In Vitro Fertilization (IVF) is a therapy that is designed to increase the chances of pregnancy for women who have difficulty conceiving naturally. It involves a series of steps that result in the development of viable embryos that can be reintroduced into the patient’s uterus. Currently, it is the most advanced and effective fertility treatment available. Success rates vary based on the age of the patient and the cause of infertility. Some patients achieve a pregnancy after just one round of in vitro fertilization while others require multiple treatment cycles. Additional options may be explored for patients who do not respond to IVF, such as using an egg donor.
A fertility specialist is actually called a reproductive endocrinologist and its an individual that has done three additional years of sub-specialty training beyond their four years of OB/GYN training. And they specialize in the use of hormonal injections and the creation of embryos in laboratory, that’s what separates a reproductive endocrinologist from a general gynecologist.
It’s an intimate and long journey and you have to pick the right doctor so, I always encourage patients to interview their doctor and make sure they are comfortable with the care they are receiving.
The term IVF stands for In-vitro Fertilization. It actually means one thing, it means the fertilization of an egg in a lab, but today when we use the term IVF we are really talking about the whole cycle, the whole series of procedures that culminates in the production of an embryo. IVF success rates are very much in line to the age of the egg provider, women in their thirties see birth rates of about fifty percent per embryo transfer, whereas women in their early forties the rate is about twenty-five percent. And that’s really for women up to about age forty three. Beyond that it’s really very low. And so age is a big indicator of IVF success. The other major factor is the quality of the IVF lab and the personnel working in that lab, those are called embryologist. So a skilled embryologist and labs that focus on gentle approaches to embryos really can have an impact on the overall success rate of the IVF cycle.
The side effects relate to IVF are actually quite minimal. Women can feel little local irritation from the injectable hormones, it’s a small needle that’s used to inject the hormones in the fat under the abdominal wall. Women also feel tired and bloated and might have some weight gain during the hormonal injections. But that weight gain typically goes away after the procedure is finished. The greatest risk for IVF is multiple pregnancies and that’s because to accommodate the decline in egg quality, we transfer more than one embryo especially to women over thirty five and over forty.
One new method that can help limit the chance for twins or triplets is called Pre-implantation Genetic screening also known as Pre-implantation genetic diagnosis PGS or PGD. In this procedure we grow the embryos till they are five days old and then take some cells out of the embryo and test those cells to see if the embryo is chromosomally normal. We also find out if it is a boy or a girl and so we can replace or transfer one embryo that is chromosomally normal and essentially eliminate the risk for twins or higher order pregnancies. It’s very effective and very accurate.
Technically, “in vitro fertilization” only refers to the process of fertilizing an egg outside the body. However, the term “IVF” has come to be used to describe the entire treatment cycle.
In natural conception, the fallopian tube provides three functions: it picks up the ovulated egg, it provides an environment in which fertilization can occur and it transports the resulting embryo to the uterus for implantation. In cases where the fallopian tube is not functional or other impediments to fertility are present, the function of the fallopian tube can be replaced by in vitro fertilization (IVF).
IVF is the most technologically advanced and successful form of fertility therapy available. The pregnancy rates associated with IVF are the highest of all fertility treatments across every age bracket. This is because IVF optimizes all of the steps associated with the reproductive process. In a natural cycle, only one egg is ovulated, fertilized and implanted in the uterus. IVF augments these processes by stimulating multiple eggs to grow, fertilizing them directly in the laboratory (in vitro) and placing multiple embryos into the uterus.
The IVF cycle has three phases: ovarian stimulation and egg retrieval; fertilization and embryo culture; and embryo transfer and progesterone support. A description of these three main principles follows.
The patient receives a series of hormone injections over a period of several weeks to stimulate the ovaries. These hormones stimulate a number of her existing eggs. Note, these are the eggs that would be naturally lost that month – stimulating multiple eggs does not lower the supply of future eggs. The eggs are then retrieved in a quick outpatient procedure, by piercing an ultrasound-guided needle through the vaginal wall.
In the laboratory, the eggs are isolated from the fluid and each is placed in a dish filled with culture media. Fresh or frozen sperm can be used to fertilize several of the patient’s eggs in an IVF dish. If needed to help improve the fertilization process, sperm can be injected directly into the egg in a procedure called intracytoplasmic sperm injection (ICSI). The eggs are observed to ensure that fertilization is successful. Then, the embryos are allowed to grow for 3-5 days. At this point, they become ready for transfer back into the patient’s body. One can choose to have excess embryos frozen for later use.
Once the eggs have been fertilized, the embryos are maintained in the laboratory before being transferred to the uterus. Typically, embryo transfer takes place after three days. A blastocyst transfer occurs after five days, and in the case of a tubal embryo transfer, the embryos are placed into the fallopian tube 24-48 hours after aspiration.
A fertilized embryo is delivered into the patient’s uterus via a narrow, flexible catheter, in a procedure similar to that used in intrauterine insemination (IUI). Rather than simply being released into the womb, the embryo is precisely placed on the wall of the uterus to increase its chances of survival.
The transfer process is critical to the success of In Vitro Fertilization. If an embryo is not placed in the correct location, or if a uterine contraction causes it to move once it has been placed inside the uterus, the embryo may fail to implant. We have a great deal of experience in this delicate process, and we utilize special catheters and ultrasound to assist us in the transfer. Additionally, the embryo transfer is practiced in advance of the actual procedure. In some circumstances, a tubal embryo transfer may be recommended for patients who do not respond well to traditional embryo transfers.
Within two weeks, a pregnancy test can be used to confirm successful implantation. Progesterone hormone treatment is continued through the first trimester. This keeps the lining of the uterine wall thick enough to nurture the implanted embryo properly.
For a description of the procedure in greater detail, please see The IVF Cycle.