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The basics of
IVF procedure

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What is IVF?

 
In Vitro Fertilization literally means "Within the glass". While considered an experimental procedure for years, IVF has been a proven way for many couples to build their family.

In Vitro Fertilization is a complex process that was developed in 1978. Louise Brown, the world's first 'test tube baby', was born in England over 30 years ago. Now, the procedure is a common treatment for infertility, and has helped numerous couples create the families they so desire.
 
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The basics of IVF procedure

 
The IVF program is made up of four steps:
  • 1) Use of fertility medications to develop oocytes or 'eggs'.
  • 2) Collection of the oocytes (eggs).
  • 3) In Vitro Fertilization of the egg and growth of the embryo.
  • 4) Replacement of the embryo back into the uterus.

Step 1: Developing and Monitoring Follicles
To assist in follicle growth, you will be started on a program of medication. Fertility medications are prescribed to control the timing of your egg ripening and to increase the chance of collecting multiple eggs during one of your cycles. This is often referred to as ovulation induction.

Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. Egg development is monitored using ultrasound to examine the ovaries and urine or blood test samples are used to check hormone levels.

This may require 8-12 days of treatment, with several ultrasounds and blood tests. When the follicles are mature, you will receive an injection of human chorionic gonatotropin (hCG) to begin the final maturation of the eggs. Eggs are collected 36 hours after the hGC injection is given.

Step 2: Collection of the Eggs
Mature eggs will be collected by a minor surgical procedure which uses a ultrasound directed needle through the pelvic cavity. egg fertility fertilizeThis technique is performed under a local anesthetic in conjunction with IV sedation. The eggs are removed from ovaries using the hollow needle, which is called follicular aspiration.

Some women may experience cramping on the day of retrieval, which usually subsides the following day; however a feeling of fullness or pressure may last for several weeks following the procedure.

Step 3: In Vitro Fertilization of the egg

Once the eggs are retrieved, they are placed in a special culture medium (fluid) and allowed to remain there for approximately 2 to 3 hours. A semen specimen collected and given to the lab within one hour of collection is prepared for combining with the eggs. You must abstain from intercourse for 2 days prior to the IVF procedure. This ensures optimal sperm quality.

The sperm are prepared and a small number of active sperm are placed in the medium with each egg. The sperm and eggs are placed in incubators, which enables fertilization to occur, a process called insemination. In some cases where fertilization is suspected to be low, intracytoplasmic sperm injection (ICSI) may be used. With this procedure a single sperm is injected directly into the egg in an attempt to achieve fertilization. If ICSI is to be done, it will be performed approximately 4 hours after the egg retrieval.

The eggs will be examined approximately 18 hours after the time of insemination, to determine if they have fertilized and cell division is taking place. Once cell division occurs the fertilized eggs are considered embryos. You will be informed about the outcome of fertilization the day after your retrieval. If fertilized, the eggs will be kept in the incubator for an additional day or possibly two for further development.

Step 4: Transfer embryos into the uterus
In consultation with your physician, you will decide the number of embryos to be transferred back to you. The risk of multiple pregnancy must be considered carefully in this decision.

day3 - 8 cellsThe embryos are usually transferred into your uterus anywhere between one to six days, but most commonly it occurs between two to three days following egg retrieval. At this point, the fertilized egg has divided to become a 4-to-8 cell embryo.

You will need to decide before the IVF procedure what will be done with the remainder of the embryos. Your choices include the following:
  • 1) discarding the extra eggs before fertilization
  • 2) freezing extra embryos for future pregnancy attempts for yourself
  • 3) donating the unfertilized eggs to another infertile couple.
The embryo replacement procedure is very simple and requires no anesthesia. The embryos are picked up into a very fine catheter, which is then inserted into the uterus through the cervix, and the embryo(s) are placed into the uterine cavity. This process is often guided by ultrasound. The procedure is usually painless, but some women experience mild cramping.

You will need to stay in a reclining head down position for approximately 2 hours after the embryo(s) have been placed in your uterus. Activities after embryo replacement should be minimal for the first 72 hours. Strenuous exercises such as jogging, horseback riding, swimming, etc. should be avoided until pregnancy is confirmed. Otherwise, the patient is free to return to her regular activities.

After these steps have been followed, all that remains is waiting and watching for early pregnancy signs and symptoms. A quantitative blood test, usually called a beta hCG test and an ultrasound will be used to determine if implantation and pregnancy has occurred.

 
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How successful is in vitro fertilization?

 
The success rate of IVF clinics depends on a number of factors including patient characteristics and treatment approaches. It is also important to realize that pregnancy rates do not equate to live birth rates. In the United States, the live birth rate for each IVF cycle started is approximately: ivf success rates graph



  • 30 to 35% for women under age 35


  • 25% for women ages 35 to 38


  • 15 to 20% for women ages 38 to 39


  • 6 to 10% for women ages over 40
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Are there any risks with in vitro fertilization?

 
As with most medical procedures there are some potential risks. The risks of in vitro fertilization depend upon each specific step of the procedure.

Ovary stimulation carries the risk of hyper stimulation, where the ovaries become swollen and painful. This condition is called Ovarian Hyper stimulation Syndrome, which is usually rare, mild and involves the following potential side affects: nausea, vomiting, lack of appetite or a feeling of being bloated.

More severe symptoms which occur in 1% of cases, include the following side affects: severe abdominal pain, severe nausea, decreased urinary frequency, shortness of breath, weight gain.

Egg retrieval and the use of laparoscopy carries the normal risks related to anesthesia. Additionally, there is a slight risk of bleeding, infection, and damage to the bowel, bladder, or a blood vessel. Less than one patient in 1,000 will require surgery to repair damage during the egg retrieval process.

The chance of a multiples pregnancy is increased in all assisted reproductive procedures. When multiple pre-embryos are transferred around 25% of pregnancies with IVF are twins. (In normal population, the rate is one set of twins per 80 births.) Triplets are seen in approximately 2-3% of pregnancies. There are additional risks and concerns related to multiples during pregnancy such as increased risk of premature delivery.
 
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Male Infertility

 
Fertility depends on the man's ability to deposit adequate numbers of healthy, mature, functioning sperm into the female reproductive tract near the time of ovulation. For most men, a detailed medical history, a physical examination and a semen analysis will for the major part of the fertility screening. Men who feel uncomfortable about the fertility evaluation should discuss these feelings with their partner and physician. Talking about anxiety beforehand can make the actual exam much easier.

More information on male infertility...
 
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