In Vitro Fertilization (IVF)

In a fertile couple, pregnancy with the release of an ovum (egg) from the woman's ovaries. The egg enters the fallopian tube where it meets with the sperm that have traveled there, following intercourse, from the vagina. The sperm normally fertilize the egg in the fallopian tube. The fertilized egg, now called an embryo, begins to divide and in three days contains many cells.



At this time, the embryo moves from the fallopian tube to the uterine cavity where it "floats" for another two to three days. The embryo Often implants in the uterine wall with a resultant pregnancy. If the fallopian tubes are blocked or damaged, fertilization and embryo transport cannot take place. In these cases in order to achieve a pregnancy we have to place fertilized eggs (i.e., embryos) directly into the uterus.

IVF (In Vitro Fertilization) uterine transfer achieves remarkable pregnancies in women with hopelessly damaged fallopian tubes. IVF can also help a couple with male factor infertility (eg., Low sperm count, motility or poor quality) achieve pregnancy when it is combined with the ICSI procedure. Couples with unexplained infertility, especially those who may have problems with sperm-egg intraction or problems with the fallopian tubes picking up the egg can be helped with IVF.

To prepare her body for the IVF procedure the woman receives hormone injections to stimulate development of the ovarian follicles, the sac-like structures that contain the eggs. Administering hormones increases the chances of retrieving many ripened eggs, each one capable of being fertilized and prcducing a pregnancy. HMG (human menopagsal gonadotropin) and recombinant FSH (follicle- stimulating hormone) are the hormones used to stimulate the production of follicles.

Up to three or more embryos are returned to the patient depending on her age ard embryo quality. If you have extra embryos we can freeze them for future attempts at pregnancy via a FET procedure.

To begin a cycle of IVF your cycle will begin to be monitored in the previous month. At a certain point you will begin administering a GnRH-Agonist or a GnRH-Antagonist to prevent the premature surge of LH (luteinizing hormone) from triggering ovulation before the eggs can be retrieved. After your menstrual cycle begins you will be examined by transvaginal ultrasound to check the status of your ovaries and pelvis in preparation for your hormone injections.

You will also have baseline bloodwork performed at this time. Once you have begin administering the hormone injections (HMG or FSH) approximately four days later you will begin periodic monitoring by ultrasound examination and blood estrogen level.

Later that day you will be informed how much HMG or FSH you will be receiving until your next monitoring appointment. The dosage and timing will depend on your age, previous response, and the estrogen level and ultrasound results demonstmted that day. When the monitoring shows the eggs are ripe and ovulation is imminent, an injection of HCG (human chorionic gonadotropin) is administered to the patient to complete the egg maturation process and prepare the eggs for retrieval. The patient is admitted for the outpatient IVF egg retrieval procedure the next day.

A semen sample from the husband is obtained while the wife is undergoing the egg retrieval procedure. It is then washed and prepared with the most active and healthy sperm being selected for fertilization of the wife's eggs. Eggs are retrieved by transvaginal needle aspiration (no surgical incision) via an ultrasound guide while the patient is under light sedation. The aspirated follicular fluid (containing the eggs) is placed in a laboratory dish and the eggs are obserued under a microscope for maturity and quality.

The eggs are then transferred to a culture dish where they are incubated in a special culture medium. Later, sperm are added to the culture dish so fertilization can take place. Alternatively, the eggs may be fertilized by the ICSI procedure. The resulting embryos will be observed for normal development over the noct few days until they are transferred back into the uterus. The patient will be able to go home a few hours later with minimal discomfort.

Two to five days after the egg retrival procedure the patient returns for the outpatient embryo transfer. This is a very simple procedure and requires no anesthesia. The patient lies on the examining table with her feet in the stirrups and a speculum is placed in her vagina. The best embryos will have been selected and arc simultaneously loaded into a sterile catheter. The catheter is inserted through the cervix into the uterus where the embryos are gently expelled into the uterine cavity.

The patient remains in a prone position for approximately 45 minutes. She is then discharged, but her activity must be minimal (i.e., bed-rest) for the next 24 hours. She will also be asked to limit her activity for the next week and get plenty of rest. Progesterone support by IM injection and/or vaginal suppository or cream will begin before your egg retrieval procedure. The hormone plogesprone supports a pregnancy by prcparing the endometrial lining so it is receptive to implantation. In one week you will have a blood test to check your hormones and further insfructions for hormone supplementation will be given later that day. Two weeks after the egg retrieval you will have a blood pregnancy test, a quanUtative beta HCG. If the test is positive you will continue hormone supplementation for four to eight weeks.

If you do not get pregnant you will discontinue these hormones. You should consider undergoing another cycle in the future as subsequent cycles would also have a good pregnancy rab. Another option is to go through a FET if your cycle yielded embryos for fertilizing.

Contact our clinic for more informaton or to arrange a consultation appointment to see if IVF or one of our many other plocedures wilt help you fulfill your dream of parenthood.
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