In-Vitro Fertilization – Embryo Transfer (IVF-ET)
In-Vitro Fertilization (IVF) describes the process in which eggs are removed from a woman’s ovaries and combined with sperm in a laboratory. One or more of the fertilized eggs (embryos) are then placed directly into the woman’s uterus. This process is called embryo transfer (ET).
Since the early 1980s, IVF-ET has been used widely around the world as a way for infertile couples to become pregnant. One advantage of IVF-ET is that a woman does not have to have healthy fallopian tubes to undergo this procedure since IVF bypasses the tubes altogether. IVF-ET is also used for patients with other diagnoses, infertility involving the male partner, or infertility that has no explained cause.
The staff of FSAC has extensive training and success with IVF-ET. Our doctors’ research and clinical experiences have contributed to advances in this technology and are now used widely by others. Our IVF laboratory director, Dr. Li, is an internationally recognized expert in IVF laboratory technology who, during the 1990’s, helped pioneer some of the revolutionary IVF treatments available today—including ICSI (Intracytoplasmic Sperm Injection), the process of injecting a single sperm into a single egg as a response to male infertility. Dr. Li was also among the first scientists to perform PGD (Pre-Implantation Genetic Diagnosis), a state-of-the-art technique to screen embryos for defects that might make them less likely to implant.
The IVF Cycle
In vitro fertilization (IVF) is a 5-step process. Most of our patients start by taking medication to stimulate egg production. Your FSAC nurse or physician will explain the different types of drugs involved and how they are administered, and are always available to answer your questions. Medications must be taken daily and on time. Please contact our office when you get your menstrual period—no later than the second or third day.
Step 1 – Egg Development
FSAC generally prescribes medications to stimulate the ovaries to produce multiple eggs. The drugs we use, such as Gonal-F, Follistim, Bravelle, or Repronex, copy the natural action of a hormone in the brain called FSH (Follical Stimulating Hormone). Our nurses teach each patient how to self-inject medications so they can conveniently do this at home. Using ultrasound, Drs. Buyalos, Hubert, and Shamonki personally determine when eggs are ready to be removed from the ovary. They do so by measuring the follicle— a small sac in the ovary that contains the egg. The larger the follicle, the more mature the egg. In addition, doctors may check patients’ estrogen levels, which also helps them tell whether eggs are ready for retrieval.
When follicles are mature enough to be retrieved, patients receive an injection of the hormone HCG, which is similar to the natural ovulation-causing hormone LH. This hormone, given 35 hours before egg retrieval, triggers the final stage of egg maturation.
Step 2 – Egg Collection
After eggs have fully matured, our doctors collect them by carefully placing a small needle through the vagina and into the follicle, guided by transvaginal ultrasound. Follicular fluid is withdrawn into the needle, and immediately, our embryologist searches the fluid for eggs in our on-site laboratory. This actual process takes only about 15 minutes and is done in our safe and comfortable on-site surgery center. This is generally done under monitored anesthesia care by a nurse anesthetist or anesthesiologist.
This step is where the importance of our onsite laboratory comes in. Unlike programs that must transport eggs to an IVF laboratory, FSAC maintains the eggs in a carefully controlled laboratory environment at all times.
Step 3 – In-vitro Fertilization / ICSI
The next step is fertilization of the eggs in a petri dish, using sperm that has been produced by a male partner or a sperm donor. A comfortable, private room is designed to aid in the collection of sperm samples. The sperm sample is usually obtained on the same day as egg collection.
• “Natural” fertilization, in which approximately 50,000 to 100,000 sperm are placed around each egg; or
• Single sperm injection (also called intracytoplasmic sperm injection, or ICSI). FSAC’s laboratory director is an expert in this area of reproductive medicine, and we have had excellent results with this technique.
Our embryologists consult with your Doctor and check the eggs for fertilization after approximately one day.
Step 4 – Embryo Replacement
Two to five days after eggs are collected, one or more fertilized eggs (embryos) are placed into the uterus through a small tube that is inserted through the cervix. This procedure is fairly simple, and anesthesia is rarely required. The patient continues lying down for about a half hour and then can return home. Physical activity should be limited for one to three days, and after that, most normal activities can be resumed unless specific instructions are given. For best results, our doctors often perform a “mock embryo transfer” before the IVF cycle even begins—to prepare for accurate placement of the embryos.
In some cases, our physicians perform a procedure called blastocyst transfer, using more developed, five-day-old embryos, which increases pregnancy rates for some patients while minimizing the risk of multiple births. Any additional embryos that have developed may be frozen (cryopreserved) for use in future cycles, avoiding additional ovarian stimulation and egg collection.
Step 5 – Luteal Phase and Pregancy Monitering
After the embryos are placed in the uterus, our doctors continue to monitor patients’ hormones to make sure that they are at optimal levels to sustain a pregnancy. Progesterone may be prescribed for 6 to 8 weeks to ensure that the uterine lining can sustain a pregnancy. (Side effects can include breast tenderness, weight gain, localized pain, and lump formation at the injection site.) A pregnancy test is performed 10 to 12 days after embryo transfer, and if positive, an ultrasound examination will be performed to ensure that the pregnancy is proceeding normally.
If a pregnancy is not achieved, the couple or woman returns to FSAC to review the cycle and plan future treatments. Much information that is learned during a treatment cycle can be used to enhance the likelihood for achieving pregnancy in a subsequent cycle.