In vitro fertilization has enabled thousands of couples to have children and is routinely used by infertility clinics. "In vitro" means fertilization outside of the body.
The eggs are fertilized in petri dishes leading to the formation of embryos. The embryos are later transferred to the uterus.
IVF may be a first line treatment for women with tubal disease, those of advanced age (reduced ovarian reserve), ovarian failure, or unexplained infertility. Women with low ovarian reserve, or ovarian failure, can use an egg donor. IVF with intracytoplasmic sperm injection (ICSI) is often used to treat moderate to severe male infertility.
Various fertility drugs are used in IVF cycles. Follicle stimulating hormone (FSH) stimulates the development of eggs. Lupron/Antagon/Ganirelix or Cetrotide is used to control ovulation and prevent ovulation before the eggs are retrieved.
IVF patients are monitored regularly using ultrasound and estradiol hormone measurements. Follicles can be seen on ultrasound and estradiol levels rise as healthy follicles develop. These tests also help prevent side effects.
Healthy follicles produce estrogen as they mature, and along with progesterone, these hormones cause the endometrium (lining of the uterus) to thicken and become more vascular. Endometrial thickening is needed to support an embryo.
Human chorionic gonadotropin (hCG) is given before the egg retrieval to cause final maturation of the eggs.
The eggs are retrieved under light sedation using transvaginal guided ultrasound. This involves passing a small “needle” through the back of the vagina into the follicle to “suction out” the egg. The eggs are passed to the embryologist who separates them from the follicular fluid before transfer to special media. The eggs are then combined with the sperm and fertilization occurs.
Sperm are collected and washed before exposure to the eggs. Intracytoplasmic sperm injection (ICSI) is often used in cases of male infertility. ICSI involves injecting a single sperm into the egg. Some men with severe male infertility may have no viable sperm in the ejaculate. In these cases, sperm can be taken from the testicles (TESA) or the vas deferens (MESA). The couple could also opt to use a sperm donor.
After fertilization, the eggs are placed in incubators with exacting environmental controls for 3-5 days, or until mature. Five day old embryos have usually developed to the blastocyst stage and have a higher success rate. We prefer transferring blastocyst embryos when possible. Assisted hatching may be used to facilitate implantation of the embryo.
Preimplantation genetic diagnosis (PGD) is sometimes used to screen the embryos for genetic diseases. Many genetic abnormalities can be identified in the embryo and abnormal embryos aren't transferred to the mother.
The embryos are transferred to the uterus in a painless office procedure. Progesterone is given to support endometrial development and patients return in two weeks for a pregnancy test.
Reputable clinics provide their IVF success rates to the Society for Assisted Reproductive Technology (SART) and the Centers for Disease Control (CDC) each year. However, the data is usually “dated” by two years