In vitro fertilization is a procedure that is used to fertilize an egg outside a woman’s body and is done in a specialized laboratory. It is often considered when other methods of conception have failed. Other reasons for IVF are when the man has very low semen parameters or the woman’s fallopian tubes are blocked.
Here is an outline of the IVF procedures:
Preparation for the IVF cycle includes the evaluation of the uterine and tubal anatomy using a Hysterosalpingogram(HSG) or Saline Infusion Sonogram (SIS). This is an important stage that helps maximize the potential of getting a positive pregnancy. This is also when infectious disease testing is performed on both partners. The hormonal evaluation including ests for thyroid dysfunction and prolactin disorders are done during this stage, as well as semen analysis and ovarian reserve testing. All abnormal testing is treated if possible before the IVF cycle begins.
Some treatment protocols may include taking of oral contraceptive pills for around two to four weeks before gonadotropin injections are administered. This is to suppress the production of hormones or to schedule a cycle. Side effects may include breast tenderness, headache, nausea, unscheduled bleeding, swelling and the risk of blood clots.
Your physician will then pick a carefully designed ovulation induction protocol. This is to make sure that the maximum number of eggs is obtained while still protecting the patient from ovarian hyperstimulation syndrome and other complications. The protocol often involves injectable fertility medication and GnRH analogs. Your doctor will perform frequent monitoring that includes vaginal ultrasounds and checking of hormonal levels to get an optimal result. When an adequate number of follicles are big enough per ultrasound with the appropriate rise of estradiol level, the patient is given an HCG trigger shot.
36 hours after the HCG shot is administered and before the eggs ovulate, the egg retrieval is done. This procedure happens while the patient is sedated. The anesthetist will make sure that the patient is comfortable. Often, the patient will not even feel nor remember any pain. During the procedure, a needle is carefully guided into each of the ovaries. All follicles visualized and large enough per ultrasound are aspirated of their contents. These aspirates are sent to the laboratory for analysis. The eggs are separated from the follicular fluid and are incubated for fertilization.
The eggs can be fertilized using either of the two methods available: the conventional method and the intra-cytoplasmic sperm injection. The IVF team will decide which of two is ideal for fertilization. A lot of factors would be considered. In general, the conventional method allows for a certain number of sperm per egg to be in the same dish and let the sperm enter the egg on its own overnight. The ICSI, on the other hand, involves placing a sperm into the cytoplasm of the egg using a needle and a highly sophisticated operative microscope.
The embryo transfer is often performed three to five days after retrieval. It depends on the couple, as well as the decision of the IVF team. The number of embryos returned also depends on various factors and guidelines. The patient is unlikely to feel any discomfort or pain during this procedure. All the remaining embryos of excellent quality may be frozen for future use.
Assisted hatching is a laboratory technique wherein an artificial opening in the embryo’s shell is made.it is often performed on the day of the transfer before the embryo is loaded into the transfer catheter. This can be done mechanically with a needle or a laser, or chemically by dissolving a hole in the shell using a dilute acid solution. Some programs incorporate assisted hatching into their protocols because they believe it can improve implantation and birth rates. We discuss it with the couple going through the treatment whether they should consider assisted hatching or not.
Luteal phase support is the stage when supplemental progesterone and estradiol are given to make sure there is sufficient hormonal support of the uterine lining. This is given if the woman’s ovaries do not produce enough of these hormones for long enough to completely support a pregnancy.
A blood pregnancy test is done about 12 days after the transfer of the embryo. If a pregnancy was achieved, blood tests and ultrasounds will be done to confirm its viability and to check if there is a multiple pregnancy. If everything is normal at 9 – 10 weeks, the patient will be referred back to her obstetrician.
If you are interested in trying IVF or you have any questions about it, you can talk to Dr. Fay Weisberg from First Steps Fertility. She can walk you through the treatment and provide you with clear answers to your specific questions.
