|Human Egg||Fertilized Egg||8-cell Embryo||Blastocyst|
In normal human reproduction an egg is released from a woman’s ovary and united with a man’s sperm. This union occurs somewhere along the fallopian tube that joins the uterus (womb) to the ovary. During the in vitro fertilization (IVF) process the union (fertilization) occurs in the laboratory after the egg and sperm have been collected from a woman and the man. The resulting embryo is then transferred to the woman’s uterus and implanted there. Once this happens, the natural chain of events in the woman’s pregnancy may begin.
In vitro fertilization has been used successfully in human beings for over thirty years. The first IVF pregnancy in Alabama was conceived through procedures performed by Dr. Kathryn L. Honea who was the former founder and director of the first IVF program in Alabama. Millions of babies have been born worldwide. It has proven to be an invaluable form of treatment for infertility. The IVF procedure has made it possible for some couples to achieve pregnancy where other methods have failed.
Many couples requiring IVF services will be candidates for the Shared Risk Refund Plan.
Before you begin an IVF program, it is necessary for us to determine if your type of infertility can be treated using the IVF technology.
IVF can be used in cases of:
- Infertility associated with tubal damage
- Resistant pelvic endometriosis
- Low sperm counts or no sperm counts
- Unexplained infertility and other select conditions
Data gathered from IVF clinics around the world tell us that today’s success rate using IVF techniques and superovulation depends on the quality and number of embryos transferred. In a majority of cases, one or two embryos will be transferred at one time. In older women, three may be transferred. We define “success” as a pregnancy resulting in a liveborn child. Unfortunately, there is no guarantee that IVF will be successful — not in our Program or in any other.
When you participate in the process of IVF and embryo transfer you will go through the following steps:
- A preliminary clinical assessment and evaluation of both female and male.
- Stimulating the woman’s ovaries to develop multiple eggs with gonadotropins. Her endometrium (uterine lining) is also stimulated to thicken so it can better receive embryos.
- Collecting the egg(s). Collecting and preparing the male’s sperm.
- Fertilization in the laboratory and culture with monitoring the early growth of the embryo.
- Transferring the early developing embryo(s) to the uterus.
Assessment and Evaluation
Prior to initiating an IVF cycle, screening tests can predict how well ovulation will respond in an IVF cycle as well as determine if there are any abnormalities that may preclude IVF from being successful. These screening tests and procedures include:
- The uterine cavity is evaluated by either a hysterosalpingogram (dye test performed in radiology), a special type of ultrasound evaluation (sonar insufflation study [SIS]), or by looking into the uterus with a small telescope (hysteroscopy). These types of evaluations make sure that there are no intrauterine abnormalities such as polyps or fibroids that may interrupt implantation of the embryo. If an abnormality is found, it may be necessary to surgically correct the abnormality before proceeding with an in vitro fertilization cycle.
- A Clomid Challenge Test is a dynamic test that is used for assessing the status of eggs that are remaining in the ovary, as well as to help establish the best medication regimen for stimulating egg production in an in vitro fertilization cycle. If levels are abnormal, the prognosis for success with in vitro fertilization is poor and you may not be a candidate for in vitro fertilization.
- When treating male infertility, we must be able to obtain an adequate number of sperm. Also, we must take steps to rule out any infection in a man’s seminal fluid that may interfere with fertilization, embryo growth and embryo implantation.
During IVF, we must be able to control the timing of the egg release from the ovaries. We must also increase the chance of collecting more than one egg. To do this, we use special drugs to stimulate the ovaries. We then use an ultrasound scanner (it takes a picture from sound waves, like a submarine’s sonar) to keep track of the development of follicles (the structures on the ovary that contain the eggs). We will also be taking blood samples to monitor hormone levels. We will use this information to calculate the timing of the egg release. When the time is right, the female receives an injection of HCG (human chorionic gonadotropin). This substance induces the follicles to undergo their final maturation and prepares the egg(s) for release and collection. On the last day of stimulation, an ultrasound evaluation of the endometrium (lining of the uterus) will be performed. In rare cases, the lining may not develop adequately. In this circumstance, cryopreservation and return of the embryos to a more normal appearing endometrium may be suggested.
Although we will know the appropriate number of maturing follicles on your ovaries from our ultrasound scan, we will not always be able to determine the number of eggs you will produce for collection. There currently is not a guaranteed method for assessing and harvesting eggs; therefore, in rare cases, no eggs are retrieved. In the average case, eight to twelve eggs may be obtained.
We use a technique called “ultrasound guided aspiration” to retrieve mature eggs from the follicles which requires the use of intravenous sedation. Ultrasound guided aspiration allows us to remove the follicular fluid containing the eggs. This procedure must be performed at exactly the right time. If the egg is collected too early, it will not develop properly and might fail to fertilize. If we delay the procedure too long, the egg may be released from the follicle and lost. Unfortunately, not every follicle contains an egg. Also, many eggs are not healthy, and some will fail to fertilize for no apparent reason.
When the fluid is removed from the follicles, it is taken to the laboratory where the embryologist identifies the egg(s) and places it in a special substance called culture medium.
The man will be asked to collect a sample for insemination at the time of egg retrieval. Many men have collected in our office or a doctor’s office before and feel that collection will not be a problem. Should you feel uncomfortable with the concept of office collection, we can arrange for a home collection before or after the retrieval if you notify us. The sample must be received within 45 minutes of collection. The best chance of avoiding a problem with collection is to assess your issues and plan for alternatives. Please feel free to discuss these issues with your doctor or the IVF nurse coordinator.
The semen is then processed to allow us to select and concentrate the most active sperm cells. After the eggs are collected and the sperm sample has been received and prepared, we then place these active sperm and the eggs inside an incubator where fertilization takes place and the embryo begins to develop. If ICSI (intracytoplasmic sperm injection) is required, it will be performed at this time.
Culture and Fertilization
Our embryologist(s) examine the culture at regular intervals to make sure fertilization has taken place and the embryo is dividing properly. Normal fertilization (70-75%) is evident by the presence of two pronuclei, which represents genetic material from one egg and one sperm. In some cases, abnormal fertilization may occur (5-7%) as evidenced by the presence of more or less than two pronuclei. Micromanipulation (ICSI) may be indicated in a subsequent IVF cycle in cases of poor fertilization.
After assessment of embryo growth, the embryos that have the best morphology (or appearance) are transferred to the woman’s uterus. This usually happens on the fifth day after the eggs are collected (at the blastocyst stage).
Embryo transfer is simpler than egg retrieval. You will need no anesthetic. We will use a speculum inserted in the vagina to look for the opening of the uterus. Then, a very thin plastic tube, called a catheter, carrying the embryo(s) will be gently guided through the cervix into the uterus. The embryo(s) passes from the tube to the top of the uterus. You will be asked to lie flat for twenty minutes and then may return home. Instructions regarding medication such as progesterone support will be given.