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In Vitro Fertilization: Understanding the Process

By Althea M. O’Shaughnessy, MD
Published in Resolve for the journey and beyond, Summer 2013

In Vitro Fertilization (IVF) describes a technique where a woman’s eggs and her partner’s sperm are combined in a special laboratory in order to create an embryo(s). The resultant embryo(s) is then inserted in the woman’s uterus through her cervix to enhance the chances of pregnancy. The first birth resulting from IVF was in 19781. When this technology was first introduced, IVF was only recommended to women with blocked fallopian tubes. Currently, IVF success rates have improved dramatically, and IVF is prescribed to couples with a wide variety of infertility factors. When other simpler types of infertility treatments are not successful, IVF is recommended in most cases.

Infertility Testing

Before proceeding with IVF, there are certain steps that must be followed. Specific infertility testing must be conducted to determine if IVF is the correct treatment option, as some couples may not benefit from such technology. Certain blood tests must be obtained from both patient and partner that must be in compliance with standards set forth by the Center for Disease Control (CDC). Most IVF labs in the U.S. are registered with the CDC for this purpose. These IVF centers are required to report pregnancy rate data on all patients that have started and/or completed an IVF cycle. This pregnancy data can be obtained at http://cdc.gov/art/ARTReports.htm2.

Besides required blood tests, evaluation of the uterine cavity is recommended. This can be done by a hysterosalpingogram (HSG) or a sonohysterogram. These tests may reveal abnormalities of the uterus which should then be corrected before an IVF procedure. Additionally, the woman’s partner must also undergo blood testing and a semen analysis.

IVF Treatment Protocol

The completion of all preliminary testing then permits your doctor to recommend a specific IVF treatment protocol. This includes when your medication begins, which medications you take, and medication dosages. You will also be instructed on how to administer the medications. Most of the fertility medications are injections that can be self administered. While on the fertility medications, you will need to be monitored closely by ultrasound and blood tests. This testing is to ensure that you are responding appropriately to the medication and to determine if medication dosage adjustments are needed. When your eggs have reached appropriate maturity, you will be instructed to take an injection that will complete the maturation process. The procedure to remove your eggs (egg retrieval) will be scheduled a certain numbers of hours after that last injection.

The egg retrieval is done under vaginal ultrasound guidance. A sterile needle is guided along the vaginal probe and punctures the back wall of the vagina allowing the needle to enter the ovaries and remove the eggs via gentle suction. Anesthesia is usually administered while undergoing this procedure. Once the eggs are removed from the ovaries, they are evaluated by the IVF laboratory staff and sperm is added to the eggs that same day to allow for fertilization. If the sperm sample is poor quality, then injecting the sperm into the egg (intracytoplasmic sperm injection or ICSI) may be required. Not all eggs removed may fertilize due to poor quality or due to immaturity. The laboratory will evaluate the eggs the following day to determine the number of eggs that successfully fertilized. The resultant fertilized eggs (embryos) will be placed in a special culture media to allow them to divide and grow. The embryo transfer will typically be scheduled three to five days after the egg retrieval. The embryo transfer is sometimes done under abdominal ultrasound guidance which requires the woman to have a full bladder. In most cases, anesthesia is not required for the embryo transfer. The number of embryos to transfer will be determined and discussed with the woman or couple. There are several factors that have to be considered when making that decision, with the goal being to become pregnant with one healthy baby. Doctors try to avoid multiple pregnancies by following guidelines recommended by the American Society for Reproductive Medicine as to the number of embryos to transfer3.

IVF can be a safe and successful approach to attaining a pregnancy. Because this procedure is not without risks, there should be careful consideration and discussion with your fertility doctor as to whether this is the right treatment modality for you.

REFERENCES:
(1) Step, P.C., Edwards, R.G (1978) “Birth After the  Reimplantation of a Human Embryo”. The Lancet 312 (8085) 366.
(2) Center for Disease Control and Prevention – Patient Resources. http://cdc.gov/ART/PatientResources.htm.
(3) Criteria for Number of Embryos to Transfer: a Committee Opinion; The practice Committee for the American Society for Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology. Fertil Steril 2013: 99: 12-17.

RESOURCES:
(1) American Society for Reproductive Medicine Website: www.asrm.org:
     a. www.reproductivefacts.org/topics/   
     b. www.reproductivefacts.org/factsheetsandbooklets/
(2) http://fertilitynj.com/services/infertility-treatment/ivf   

Dr. Althea M. O’Shaughnessy is board certified in reproductive endocrinology and infertility and is currently an associate with Reproductive Science Center of New Jersey in Eatontown New Jersey. She is affiliated with Capital Health System in Hopewell, NJ and The University Hospital at Princeton-Plainsboro, Plainsboro, NJ.