In Vitro Fertilization (IVF)

By OpenStax College via Wikimedia Commons

By OpenStax College via Wikimedia Commons

There are many different reasons for infertility and couples that are having a difficult time conceiving may need to undergo fertility treatment. There are many different degrees of infertility as well as different treatments. In vitro Fertilization (IVF) is one type of Assisted Reproductive Technology (ART). IVF means fertilization occurs outside the female body. Eggs are taken out from the ovary and mixed with sperm. The sperm will then fertilize the egg creating an ovary. One full cycle of IVF generally includes 1 episode of ovarian stimulation with the transfer of any resulting embryos (fresh or frozen) into the uterus.

Oocyte or egg retrieval is the surgical harvesting of eggs just before follicular rupture in women. Some women will have a natural method and wait for their own bodies to produce and mature an egg and other women will have ovarian stimulation. Ovarian stimulation occurs  when women are given medications which  stimulate egg production.  During this phase women may have frequent ultrasounds to examine the ovaries and eggs as well a blood test to check hormone levels. Once the ovaries have produced an egg they will then need to mature and then  be retrieved.  The retrieval of eggs is considered a minor surgery known as follicular aspiration. This procedure is usually done as an outpatient basis in an office  and can be performed transvagianlly or transabdominally. This procedure can be uncomfortable and often requires the women to receive medications such as an anesthetic or conscious sedation so that she does don’t feel pain during the procedure. An ultrasound is used to help guide the healthcare provider to where the ovary and eggs are. The eggs are then suctioned out one at a time and the procedure is then repeated for the other ovary.File:Icsi.JPG

 Following the retrieval of the eggs they will then need to be fertilized with the sperm. The best eggs are selected and placed in a medium along with his sperm. The sperm most often enters the egg within a few hours. If the chance of this fertilization is low, then the sperm may  then need to be injected into the egg this is also known as Intracytoplasmic sperm injection (ICSI).

After  fertilization, the egg starts to dive into many cells becoming an embryo. Embryos are cultured and allowed to grow in specialized media. The embryos are grown to either a cleaved stage of 6 or 7 cells (day 3 after fertilization) or a blastocyst stage (day 5 after fertilization). If there is a chance for a genetic disorder a procedure known as preimplantation genetic screening is done on one of the cells and screened for the specific genetic disorders. This allows individuals to determine which embryos to transfer into the uterus.

Approximately 3-5 days after egg retrieval and fertilization the embryos are placed into the woman’s uterus. This is typically done in the doctor’s office while the women are awake. A thin catheter containing the embryos is used. It is passed into the vagina, through the cervix and into the uterus. If the embryo implants into the lining of the uterus a pregnancy can result. Unused embryos may be frozen and implanted or donated at a later date.

 Before IVF

Before a woman undergoes IVF there are many tests, evaluations and procedures that are done. This can include a complete physical exam of the women as well as the male sperm doner including analysis of the sperm. A test to check for sexually transmitted diseases are done. Blood test that check hormone levels and ovulation testing. There may involve a pelvic exam with an ultrasound to check the organs. An additional procedure that is often done is a hysterosalpingogram which is an x-ray to assess the uterus and fallopian tubes. Dye is typically used and inserted into the uterus and fallopian tubes to determine the patency and for any abnormalities. For some women this procedure is uncomfortable but a very important aspect of the infertility work up. For some women just having this procedure has been enough for the to conceive.

Single or double embryo transfer?

In past years the practice of transferring multiple fertilized eggs into the uterus was to for the hopes that at least one fertilized egg implanted. This resulted in numbers pregnancy of triplets and quadruplets.

When pregnancies result in multiple babies it places the mom and all the developing baby at major health risks, compromising the pregnancy. Then this change to a more modest approach of 2 embryo transfers. Although this reduces the risk and the chance of you have  multiple babies it doe results in about 1/3 of the moms having twin pregnancies.

There is debate about the risk of having 2 embryo transfer, which can result in a twin pregnancy or having just a single embryo transfer without the risk of a twin pregnancy. This is something that women should discuss with their doctors, the risk and benefits of single or double embryo transfer.

If you compare a twin pregnancy to that of a single pregnancy the risks to both mom and baby will always be higher, but this is not the issue. The issue presents when a woman wants 2 children. We need to consider if the risk of 1 twin pregnancy is greater than the risk of having to go through 2 fertility cycles, 2 pregnancies, 2 labor and deliveries, and 2 postpartum periods. There is no robust evidence of a twin pregnancy being a much greater health risk to the mom and babies when compared the mom that undergoes 2 IVF treatments and pregnancies.

The risks of having IVF

  • Emotional issues and depression.
  • Bloating, abdominal pain or discomfort.
  • Bleeding and infection.
  • Anesthesia problems.
  • The procedure not working.
  • Having a multiple pregnancy (2 or more).
  • There is a higher incidence of early delivery, even with a single pregnancy.
  • A higher incidence of ectopic pregnancy.
  • Financial burden

To learn more about New England IVF procedure and infertility centers watch the videos below.

 

 

References

Gleicher, N. (2013). For some IVF patients, twins are the best outcome.Contemporary OB/GYN58(9), 40-46.

The Practice Committee of the Society for Assisted Reproductive Technology and the Practice Committee of the American Society for Reproductive Medicine. Criteria for number of embryos to transfer: a committee opinion. Fertil Steril. Jan 2013;99 (1):44-46.

 

More information on getting pregnant.