Do You Have Questions About In Vitro Fertilization, IVF Treatments? Texas Fertility Center has the Answers.
The History of In Vitro Fertilization
In vitro fertilization is arguably the most significant advance in fertility treatment since the field of reproductive medicine began. The first IVF baby, Louise Brown, was conceived and born in England in 1978. Since that time, an estimated one million babies have been born as a result of this technology. Initially, in vitro fertilization was developed for the treatment of women with fallopian tube disease, but now it is the treatment of choice for fertility caused by many other conditions, including significant male factor, unexplained infertility, and endometriosis-associated infertility. IVF is the most successful fertility treatment available using a patient’s eggs and her partner’s sperm.
The IVF Treatment Process
The five steps of in vitro fertilization include ovulation induction, the oocyte retrieval, fertilization, the embryo transfer, and hormonal support of the luteal phase with progesterone. In most cases, ovulation induction initially involves the use medications to suppress ovarian cysts and prevent ovulation from a spontaneous LH surge. The most common protocol utilized by IVF programs in the United States includes administration of oral contraceptives with an overlap of an injectable medication called Lupron™. This medication is given prior to ovarian stimulation and suppresses the pituitary gland’s ability to produce the hormone LH – which could trigger ovulation to occur, ruining the stimulation cycle.
We ask patients to continue to take their birth control pills for the first five days that they are taking Lupron, and they then typically start a period soon after stopping the pills. Once the menses occurs, ovulation induction is begun using subcutaneous daily injections of the gonadotropin hormone FSH (FollistimTM, Gonal-FTM, or BravelleTM.) Some centers add the hormone LH or HCG in low doses to the stimulation protocol, as some people believe that may produce a better stimulation in some patients. During the course of gonadotropin administration, the woman is evaluated with blood tests to measure estradiol (estrogen) production from the follicles as well as transvaginal ultrasound examinations every 2-3 days to monitor the development of the ovarian follicles. This monitoring is performed every two to three days during stimulation – which typically takes 9 to 14 days. Once the follicles reach maturity, as determined by their average diameter as well as their estradiol production, the oocyte retrieval is scheduled. In order to achieve optimal egg maturity, we administer a single injection of OvidrelTM approximately 36 hours before the scheduled retrieval time.
The oocyte retrieval is performed in a surgical suite where an anesthesiologist will give you intravenous (IV) medication to keep you comfortable. Oocyte retrieval is performed on a outpatient basis – the entire procedure typically lasts 20 minutes, following which time you will remain in the recovery area for about an hour. You are technically not put to sleep for the retrieval, you do not have breathing tube placed in your throat, and there are not any incisions in your body. Rather, the eggs are removed transvaginally under ultrasound guidance.
Your male partner provides a sperm sample on the morning of the oocyte retrieval, and the sperm are prepared by the embryologists for their addition to the eggs. If your partner’s sperm are normal, then approximately five hours after the eggs are removed, 15,000 moving sperm will be added to a drop of media (the special liquid in which the eggs grow). If the sperm are abnormal, then the embryologists inject a single sperm into each mature egg – a procedure called intracytoplasmic sperm injection (ICSI) in order to facilitate fertilization. Following either insemination or ICSI, dishes containing the sperm and eggs are placed into an incubator where the environmental conditions (temperature, humidity, light, gas concentration, etc.) can be tightly controlled in order to simulate the conditions inside the woman’s fallopian tubes and uterus as closely as possible.
The following morning, the embryologists evaluate the eggs to determine whether or not fertilization has taken place. All normally fertilized eggs are placed back into the incubator and evaluated for the next several days to determine if appropriate embryo development is occurring. Embryos are transferred into the uterus on either Day #3 or Day #5 after the retrieval (which occurs on Day #0), depending on the number of healthy embryos available for transfer. The recommended number of embryos to transfer is determined by the female’s age, the cause of infertility, previous pregnancy history, and other factors. If abnormal fertilization occurs, those embryos have a chromosomal number incompatible with life and, as such, they are discarded, as they can never develop into a viable human being.
The embryo transfer is similar to a pelvic exam and may be performed under abdominal ultrasound guidance. A soft flexible catheter is introduced into the cervix and positioned approximately 1-2 cm from the top of the uterine cavity where the embryos are released. Extra, viable embryos that are of good quality can be cryopreserved and stored for future use. A serum pregnancy test is performed exactly two weeks after the oocyte retrieval.
Many studies over the years have demonstrated that pregnancy and delivery rates are significantly higher in women who receive luteal phase support with progesterone following the embryo transfer. Progesterone is a hormone that is produced by the ovary following ovulation, and it results in maturation and stabilization of the uterine lining for implantation. Luteal phase support has traditionally been accomplished with the administration of intramuscular progesterone – although recent studies, including one performed by our physicians, suggest that a vaginal progesterone product (Crinone™) may be even more effective. The standard protocol for luteal phase support is to administer progesterone from two days after oocyte retrieval until the pregnancy test. If a pregnancy occurs, the progesterone may be continued or stopped depending on the serum progesterone level. Studies have confirmed that there is no increased risk of birth defects or other fetal abnormalities resulting from the administration of progesterone during the luteal phase and/or early pregnancy.