In vitro fertilization (IVF) is the most successful assisted reproductive technology (ART). In this treatment, the sperm are combined with an egg in the embryology laboratory in hopes of achieving fertilization, resulting in an embryo. The embryo is then transferred into a woman's uterus (womb) or is cryopreserved (frozen) for future use.
Our IVF Program cycle consists of these basic steps:
InductionOvulation Induction is a process where fertility medication is administered to stimulate the ovaries to produce multiple mature eggs.
The egg retrieval process is a minor surgical procedure that uses an ultrasonic probe to guide a thin needle through the wall of the vagina into the ovary to collect the mature eggs. The needle penetrates the follicle, where the egg resides in the ovary, aspirating the follicular fluid. The eggs are then identified under a microscope, washed and placed in a culture dish with nutrient fluids. This procedure may last anywhere from 15 to 45 minutes and can done on an outpatient basis under sedation to avoid any pain or discomfort. There is no skin incision and usually very minimal blood loss.
Sperm collection and preparation is usually done on the day of the egg retrieval. Sperm can either be obtained from the woman's male partner or from a sperm donor. Sperm used is typically "washed," separating the sperm from the seminal fluid, increasing the number of motile sperm and improving the likelihood for fertilization.
Sperm collection can sometimes be stressful for a man. For those men, a semen sample can be produced ahead of time and frozen until needed. In some male factor infertility cases, a testicular biopsy can also be performed as a method to extract sperm for IVF.
Insemination/ICSI. In the embryology lab, sperm and egg are then combined to allow fertilization, creating embryo(s). This process is referred to as conventional insemination, allowing the natural process of sperm selection to take place.
Another option used in select situations however, is a process known as intracytoplasmic sperm injection (ICSI). This process involves injecting a single sperm into each egg. This technique can greatly increase the chances that fertilization will occur. It is a very common procedure to overcome poor sperm quality, fertilization difficulties and some cases of unexplained infertility. Men with only a few sperm can now have children! Our lab director, Brett Reggio, PhD, is an expert in this procedure.
Fertilization. Twelve to eighteen hours after conventional insemination or ICSI, the eggs is examined to confirm that fertilization has taken place. Fertilization is the union of male and female reproductive cells, or "gametes" (sperm and egg) to produce a fertilized egg (zygote). Once this occurs, the fertilized eggs are considered embryos.
Embryo Development. The embryo(s) are then cultured to grow and divide in the laboratory for three to five days before being transferred to the uterus.
Transferring the embryo(s) is the final and most important step in the IVF process. After three to five days following fertilization, one or more embryos are placed into a woman's uterus. This step requires the use of a small catheter to draw up the selected embryo(s) and to inject them into the middle of the woman's uterine cavity. This procedure mimics that of a routine pap smear and has little pain or discomfort associated. For best results, ultrasound is used to guide the catheter to the best location within the uterine cavity.
While some infertility clinics transfer multiple embryos that can result in multiple births, Elite IVF Solutions follows the American Society of Reproductive Medicine (ASRM) guidelines for embryo transfer. For most patients, transfer of a single embryo is recommended, thus reducing the likelihood of multiple births.
Upon completion of transferring the embryo(s), the embryo(s) should "hatch" from their outer shell and implant into the uterine wall. A blood test is performed, typically nine to eleven days after transfer, to determine if a woman is pregnant. If embryo implantation has occurred, the hCG hormone will be detected in the bloodstream and the woman will be considered pregnant.
Assisted hatching is a procedure that is performed in order to help an embryo hatch out of its outer protective layering (zona pellucida) and implant into the uterus. In certain situations the outer shell surrounding the embryo is thickened and/or hardened, therefore not allowing it to "hatch," or break out, and compromising an embryo's ability to implant into the uterine wall.
The procedure involves making a small incision into the outer shell just prior to the transfer of the embryo into the uterus. This may increase the likelihood that the embryo will implant into the uterine wall, resulting in a successful pregnancy.
In the early years of IVF, embryos were transferred into the uterus three days after fertilization. This is occasionally still done; however, it is now standard of care to extend the time an embryo is allowed to develop in the IVF laboratory incubators to approximately five days after fertilization. This extra time allows an embryo to grow to the "blastocyst" stage. The advantage to waiting these extra days before transfer is that it helps provide more information on the quality of embryos and gives a better choice of which embryos to choose for transfer.
Time-lapse imaging in IVF involves capturing continuous images of developing embryos within a specialized incubator. This allows the embryologist(s) to monitor their development without disturbing the culture environment and potentially the embryo. Time-lapse imaging provides a detailed and continuous recording of embryo "morphokinetics" (the combination of morphology and kinetics), which can help predict the embryo viability and implanatation potential, potentially improving IVF outcome.
During the IVF process, oftentimes, more embryos develop than are used or transferred. Should this be the case, there is the option to freeze (cryopreserve) any excess good quality embryos for future embryo implantation attempts. Embryos are typically frozen at the blastocyst stage (five to seven days after fertilization), and can remain frozen for many years without losing viability.
Historically a "slow-freeze" method of cryopreservation was used to freeze embryos. However, this has been replaced by a process called "vitrification" - an ultra-rapid freezing technique minimizing any ice crystal formation and potential damage to frozen embryo(s). The embryologists at Elite IVF Solutions utilize only the vitirifcation method currently.