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How is in vitro fertilization performed?
1. Basic screening tests are performed on both partners at all IVF clinics.
In general, some testing of "ovarian reserve" should be done on the female prior to
starting the injections. We use day 3 FSH testing as well as antral follicle counts for
this purpose. The results of these tests give us some ability to predict whether her
ovaries will respond well to the drugs (make sufficient follicles and eggs).
2. Consents are signed by all parties.
3. The woman is stimulated with injected medications to develop multiple egg development.
These injections continue for about 8 - 10 days.
Details about ovarian stimulation protocols for in-vitro fertilization
Details about the subcutaneous injectable medications
Sample in vitro fertilization calendar of a "typical" cycle that shows the days
medications are given, office visits, etc.
4. Blood and ultrasound testing is done every 1-3 days to monitor the development of the
follicles (egg-containing structures) in the ovaries.
We need to get a minimum number of follicles (4-5) to develop to maturity in order to be
able to proceed with the egg retrieval. About 90% of women under 40 with a normal FSH
and normal antral follicle counts will develop at least this minimum number of follicles.
If this many mature follicles can not be obtained from the stimulation process - we
will "cancel" the cycle (not proceed to egg retrieval). Criteria for cancellation vary
somewhat from clinic to clinic.
Our criteria for cycle cancellation
5. When the woman's follicles are mature, a transvaginal ultrasound-guided egg retrieval
(egg aspiration) procedure is performed to remove the eggs from the follicles. The
average duration of this procedure is 5-6 minutes (at our facility).
The egg aspiration procedure in progress - an egg is being aspirated from a follicle
Ovary outlined in blue - area between red and blue lines is tissue at top of vagina
The needle is passed through the top of the vagina to get to follicles and eggs
The eggs are then fertilized in the laboratory with her partner's sperm. If the sperm
(or the eggs) are of poor quality, the ICSI procedure might be used to aid in
fertilization.
6. The embryos are cultured in the laboratory for 2-6 days.
7. The embryo transfer procedure is done which places the embryos in the woman's uterus
where they will hopefully implant and develop to result in a live birth. This is like
a Pap smear for the woman. There should be no discomfort.
8. If there are leftover embryos (of sufficient quality) beyond the number that is
transferred, many couples prefer to have them frozen (cryopreserved) for use in a
future cycle. Embryo cryopreservation can be used for another attempt at having a baby
if the "fresh" cycle fails - or as an attempt to have another child if the fresh cycle
is successful.
Pregnancy rates:
Our program's IVF pregnancy rates
Success rates for IVF procedures vary considerably by the program handling the case.
This is an important factor to consider - and not well understood by many consumers of
infertility services.
Make sure that you discuss pregnancy and delivery rates in detail with your doctor
before you start a cycle. You should ask about their pregnancy and delivery rates for
couples similar to you (e.g. same age group and diagnosis).
Get numbers in writing from your center before getting started. Any program will be able
to provide this. If they are unwilling to provide pregnancy and/or delivery rates in
writing, consider going elsewhere - they probably have low pregnancy rates.
The national summary, as well as clinic-specific IVF results for the 1999 calendar year
were released in December of 2001 and posted on the web site of The Centers for Disease
Control and Prevention (CDC, a US government agency).
Day 5 IVF embryo at the blastocyst stage
The cluster of cells on the right side are fetal cells
The other peripheral cells will become the placenta
The cavity of the blastocyst is on the left side
Blastocyst transfer of 2 embryos allows high pregnancy rates no risk for triplets or
higher
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