What is In Vitro Fertilization?
An Overview of IVF
In Vitro fertilization (IVF) has become the most popular choice of treatment for couples with various types of infertility. It is generally accepted as the most successful and fastest method available to achieve pregnancy. While it was initially reserved for patients with blocked, damaged, or absent fallopian tubes (tubal factor infertility), IVF is now also used to overcome infertility caused by endometriosis, male factor (sperm) issues, diminished egg quality, ovulatory problems, or other unexplained reasons.
IVF is an advanced method of assisted reproduction in which the man’s sperm and the woman’s eggs are combined in a laboratory where fertilization occurs, and the resultant embryos are then transferred to the woman’s uterus (embryo transfer) in hopes of achieving a pregnancy. Initially, the patient undergoes ovulation enhancement (superovulation) with a combination of injectable fertility medications that results in the development of multiple eggs in both ovaries. When the eggs have sufficiently matured, the transvaginal ultrasound-guided egg retrieval procedure is then performed in the office, with an anesthesiologist present to provide complete pain relief. The patient is discharged home soon after the procedure.
On the day the eggs are harvested, the partner provides a semen specimen from which the sperm are isolated in the laboratory, and used to fertilize the eggs. If a significant male factor is present, such as low sperm concentrations, or a diminished percentage of normal appearing sperm (morphology) or normally motile sperm (motility), intracytoplasmic sperm injection (ICSI) is an extremely useful modality that is employed to maximize the chances for fertilization.
Intracytoplasmic Sperm Injection (ICSI — pronounced “ick-see”) is a technique of gamete (sperm/egg) micro-manipulation, or assisted fertilization, in which individual sperm are captured in a microscopic glass pipette and meticulously injected directly into the individual eggs. The resultant fertilized eggs (early embryos) are then allowed to grow and mature in the sterile laboratory conditions in a manner similar to that of standard IVF. In cases where there is a complete absence of sperm in the ejaculate, such as in gentlemen who have previously undergone a vasectomy, microsurgical epididymal sperm aspiration (MESA) or testicular sperm extraction (TESE) is performed by a specialized urologist here in our office for retrieval of the sperm, and ICSI is then carried out.
An appropriate number of fertilized eggs (pre-embryos) are returned into the patient’s uterus three days later following the egg retrieval via Day 3 embryo transfer, or in select cases, the embryos are cultured for an additional 2-3 days and a blastocyst transfer is performed. We are extremely careful to limit the number of embryos transferred so as to help avoid a high order multiple pregnancy (3 or more fetuses) from occurring.