In vitro fertilization is an accepted “first line” treatment for many conditions causing
infertility. IVF was first introduced as an “experimental procedure,” and the first successful pregnancy in the United States occurred in 1981. Since that time, thousands of healthy babies have been born and
IVF success rates have increased dramatically, with the procedure no longer considered experimental.
If you are undergoing IVF, you will receive daily injections of
FSH (Gonal-F, Follistim, Bravelle, Repronex), which causes your ovaries to recruit additional follicles. Depending upon your specific protocol, you will also administer
Lupron or Antagon on specific days of your menstrual cycle to “down regulate” your hormonal system. Lupron and Antagon induce a “menopause like” state with the accompanying side effects. Most importantly ovulation cannot occur while you are on these products as they prevent the LH surge. Premature ovulation (before egg retrieval) can cause the “loss” of the IVF cycle.
You will come to our clinic several times for estradiol hormone level measurements and vaginal probe ultrasound while you are taking medications. The specific number of visits required is dependent upon each patient’s individualized response to ovulation induction. Monitoring is extremely important and the measurements are used to “adjust” your FSH doses and prevent serious side effects.
Rising estradiol measurements indicate that healthy follicles are developing. The
ultrasound is used to visualize and measure the follicles as they develop. It is also used to measure the thickness of the endometrium.
Once your physician judges that your follicles are mature, you will be given an injection of
hCG, which signals the body that ovulation is eminent. You will then be scheduled for egg retrieval.
Egg retrieval is accomplished using ultrasound guided transvaginal egg retrieval under conscious sedation anesthesia. This is an outpatient procedure that is accompanied by minor discomfort. A small needle is passed through the back of the vagina into the follicles located on the ovaries. Each egg is withdrawn from its follicle and passed to the embryologist.
The eggs are washed in special solutions to prepare them for exposure to your partner’s sperm. He provides a semen sample on the day of the retrieval that is prepared for introduction into the culture dishes containing the eggs. If you are scheduled for
intracytoplasmic sperm injection, each egg will be individually injected with a single sperm.
After exposure to sperm, the fertilized eggs are transferred to incubators that control temperature, gases, and other environmental variable. The resultant embryos remain in the incubators until the embryologist and physician judge that they are mature, usually in three days.
Once the embryos mature, you will be scheduled for embryo transfer. If your embryos require procedures such as assisted hatching or
preimplantation genetic diagnosis (PGD) they will be performed prior to inserting the embryos. The embryos are inserted directly into your uterus using a small catheter in a painless procedure.
IVF is usually a first line treatment for the following conditions: