In Vitro Fertilization (IVF)
IVF is a medical procedure in which the eggs and sperm are combined outside of the body. In vitro literally means, in glass, as the fertilization and early embryo development happen in a laboratory dish . IVF is also known as the "test tube baby procedure," even though embryos are neither fertilized nor grown in a test tube.
IVF is not a new procedure and it is not experimental. The first IVF baby is now over 30 years old and even has 2 children of her own. Since that first conception in the UK, millions of healthy babies have been delivered from IVF.
Even though IVF was first developed to help women with missing or damaged fallopian tubes, it is now routinely used to treat infertility caused by many different problems such as sperm problems, endometriosis, unexplained infertility and any other type of infertility that does not respond to more conventional treatments.
The IVF procedure is best understood as a series of steps that lead up to a successful pregnancy.
The steps of IVF include:
- Pre-procedure evaluation includes ovarian reserve testing (FSH, AMH), evaluation of the uterus with HSG or hysteroscopy, semen analysis, measurement of the uterine cavity and counseling
- Suppressing the ovaries with a GnRH agonist such as leuprolide (Lupron®) and/or birth control pills. This enables synchronization of the eggs and may prevent premature ovualtion. Patients on birth control pills may start GnRH antagonists such as Cetrotide® or Ganirelix later in the cycle.
- Stimulating the ovaries with fertility drugs such as Gonal-F®, Follistim® , Bravelle® and Menopur® in order to obtain as many eggs as possible for the procedure. This process is monitored with early morning transvaginal ultrasound exams and blood tests about every other day, and then daily as the eggs mature.
- Stimulating the eggs to release with an hCG injection (Pregnyl®,Novarel®, Ovidrel®) or with GnRH agonist such as leuprolide.
- 34-36 hours after the hCG injection (just before the eggs would be released), a transvaginal egg retrieval is performed using a needle guided by ultrasound. This can be done with intravenous sedation, local anesthesia or general anesthesia.
- The eggs are handed off to the embryologist who fertilizes the eggs with the partner's sperm and cultures them in the incubator overnight. The next morning evidence of fertilization can be seen under the microscope.
- After 3 days in the laboratory, the embryos have usually divided to the 6 or 8 cell stage and are ready for transfer. Embryo transfer is accomplished by passing a small plastic transfer catheter into the uterus. The embryos may be grown an extra 2-3 days and transferred at the blastocyst stage. Anesthesia is usually not required for the embryo transfer.
- Progesterone supplements (injections or vaginal) which were begun the day after retrieval continue. Progesterone is used to support the early pregnancy until the pregnancy test is negative or throughout the first 8 weeks of pregnancy. Pregnancy test results are available just over 1 1/2 weeks after transfer.