Assisting your reproduction with in vitro fertilization
There are a variety of reasons why some couples cannot conceive through intercourse. Thanks to advancements in Assisted Reproductive Technologies (ART), treatment is available where the egg and sperm are united outside of the woman’s body. These procedures have high rates of success. Perhaps the most recognized of these technologies is in vitro fertilization (IVF). IVF begins with ovulation induction. At the beginning of your menstrual cycle, hormonal medications are used to stimulate the production of eggs. As soon as the eggs have reached maturity and are ready for retrieval, we will administer a hormone called hCG to stimulate final egg maturation. We will prescribe a prenatal vitamin and folic acid prior to your IVF cycle.
Just before the eggs are to be released from the ovary, we will harvest them in our laboratory through an egg retrieval procedure. Using a vaginal ultrasound as a guide, we insert a needle into the ovary and aspirate the eggs from the follicles. The embryologist will then work with the eggs in our state-of-the-art embryology lab where they will be checked for maturity.
The mature eggs are fertilized with sperm several hours after harvesting. The husband’s sperm is added to the egg holding container. Approximately 60% to 70% of the mature eggs will be successfully fertilized (the fertilization rate can increase to 70% to 80% using ICSI) and are kept incubated for three to five days until they are either transferred to the mother’s womb or cryopreserved (frozen).
It is important to note here that if the eggs do not fertilize, there may be a problem with either egg or sperm function. While the first response to this result may be disappointment, a failed fertilization allows IVF to be an important diagnostic tool as it can help us identify issues in your case that otherwise might not have been discovered.
At the end of the incubation period, the quality of the fertilized eggs is evaluated, and this, along with the woman’s age, dictates the number of embryos then transferred to the uterus. The number of embryos to be transferred will vary from case to case to ensure the best possibility of conception while minimizing the chance of a high-risk multiple pregnancy. There are, of course, exceptions in difficult cases. For instance, in women 40 or over or in cases where there have been three previous IVF cycle failures, we may transfer additional embryos to maximize the chances of conception.
If more embryos have been developed than can be transferred, you may want to consider freezing your embryos to preserve them for a future cryotransfer cycle through the cryopreservation and thawing process.
The embryo transfer process is very similar to a pelvic exam. Once the transfer is complete, you will rest quietly in our holding suite for about two hours to allow the body to accept the embryo. You will then return home where you will remain on full bed rest for several days, getting up only for meals or to use the bathroom. Most likely, you will also be taking progesterone by injections or vaginally and possibly taking estrogen. When the embryo reaches about two weeks of development, you will be administered a pregnancy blood test. If this test is positive, it will be repeated two days later.
If the pregnancy progresses, you will receive an ultrasound at six weeks of gestation. In your 12th week, if we confirm the pregnancy is proceeding normally, we will transfer responsibility for your neonatal care to your obstetrician and you will continue your journey toward parenthood.