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In Vitro Fertilization, IVF and PGD
The advent of in vitro fertilization (IVF) gave new hope to thousands of couples suffering from infertility who otherwise had no hope of conceiving a child. When a woman experienced premature ovarian failure, she had few treatment options. Donor egg IVF makes it possible for these women to conceive using the eggs of a donor.
Also, men who had significant male factor infertility had little chance of creating a genetically related child. It was usually necessary to utilize a sperm donor and, of course, the offspring would not have the genetic makeup of the father.
Intracytoplasmic sperm injection (ICSI) with IVF revolutionized the treatment of male factor infertility. A man with as few as one sperm could father a child because using ICSI the sperm is injected directly into the egg. Using other techniques, sperm can be withdrawn directly from the reproductive tract when their are none in the ejaculate.
Explanation of the IVF Process
In Vitro Fertilization (IVF) requires
a team of experts, takes several weeks and consists
of five basic steps:
IVF and Ovarian Follicle Development
IVF is made possible by the administration of follicle stimulating hormone (FSH) which causes the ovary to develop multiple follicles each containing an egg. A follicle is
similar to a small bag of water that houses the egg
and is usually visualized on the video screen of an
ultrasound machine. Many eggs are needed to increase the chances of a successfully IVF procedure. In a normal, unstimulated cycle, women usually develop a single
egg each month. While IVF has been successful with as few as one egg (unstimulated cycle), the pregnancy rates are very low.
During the IVF cycle, egg development is monitored closely to provide information of adjusting medication dosages and preventing medication side effects. The monitoring of the egg development
is accomplished in three ways:
- Ultrasound monitoring of follicle growth during IVF
- Monitoring of blood or urinary
estrogen (E2), progesterone (P4), and luteinizing
hormone (LH)
- Physician's interpretation
of the cycle data
The
IVF team (physicians, nurses, and embryologists)
evaluate these data on an ongoing basis for the appropriate
timing of the administration of the human chorionic
gonadotropin (hCG) injection to trigger the final stages
of ovulation. The hCG injection is usually given about
35 hours before egg retrieval is scheduled.
Egg Harvesting - Oocyte Retrieval
in IVF
In the early days of IVF,
the eggs were retrieved by laparoscopy. Today, they
are collected by transvaginal ultrasound-guided oocyte
aspiration. This is a simple technique which involves
the introduction of a small needle through the
vaginal wall guided by the ultrasonic probe. This technique
is easy to perform and has been utilized by our group
since its introduction in the US in 1985. The vast majority
of HRC's patients undergo the egg harvesting procedure
in our office under local anesthesia and IV sedation.
In this way, there is no hospital fee and HRC does not
charge a facility fee for the aspiration.
In Vitro Fertilization Laboratory
in IVF
After the oocyte collection procedure an incubator which houses a powerful
dissecting microscope receives the follicular fluid
containing the eggs. This fluid is placed in a special
culture medium which consists of several essential chemicals.
The eggs remain in the carefully-controlled extracorporeal
system for 4-6 hours before the embryologist adds the
specially-processed sperm to allow the fertilization
process to occur. (If there is male factor infertility, we would probably perform ICSI to assure fertilization).
After a period
of 16-20 hours, the eggs are examined and checked for
the first signs of fertilization. At this time, the
embryologist can observe under the microscope "two
pronuclei". The egg essentially looks like a "round
ball with two eyes" and they represent the genetic
material from the husband and wife. After two to three
days, if the embryos are growing normally, they are
ready for the embryo transfer.
Embryo
Transfer in IVF
The IVF embryo transfer is not a complicated
procedure and is performed in our office without anesthesia.
The embryos are placed in a catheter (a tubular instrument)
and then the tiny plastic tube is introduced into the
uterus through the cervix and the embryo(s) are transferred
into the uterine cavity. The woman is required to
stay in a gynecological position for a few minutes,
then her legs are repositioned to be more comfortable.
We require the patient to remain lying down for about
an hour after the embryos have been replaced into the
uterus.
 After
the embryo transfer, we request patients to absolutely
restrict their physical activities for the first 24-72
hours and until a pregnancy test is performed approximately
9-12 days post transfer to moderately restrict their
activities.
Luteal Phase
Monitoring & Support
This phase consists
of monitoring the blood levels of progesterone, estradiol,
and BhCG (pregnancy test). If there is a positive pregnancy
test, close monitoring of the early pregnancy is highly
advisable. At HRC, we continue to perform the blood
tests plus the pregnancy ultrasound for detection
of the baby's heartbeat. The evaluation of the number
of embryos implanted is usually done between the 4th
and 6th week post transfer.
In the event of an unsuccessful
cycle, HRC's patients are encouraged to talk to their
physician to help them understand the cycle outcome and to actively
participate in planning for future treatments. During
a treatment cycle, we gather an enormous amount of information
which is frequently beneficial in tailoring a patient's
future treatments.
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