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IN VITRO FERTILIZATION (IVF)

In vitro fertilization (IVF) is the process in which mature eggs are retrieved from the ovaries and fertilized by sperm in an embryology lab to become embryos. The embryos are then transferred into the uterus by the doctor.

RMA at Jefferson offers a variety of treatment packages and financing options for in vitro fertilization (IVF). Our multi-cycle packages offer patients affordable options that best suit their personal needs when building their family. Our financial coordinators provide patients with information on all of these options and assist them in determining the best approach as they move forward in this process.

To learn all about our IVF success rates, please view our SART data.

There are several steps required for IVF:

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 that is prescribed by the doctor is determined by a number of factors, including their medical history, age, ovarian reserve testing, and previous experience with fertility medication.

During this process it is essential that close monitoring be performed using ultrasound and blood tests. Most cycles will require approximately 7 monitoring visits.

Egg retrieval is a procedure that is performed in the surgery center adjacent to our King of Prussia office. Patients will receive sedation 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 fluid from each follicle is collected. The embryologist then analyzes the fluid, looking for eggs. 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 15-20 minutes. During the egg retrieval, a semen sample is collected in a container, typically by masturbation either onsite or at home. If semen is collected at home it should be brought into the office within about an hour. He should abstain from ejaculation for two days prior to the egg retrieval. For men who are known not to have sperm in the ejaculate, sperm can be retrieved from the epididymis or testicle. For patients without a male partner donor sperm would be used.

The focus of care now shifts to the embryology laboratory. The eggs are placed in a Petri dish to mature for several hours before adding sperm to achieve fertilization. For an IVF procedure, approximately 50,000 sperm are combined with each egg. In cases of low sperm count, motility, or for sperm that appear abnormal intracytoplasmic sperm injection (ICSI) is used.

ICSI is an IVF procedure in which an embryologist selects a single sperm to be injected directly into an egg for fertilization. Approximately 70% of fertilized eggs become embryos. The fertilized egg grows in a laboratory for up to five days, and then it is placed in the woman’s uterus. This differs from traditional IVF, where many sperm are placed near an egg in a Petri dish for fertilization.

ICSI helps to overcome a man’s fertility issues if sperm production is too low or does not move in a normal fashion. Also, ICSI is an option in cases where the sperm may have trouble attaching to the egg or there is a blockage in the reproductive tract that may keep sperm from getting out. This process can also be used when traditional IVF has not produced fertilization, regardless of the condition of the sperm.

The day after egg retrieval, our embryologists 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 will reach the six to eight cell stage. Five or six days after egg retrieval, the embryos will reach the blastocyst stage.

An embryo transfer typically occurs five days after egg retrieval and does not require anesthesia. Typically, one to two 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.

Preimplantation Genetic Testing (PGT) can be used to ensure that embryos of the highest quality are being transferred. PGT is comprised of two distinct parts: Preimplantation Genetic Diagnosis (PGD) and Preimplantation Genetic Screening (PGS).

Preimplantation Genetic Diagnosis (PGD)
Preimplantation Genetic Diagnosis (PGD) is used to diagnose embryos that may be affected with inherited single gene disorders such as cystic fibrosis or sickle cell disease. PGD is also used to evaluate embryos at risk for sex linked disorders such as hemophilia or an unbalanced translocation (extra or missing genetic information). In addition, women with multiple prior miscarriages, failed IVF cycles, or advanced maternal age may benefit from PGD.

Preimplantation Genetic Screening (PGS)
Preimplantation Genetic Screening (PGS) is an option for patients who would like their embryos screened for any abnormalities in all 46 chromosomes or who desire sex selection for family balancing. Family balancing is a process in which gender selection is done for the purposes of achieving a more balanced representation of both genders within a single family.

Comprehensive Chromosome Screening (CCS) is a specific type of PGS.

CCS is the process of analyzing and selecting only chromosomally normal embryos for the transfer process. CCS samples non-critical cells on the fifth day of development when the embryo has reached the blastocyst stage. It looks at all 23 pairs of chromosomes. It uses an exceptionally accurate method that allows a DNA analysis to occur within hours instead of days, so the embryo can be transferred as early on as the sixth day of development. This screening technique is performed without risking harm to the embryo.

Patients may also pair CCS with Elective single-embryo transfer (eSET). eSET is a procedure in which a single, high quality embryo is selected and transferred into the uterus.

RMA at Jefferson especially recommends eSET for patients ages 35 or older, or who have had multiple unsuccessful in vitro fertilization (IVF) cycles or miscarriages. Approximately 60% of early miscarriages are due to chromosomal abnormalities in the embryo.

Following embryo transfer, the patient will continue to use 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 egg retrieval, the patient will return to the office for a blood test to determine if pregnancy has been achieved.

The IVF process typically produces many viable embryos; however, it is recommended that in most cases, only one or two embryos are placed into the woman’s uterus. Embryos not used in an IVF cycle can be frozen (cryopreserved) for use during a later treatment cycle. The chance of achieving pregnancy and delivering a healthy baby following the transfer of cryopreserved embryos is the same as when fresh embryos are used.

RMA’s Dr. Martin Freedman was responsible for the first cryopreserved embryo pregnancy in the Mid-Atlantic region.

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