In Vitro FertilizationColoCRM2018-10-30T11:19:02+00:00
In Vitro Fertilization – IVF Treatment Process
Unfortunately, infertility has been estimated to affect over 7 million people in the United States alone. Many individuals or couples can be treated with less aggressive measures. However, when these more conservative measures fail or in circumstances in which they are not appropriate, in vitro fertilization (IVF) may become necessary. In a nutshell, IVF is a method of assisted reproduction in which sperm and egg are combined in a laboratory setting to allow for fertilization outside of the body with subsequent transfer of the embryo back into the uterus.
Many couples and individuals seek in vitro fertilization because of problems with infertility that may not respond to less aggressive measures. IVF is usually the treatment of choice when a woman has blocked or damaged fallopian tubes or no fallopian tubes at all or when a male has extremely compromised sperm concentrations or is producing no sperm at all, including those who have had prior vasectomies or failed vasectomy reversals. In addition, this technique has been commonly used in women who are infertile due to endometriosis, those who do not ovulate and do not respond to lesser aggressive fertility measures, and those with so-called unexplained infertility with failure to conceive with lesser aggressive measures. Others require IVF to allow for comprehensive chromosomal screening of embryos (CCS) due to recurrent pregnancy loss or single-gene preimplantation diagnosis.
In vitro fertilization has become an extremely safe and effective process. The pregnancy rate by age is greater than that achieved with natural conception, although the rate of miscarriages with IVF pregnancies is about the same as those conceived naturally unless comprehensive chromosomal screening of embryos is performed, in which case, the miscarriage rate is significantly lower, as will be discussed later. In the United States it is required by law for cycle outcomes to be reported by the Center for Disease Control (CDC). CCRM also reports these outcomes directly to the Society of Assisted Reproductive Technologies (SART), of which we have been longstanding members. This organization, which represents over 95% of clinics in the United States, requires strict adherence to practice, advertising, and reporting guidelines which is not required by reporting directly to the CDC. This is something of which we are proud.
Here is an overview of how IVF works:
First, fertility medications are given to stimulate the ovaries to produce an increased number of eggs. A personalized protocol is developed based on the woman’s age, past history and results of both hormonal and ultrasound evaluations. The individual is monitored carefully with serial ultrasound examinations and blood tests.
When the eggs are predicted to be mature, they are retrieved through a minor surgical procedure performed under intravenous anesthesia, in which a needle is inserted through the vagina into the ovary to remove the eggs under direct ultrasound guidance. The fluid is then examined by skilled embryologists to isolate the eggs.
A sperm sample is separated from the semen and carefully prepared in culture medium in a laboratory setting. With conventional insemination techniques, a specific concentration of separated sperm is allowed to fertilize the eggs in a laboratory setting. In other situations, a single sperm is injected into each egg through a procedure called ICSI (intracytoplasmic sperm injection).
After approximately 18 hours, fertilization can be documented. Embryos are then incubated in specified culture medium in a tightly controlled laboratory environment 5 or 6 days (blastocyst stage). At this point, an agreed upon number of embryos are typically transferred into the woman’s uterus using a painless ultrasound guided approach. Additional embryos are cryopreserved. In some circumstances including those in which comprehensive chromosomal screening or single-gene analysis of embryos is to be performed, all embryos are cryopreserved. The pregnancy test is obtained 9 to 11 days after the embryo transfer via a blood test.
The steps involved in an IVF treatment cycle include controlled ovarian hyperstimulation, egg retrieval, fertilization, embryo culture, embryo transfer, and embryo freezing or cryopreservation.