IN VITRO FERTILIZATION

The indications for advanced reproductive techniques have been extended to include almost every infertility problem: endometriosis, tubal factor, DES exposure, abnormal sperm counts, and sperm antibodies are some of the most common indications. Intracytoplasmic sperm injection (ICSI) is performed when the sperm count or motility is inadequate for IVF. ICSI can also be done with sperm removed directly from the testes.

In vitro fertilization involves the following series of steps:

INDUCTION OF OVULATION

In a normal menstrual cycle only one egg is ovulated. To increase the chance for success, we attempt to gather more than one egg (oocyte). This is done by stimulating the ovary with medications. Most of these medications have to be given by daily injection. Careful monitoring is required for ovulation induction to be successful. The egg is inside a small fluid-filled structure called a follicle. As the eggs mature, more fluid gathers in the follicle and the blood estrogen level rises. By using ultrasound to measure the follicle size and blood estrogen levels, it is possible to accurately judge the proper time for egg retrieval. Blood is usually drawn every morning or every other morning before 9 a.m. for about 14 days. Ultrasounds are done for 5- 7 days starting around cycle day 8. For your convenience, our office opens at 7 a.m. on weekdays and 7:30 a.m. on weekends.

OOCYTE (EGG) RETRIEVAL

Oocyte retrieval is done through the vagina under ultrasound guidance and intravenous sedation. Retrievals take approximately 30 minutes and are done during the morning hours. The egg(s) and the fluid are then given to the laboratory team to evaluate the egg(s) and to begin its incubation for later fertilization. Most patients leave the recovery room one hour after the retrieval. Patients are expected to remain on bed rest the rest of the day.

OOCYTE INSEMINATION AND FERTILIZATION

Your husband/partner will be asked for a semen specimen either before or right after the egg retrieval. In some cases, both mature and immature eggs are found and it may be necessary to perform two separate inseminations. In this case, another semen specimen may be needed the day after surgery. In most cases, insemination of the eggs is done the afternoon of the retrieval.

EMBRYO TRANSFER

Embryo transfer is a process by which we place the fertilized egg (embryo) into the uterus. The procedure takes 5 minutes and does not require anesthesia or medication. A small catheter with the embryos in a small amount of fluid is inserted through the cervix into the uterus. Natural progesterone injections or suppositories will be given to support the attachment and growth of the embryo. Usually the embryo transfers are done three days after retrieval. In some cases, we wait for 5- 6 days and do a blastocyst transfer. A blastocyst is an advanced-stage embryo. Only approximately 30% of good quality Day 3 stage embryos will form blastocysts. Performing a day 3 transfer gives the patient the opportunity to have more embryos to freeze to improve the overall chances to achieve a pregnancy from one egg retrieval.