In Vitro Fertilization
A series of procedures used to treat fertility or genetic problems and assist with the conception of a child.
During In Vitro Fertilization (IVF), mature eggs are collected (retrieved) from the ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs are implanted in your uterus. One cycle of IVF takes about two weeks.
IVF is the most effective form of assisted reproductive technology. The procedure can be done using your own eggs and your partner’s sperm. Or IVF may involve eggs, sperm or embryos from a known or anonymous donor. In some cases, a gestational carrier (a woman who has an embryo implanted in her uterus) might be used.
Your chances of having a healthy baby using IVF depend on many factors, such as your age and the cause of infertility. Your doctor can help you understand how IVF works, the potential risks and whether this method of treating infertility is right for you.
IVF involves several steps:
- Controlled Ovarian Stimulation
- Egg Retrieval
- Sperm Retrieval
- Embryo Transfer
One cycle through these steps can take about 10-20 days and more than one cycle may be required.
1. CONTROLLED OVARIAN STIMULATION
If you’re using your own eggs during IVF, at the start of a cycle you’ll begin treatment with synthetic hormones to stimulate your ovaries to produce multiple eggs, rather than a single egg that normally develops each month. Multiple eggs are needed because some eggs won’t fertilize or develop normally after fertilization.
Typically, you’ll need 1-2 weeks of ovarian stimulation before your eggs are ready for retrieval. To determine when the eggs are ready for collection, your doctor will likely perform:
- Vaginal Ultrasound – An imaging exam of your ovaries to monitor the development of follicles (fluid-filled ovarian sacs where eggs mature).
- Blood Tests– This is done to measure your response to ovarian stimulation medications. Estrogen levels typically increase as follicles develop and progesterone levels remain low until after ovulation.
2. EGG RETRIEVAL
During egg retrieval, you’ll be sedated and given pain medication. Transvaginal ultrasound aspiration is the usual retrieval method. An ultrasound probe is inserted into your vagina to identify follicles. Then a thin needle is inserted into an ultrasound guide to go through the vagina and into the follicles to retrieve the eggs.
If your ovaries aren’t accessible through transvaginal ultrasound, an abdominal surgery or laparoscopy (a procedure in which a tiny incision is made near your navel and a slender viewing instrument called a “laparoscope” is inserted) may be used to guide the needle.
The eggs are then removed from the follicles through a needle connected to a suction device. Multiple eggs can be removed in about 20 minutes.
After egg retrieval, you may experience cramping and feelings of fullness or pressure. Mature eggs are placed in a nutritive liquid (culture medium) and incubated. Eggs that appear healthy and mature will be mixed with sperm to attempt to create embryos. However, not all eggs may be successfully fertilized.
3. SPERM RETRIEVAL
If you’re using your partner’s sperm, he’ll provide a semen sample the morning of egg retrieval. Other methods, such as testicular aspiration (the use of a needle or surgical procedure to extract sperm directly from the testicle) are sometimes required. Donor sperm also can be used. Sperm are separated from the semen fluid in the lab.
Fertilization can be attempted using two common methods:
- Insemination – Healthy sperm and mature eggs are mixed and incubated overnight.
- Intracytoplasmic Sperm Injection (ICSI) – A single healthy sperm is injected directly into each mature egg. ICSI is often used when semen quality or number is a problem or if fertilization attempts during prior IVF cycles failed.
In certain situations, your doctor may recommend other procedures before embryo transfer:
- Assisted Hatching – On Day 3 after fertilization, an embryo “hatches” from its surrounding membrane (zona pellucida), allowing it to implant into the lining of the uterus. If you’re an older woman, or if you have had multiple failed IVF attempts, your doctor might recommend assisted hatching – A technique in which a hole is made in the zona pellucida just before transfer to help the embryo hatch and implant.
- Preimplantation Genetic Testing –Embryos can develop in the incubator until they reach a stage when a small sample can be removed and tested for specific genetic diseases or the correct number of chromosomes, typically after 5-6 days of development. Embryos that don’t contain affected genes or chromosomes can be transferred to your uterus. While preimplantation genetic testing can reduce the likelihood that a parent will pass on a genetic problem, it can’t eliminate the risk. Prenatal testing may still be recommended.
5. EMBRYO TRANSFER
Embryo transfer usually takes place on Day 3 or 5 after egg retrieval. You might be given a mild sedative, as a doctor or nurse will insert a long, thin and flexible tube called a catheter into your vagina, through your cervix and into your uterus.
A syringe containing one or more embryos suspended in a small amount of fluid is attached to the end of the catheter. Using the syringe, the doctor or nurse places the embryo or embryos into your uterus.
If successful, an embryo will implant in the lining of your uterus about six to 10 days after egg transfer.
The procedure is usually painless, although you might experience mild cramping. After the embryo transfer, you can resume your normal daily activities. However, your ovaries may still be enlarged. Consider avoiding vigorous activity, hot tubs, saunas (any activity that increases core body temperature) and avoid lifting anything over 20 pounds.
Typical side effects include:
- Passing a small amount of clear or bloody fluid shortly after the procedure, due to the swabbing of the cervix before the embryo transfer
- Breast tenderness due to high estrogen levels
- Mild bloating
- Mild cramping
If you develop moderate or severe pain after the embryo transfer, contact your doctor. He/she will evaluate you for complications, such as infection, and severe ovarian hyperstimulation syndrome.
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