In Vitro Fertilization (IVF), Premier Fertility Clinic, Greensboro, NC
IVF was first successfully performed by Drs. Steptoe
and Edwards in England in 1978. IVF success rates In the early 1990’s
were low, and IVF was considered by many
to be an experimental procedure.
IVF has now become a mainstay
of infertility therapy
bringing hope to thousands of otherwise infertile couples. IVF
success rates have improved dramatically and approach
50% per cycle in some programs. IVF success rates depend upon
many factors, most importantly female age.
Our North Carolina IVF clinic offers "standard" IVF and we have an active donor egg program.
IVF is now considered a “first line” therapy
in many women with conditions such as blocked or damaged fallopian tubes .
“In Vitro” literally means fertilization outside of the body, sometimes referred to as a “test tube” baby. Actually, in IVF fertilization does not occur in a test tube but in a Petri dish.
IVF begins with ovulation
induction, which causes the ovaries to produce numerous
eggs. The patient receives follicle
stimulating hormone, (FSH) which directly stimulates
her ovaries. These patients are monitored closely
via ultrasound
and estradiol hormone measurements. This is necessary
to insure proper follicular development (each follicle
contains one egg) and avoid medication side effects.
IVF patients also receive medications, such
as Lupron, or Ganirelex, to
delay ovulation until the eggs are ready for retrieval.
If ovulation occurred early, the “eggs would be
lost” and the IVF cycle could not be completed.
Once the follicles mature, the egg retrieval
is scheduled and an injection of hCG
is given. The eggs are retrieved via transvaginal
ultrasound guided aspiration. A small needle is passed
through the back wall of the vagina into the follicle
and the egg is withdrawn. This procedure is performed
under sedation in an outpatient setting. Many eggs are needed for the various steps in the IVF process.
As the eggs are withdrawn, the are passed to the embryologist who separates them from the follicular fluid. The eggs are then placed in Petri dishes and specially prepared sperm is introduced. The sperm comes from the partner or a donor.
In cases of poor sperm quality or quantity,
intracytoplasmic
sperm injection (ISCI) with IVF may be employed. Using
the ICSI procedure, a single sperm is injected directly
into the egg. This procedure is often successful even
in cases of severe sperm deficiencies.
IVF- Incubation
The fertilized eggs are placed in incubators and allowed to mature into embryos. Incubators strictly control environmental factors such as temperature, gasses, pH, etc.
The embryos are cultured from 3-5 days, or until mature. IVF transfer usually occurs on day three unless blastocysts are used. Blastocysts are embryos that have matured to two distinct cell types, usually by day 5. Blastocysts are “heartier” and more likely to implant in the uterus and develop. Not all IVF couples are candidates for blastocyst transfer.
IVF- Transfer
Once the embryos mature and are ready for transfer, the IVF coordinator contacts the patient and the transfer is scheduled. Embryo transfer is performed as an outpatient procedure without the need for anesthesia.
A small catheter is used to insert the embryos directly into the uterus. This is done with the utmost care to prevent damage to the developing embryos.
IVF- Implantation
The embryos must implant into the wall of
the endometrium.
Endometrial development is monitored during the IVF stimulation
cycle to insure that the lining of the uterus thickens
and becomes more vascular.
Progesterone
is given to IVF patients after transfer to support endometrial
development. This is because fertility drugs used during ovulation
induction can impede the development of the endometrial
lining.
Sometimes, for reasons unknown, embryos will not develop properly during the IVF cycle. This may be due to genetic defects such as an abnormal number of chromosomes, known as aneuploidy, or other unexplained conditions.
IVF Success Rates
IVF success rates vary for many reasons. One
of the most important factors is female age. As women
age, their eggs naturally begin to loose their capacity
to fertilize and develop normally. Success rates
begin to drop at the female age of 35 and become very
low after the age of 40. While we offer IVF to women
up to the age of 43, we also counsel regarding other options
such as adoption or our donor egg program .
Fortunately, donor egg IVF success rates correlate with the age of the donor. For example, a 39-year-old woman using eggs from a 20-year-old donor will have the success rates common for the 20-year-old age group. Obviously, IVF success rates vary according to many other factors including the cause(s) of infertility.
We have an active donor
egg program to help meet the needs of our older patients.
