IN VITRO FERTILIZATION
In vitro fertilization (IVF) and other "high tech"
procedures are now referred to as the assisted reproductive technologies (ART). These procedures all involve collecting the oocytes (eggs) and
placing them in direct contact with sperm. Together they form an alphabet soup of
techniques including: IVF, GIFT, ZIFT, ICSI, FET.
In its simplest term, IVF is simply the uniting of egg and sperm
in vitro ( in the lab). Subsequently the embryos are transferred into the uterus through
the cervix and pregnancy is allowed to begin. IVF was the first of the ART techniques to
be developed. The first birth was in 1978 in England. The procedure was pioneered by a
Gynecologist and a Ph.D. ( Drs. Steptoe and Edwards). Next came GIFT
which stands for gamete (egg and sperm) intrafallopian transfer. This procedure requires
laparoscopy which is small incision surgery and requires a general anesthetic. With
existing technology, pregnancy rates are similar with IVF and GIFT. Since IVF does not
require surgery, it has supplanted GIFT.
ZIFT (zygote intrafallopian transfer) involves IVF and then a
laparoscopic surgical procedure to transfer the embryos into the fallopian tube. Since
transferring embryos through the cervix with IVF gives the same pregnancy rate as ZIFT,
and is nonsurgical, IVF has also supplanted ZIFT.
As the years have passed, IVF has become the dominant ART technology
due to its simplicity, efficacy and lack of invasiveness. A typical IVF cycle
begins with shutting down the ovaries. This is done with a medication known as a GnRH
agonist or a birth control pill. The most common drug that is used is Lupron. Lupron
is given for approximately two weeks after which the ovaries are shut down temporarily.
The reason for ovarian shut down is so that the follicles when stimulated will all ripen
at approximately the same time. The next phase involves stimulation of the ovaries
with potent ovulation medications such as Pergonal, Bravelle, Repronex, Gonal-f or
Follistim. These are basically potent ovulation medications given to stimulate the
development of several eggs. For a full description of these agents go to the page on ovulation medication. These injections are
given for approximately 10 days. When the eggs are ready for harvesting, a final step is
to give hCG to induce final maturation. The eggs are then harvested by a process called
ultrasound guided vaginal retrieval. Under moderate sedation, and with ultrasound
guidance, a thin needle is passed a short distance into the ovaries and the eggs are
suctioned from the follicles. Typically 5-15 eggs are collected.  Typically the eggs are fertilized by adding approximately 100,000 motile
sperm to each egg. If the sperm will not fertilize the eggs naturally we can perform
intracytoplasmic sperm injection (ICSI). This procedure involves
injecting one sperm directly into the egg:
The day following retrieval, we can document fertilization under the microscope. We then
observe the embryos for 3-6 days. Typically 2-3 embryos are then placed in a catheter and
transferred through the cervix into the uterus 3 days following egg retrieval. The number
of embryos to be transferred depends on the 
age of the woman. Women in the twenties have fewer and women in the thirties have more
embryos transferred. An embryo transfer is a simple procedure much like a pap smear. At
the present time, embryos can be transferred either 3 or six days following retrieval. A 3
day embryo is usually at the 6-8 cell stage:
For some photos of the IVF retrieval area and the embryo lab
please go to IVF photo gallery.
BLASTOCYST TRANSFER
It is also possible now in some cases to perform advanced stage or blastocyst embryo
transfers. These embryos are further along and usually fewer of them need to be
transferred:
 Blastocyst transfer is
appealing because of its ability to decrease multiple pregnancy rates. It does have its
drawbacks. It can only be attempted if there are a high number of rapidly dividing
embryos. This is because the majority of embryos cannot with existing technology make it
to this final stage. Blastocyst transfer therefore uses a large number of fresh embryos
and in many circumstances will not leave any more embryos for freezing and future
transfers. We have been working with blastocyst transfer for greater than 5 years and have
been able to achieve excellent results with both fresh and frozen blastocysts. In March of
1999 channel 9 aired a story about 2 tristate
couples. One had conceived with fresh and the other with frozen blastocysts. We find the
technique to be helpful to some couples. All patients at the present time are considered
for blastocyst transfer if they have 4 or more high quality embryos at 72 hours. At the
present time, blastocyst transfer is to be considered a technique to lower multiple
pregnancy rates rather than to increase pregnancy rates per se.
Two weeks after embryo transfer a pregnancy test can be obtained. Two weeks after the
pregnancy test, an ultrasound can be performed and the fetal heart beat can be seen.
1. Single pregnancy at eight weeks
2. Twin pregnancy at eight weeks
The image on the top is of a single pregnancy 6 weeks after egg retrieval and the one
on the bottom is of a twin pregnancy. If more embryos were generated than can be replaced,
these additional embryos can be saved by freezing (cryopreservation). Frozen embryos can
be stored for future replacement at much lower cost than the original IVF cycle.
one of our recent IVF arrivals
As the years have passed, IVF has improved greatly. Today it is arguably the most
effective technique to treat infertility when compared with others on a month by month
basis. IVF is not a perfect technology. First ,it is expensive. An IVF cycle can cost
$8,000 to $9,000. It may not work on the first cycle. Multiple pregnancies can result. The
truth is that it is a powerful technology and must be used carefully. Some patients may
have very high odds of success: 50 - 55% chance per attempt. Others may, due to their
situation, have only a 20% chance of success. Age of the wife is the single
most important variable controlling pregnancy rates. Women in the twenties and early
thirties have the best chance of success. The multiple pregnancy risk varies from
20% - 35% depending on clinic practices. Most multiples contrary to popular opinion are
twins. Younger patients need fewer embryos to be replaced, and older patients need more.
The worst thing that has happened with IVF is the various centers entering into a race to
see who can get "the best statistics". This has encouraged centers to transfer
high numbers of embryos to get the stats while accepting too high a risk of multiple
pregnancy. Also in order to get the best stats, some patients will be refused care in
order to " protect the statistics".
Our data is contributed in great detail annually to the Center for
Disease Control (CDC). The 2005 data have just been released. To see this information
please click on the following CDC link:
IVF DATA
Our center was the first in the tristate area to report the birth of 1,000 IVF babies as
of June of 1998. As of early 2007 we have now experienced more than 4,000 births. We were
able to achieve these landmarks without refusing treatment to patients who were less
likely to succeed. Our center has been successful with a variety of techniques including
IVF, GIFT, frozen embryos, and egg donation. We have also been pleased with the ability of
ICSI to help patients with very few sperm become parents. ICSI allows us to treat cases
that were untreatable five years ago. We continue to improve the results of our program by
participating in national and regional research trials. We also strive to improve clinical
and laboratory techniques through implementation of promising new technologies.
cincinnatifertility.com:
your complete source for information about in vitro - Cincinnati Ohio |
