg. If there are no sperm in the ejaculate, they can often be taken from the testicles or the reproductive tract.
After fertilization, the eggs are placed in incubators that have exacting environmental controls where they remain for 3-5 days, or until mature. Five day old embryos have usually developed to the blastocyst stage and have a higher implantation rate. We prefer transferring blastocyst embryos when possible.
Preimplantation genetic diagnosis (PGD) is sometimes used in IVF to screen the embryos for genetic diseases. Many genetic abnormalities can be identified in the embryo and abnormal embryos aren't transferred to the mother. Assisted hatching may be used to facilitate implantation of the embryo in the uterine wall.
Once mature, the embryos are transferred to the uterus in a painless procedure in our office. Progesterone is given to support endometrial development. Patients return for a pregnancy test in two weeks.
Reputable IVF clinics provide their pregnancy success rates to the Centers for Disease Control (CDC) each year. However, the CDC data is usually “dated” by two years. Most clinics also submit their data to the Society of Assisted Reproductive Technology (SART) which is usually “dated” by one year. RCC has consistently delivered IVF success rates above the national average and we report to the CDC and SART.