In Vitro Fertilization – IVF
IVF is not a new concept, in fact, it has been around for about 20 years but its components are very complex. In general, IVF refers to assisted reproduction, during which a man’s sperm is combined with a woman’s egg outside of the body.
In a lab setting, the fertilization process is overseen by professionals. Once an embryo is achieved, it can then be transferred into a woman’s uterus, where subsequent development can occur naturally.
Although many factors can influence the ultimate outcome of IVF, the process has resulted in numerous successes. In fact, in the United States alone, IVF has been the source of more than 45,000 babies. Parents could be comforted to know that babies conceived through IVF are no more likely to suffer birth defects than children conceived naturally.
IVF is a way to bypass fertility issues related to normal conception. The female body might be incapable of fertilization because it does not allow sperm to reach the egg. If mucus levels are too low, for example, sperm cannot survive. The same is true for mucus levels that are too high. In some cases, the body will actually fight against the sperm cells with antibodies. IVF eliminates sperm’s exposure to such hostile environments.
In other scenarios, the egg might be unable to find its way into the uterus, or it may have difficulty implanting in the uterine lining. One example is a blocked fallopian tube which prevents the egg from properly leaving the ovary. IVF can move the egg’s fertilization and development beyond some of the trickier phases of fertilization so that later development can occur.
Our IVF Process
The Process of IVF/ICSI
1. Basic Screening tests are performed on both partners
Basically, some testing of the ovarian reserve must be done on the female prior to starting the injections. We use AMH as standard as well as D2-3 FSH, E2, P4 and antral follicle counts for this purpose. The results of these tests give us some information to predict her ovarian responses and also help us to administer a dose of injections.
2. Start injection and Controlled Ovarian Hyperstimulation
The woman is stimulated with injected medications to develop multiple follicles in the ovaries. Each follicle contains a microscopic egg. These injections continue to stimulate follicle and egg growth and development for about 8-10 days.
Blood test for hormone and ultrasound scan is done 1-2 times to monitor the development of the follicles.
After the follicles are in 16-18 mm. in diameter, injected medicine is used to trigger the final maturation. Then egg retrieval is performed 35-37 hours later.
3. Egg Retrieval and fertilization
When a sufficient number of the woman’s follicles are mature, a transvaginal ultrasound-guided egg retrieval (egg aspiration) procedure is performed to remove the eggs from the follicles. At our IVF clinic, the average duration of the egg retrieval procedure is under 10 minutes. Powerful anesthesia medications are used so that the woman is “out” during this procedure and does not feel or remember anything.
Around the time of egg retrieval, semen is collected. If a male partner is not available, frozen sperm may be used. 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. The embryos are cultured in the IVF laboratory for 2-6 days.
4. Embryo transfer into the uterus
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.
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.
We usually recommend the patient to be transferred only 1-2 embryos each time. We transfer routinely D5-D6 stage embryo, which is able to give highest success rate.
5. Luteal Support
After eggs retrieval, the woman is given medicines for luteal support. The medicines comprise of 4-5 kinds varies from patient to patient. The medicines have to be used until pregnancy test. If the pregnancy test is positive, the woman has to continue the taking the medicine until around 12-week gestation. These medicines help embryo for implantation.
6. Pregnancy test
7-10 days after embryo transfer, the woman has a blood test for pregnancy result.
IVF live birth success rate statistics: 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 and IVF services.
Make sure that you discuss pregnancy and delivery success 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).
We achieve pregnancy rates around 40% in women under 40 years who using her own eggs. However, the cumulative pregnancy rate is around 80% within three cycles. In egg donor program, the success rate is much higher. These women have a pregnancy rate 60-70% at the first attempt and cumulative pregnancy is around 90% within three attempts. Our success rates are higher than the average.