In Vitro Fertilization (IVF)
In Vitro Fertilization (IVF) is the process in which oocytes (eggs) are fertilized outside the body. There are several steps required for IVF. The first step is ovulation induction in which medication is taken in order to produce multiple follicles and eggs. The next step in the process is oocyte retrieval, where the matured oocytes are removed from the ovaries. In a process called insemination, the oocytes are exposed to sperm to fertilize the eggs in order to generate embryos. Embryos are then transferred back to the uterus. The time period after oocyte retrieval and embryo transfer is the luteal phase. Extra embryos are typically cryopreserved, according to each individual’s wishes.
During an IVF cycle, a woman begins taking ovulation induction medications to stimulate the ovaries to produce multiple follicles, each of which may contain an egg. There are several different medications that can be used for ovulation induction for IVF. The medication you will be prescribed by your doctor at RMA of Philadelphia and Central Pennsylvania is determined by a number of factors, including your medical history, age and previous experience with infertility medication.
Egg retrieval is a minor surgical procedure that is performed right at our practice. You will be lightly sedated and feel no discomfort as the egg retrieval is performed. Guided by ultrasound, a needle is placed through the vaginal wall and into the ovary. The egg from each follicle is collected into a test tube, which is then analyzed by our embryologist. After all of the eggs are retrieved from one ovary, the procedure is repeated on the other ovary. An egg retrieval procedure typically takes up to 30 minutes. During the egg retrieval, the male partner will collect a semen sample by masturbation. He should abstain from ejaculation for two days prior to the egg retrieval. Occasionally, if necessary, sperm can be removed from the epididymis or testicle.
The focus of care now shifts to the embryology laboratory. The woman’s eggs are placed in a dish to mature for several hours before sperm are added, to achieve fertilization. For an in vitro fertilization (IVF) procedure, approximately 50 thousand sperm are combined with each egg. In cases of abnormally low sperm count, motility or for sperm that appear normal, one individual sperm will be injected into each egg in a process called intracytoplasmic sperm injection(ICSI). Usually, approximately 70 percent of eggs fertilized, become embryos.
The day after egg retrieval, our embryologist will determine if fertilization has occurred. Two days after egg retrieval, embryos will start to divide, reaching two to four cells. Three days after egg retrieval, embryos ideally will reach the eight cell stage. Five or six days after egg retrieval, the embryos will ideally reach the blastocyst stage.
Embryo transfer typically occurs about 72 hours after egg retrieval. It is a simple procedure that does not require anesthesia. Typically, one to three of the embryos are selected for transfer into the uterus. The selected embryos are inserted into a catheter, which is a thin, flexible tube, and then placed in the woman’s uterus using ultrasound to guide placement. Once in the uterus, the embryos continue their natural development. Rest and recovery are recommended for 24 to 48 hours following this procedure.
Following embryo transfer, the patient will continue to take injectable or vaginal progesterone. This helps support the lining of the uterus and aids with embryo implantation. It is not uncommon to have a small amount of bleeding during the post transfer luteal phase. As the embryo implants in the endometrium, blood vessels may leak. It is also not unusual to have symptoms of pregnancy that come and go during this two week period. Two weeks after the embryo transfer, the patient will return to our office for a blood test to determine if pregnancy has been achieved.
Many couples produce many viable embryos; however, it is recommended that in most cases, only one or two embryos be implanted in the woman’s uterus. Embryos not used in an IVF cycle can be frozen, or cryopreserved, for use during a later treatment cycle. Since 1981, many healthy babies have been born worldwide using frozen embryos. The chance of achieving pregnancy and delivering a healthy baby following transfer of cryopreserved embryos is approximately 30 to 40 percent per transfer. Dr. Freedman was responsible for the first pregnancy from a frozen embryo in the Mid-Atlantic region.