IVF is an assisted reproductive technique that is used to treat infertility due to multiple etiologies including tubal disease, male factor, endometriosis, and unexplained causes. The treatment involves stimulation of the ovaries to produce multiple eggs, removal of the eggs by an ultrasound directed needle aspiration, followed by insemination of the eggs in the laboratory. The fertilized eggs, or embryos, are grown in culture for 2-5 days before being transferred into the uterine cavity.
A woman’s natural cycle is self-regulated to produce one egg per month. The eggs develop within fluid-filled sacs inside the ovaries, called follicles. The hormone that is released by the pituitary to stimulate the follicles to grow each month is called follicle stimulating hormone, or FSH. By giving daily injections of medications containing FSH we can increase the blood level of this hormone, causing several eggs to develop to maturity.
There are several different types of medications used to prepare the ovaries for an IVF aspiration. Lupron and Ganirelix are used to prevent the surge of LH in mid-cycle and thereby prevent ovulation. Preparations containing FSH include: Gonal F, Follistim, Bravelle, and Menopur. These medications are used to stimulate multiple follicle growth.
Careful monitoring of the ovaries during treatment is essential for the development of high quality eggs as well as patient safety. Several ultrasounds and blood tests are used to evaluate the ovarian response and timing of egg recovery. The sizes of the follicles correlate with maturity of the eggs inside. When the eggs reach predicted maturity, an ultrasound guided aspiration procedure is scheduled to harvest the eggs.
The egg retrieval is a simple outpatient surgical procedure that is performed under intravenous anesthesia by Dr. Marrs. A vaginal ultrasound probe is used to guide a needle through the vaginal wall and into the ovary. Once the needle is inside the follicle, suction is used to aspirate the fluid and the egg into a test tube. Dr. Richards then examines the fluid for the presence of the egg. The entire procedure takes approximately twenty minutes to perform.
Dr. Richards then mixes the eggs with sperm. The embryos are then cultured in a tightly controlled laboratory environment for 2-5 days. Extra embryos may be frozen and stored until a later time. The number of embryos transferred into the uterus is determined based on the woman’s age. A blood test twelve days following embryo transfer later will confirm pregnancy.
Embryo Freezing
Some woman are fortunate enough to have sufficient eggs and embryos from one egg retrieval procedure to allow the extra embryos to be frozen and stored for future use. Any remaining good quality embryos that are not transferred in the fresh cycle may be frozen. The frozen embryos may be stored for an indefinite time period. When needed, the embryos are thawed and transferred into a hormonally prepared uterus.
