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In vitro fertilization and embryo transfer is a technique devised to help couples achieve pregnancy where other fertility therapies have failed. In vitro means outside the body whereas in vivo means inside the body. In this procedure, the eggs are removed from the ovaries and mixed with sperm in glass culture dishes. These dishes are placed in an incubator and fertilization occurs. The fertilized egg is then called an embryo. Once it is determined that the embryo is dividing normally, it is then transferred into the uterus where it develops into a normal pregnancy.
The IVF-ET treatment cycle consists of four phases.
1) Ovarian Stimulation and Follicular Development
This phase corresponds to the first half of the menstrual cycle. It is during phase that the follicles (small cysts containing the eggs) will grow and the eggs will develop. In order to control the timing of the development and to increase the chances of obtaining more than one egg, fertility medications are used to stimulate multiple follicles in each ovary. Once the menses begin, injections of FSH (follicle stimulating hormone) are self administered usually starting on cycle day 1 to 3.
The development of the follicles will be monitored by getting frequent blood tests for estradiol and vaginal ultrasounds to determine when the follicles are nearing maturity. When the follicles have reached maturity (~ 18X18 mm.) HCG (human chorionic gonadothopin) will be self administered by injection to prepare the follicles and eggs for retrieval. An ultrasound guided retrieval will be scheduled 36 hours after the administration of HCG.
2) Egg Retrieval
The primary method of obtaining eggs is by doing vaginal ultrasound guided aspiration. This is done under a light general anesthetic and you will be sent home in ~ 1 hour. You will need to take the rest of the day off and my experience some pelvic discomfort but usually you do not need any prescription for pain medication.
3) Egg Fertilization and Embryo Culture
The eggs are handled under sterile conditions at all times and are placed in a special culture media prior to insemination. A sperm sample will be obtained from the husband the morning of the retrieval and possibly the next day. Husbands are asked to abstain from ejaculation for two days prior to retrieval.
The sperm are then washed in a nutrient fluid and then incubated with the eggs to allow fertilization to occur. It should be noted that, just as with a normal situation, fertilization does not always occur when the egg and sperm meet. Furthermore, sometimes development begins and then stops (arrests). It is not known if these events are more common in the laboratory than they are in a natural setting. If fertilization occurs and division begins, the embryos will be incubated for 3 to 5 days in the laboratory and embryo transfer will be performed.
4) Embryo Transfer
Embryo transfer does not require anesthesia and is performed on a gynecological examination table in the routine position for a gynecologic examination. All embryos that mature will be transferred. A small, soft cather containing the embryos is placed through the cervix under abdominal ultrasound guidance and they are gently injected into the uterus. This is generally a painless procedure but a mild sedative is prescribed prior to the procedure. Husbands are encouraged to be present for the procedure. After reclining a short period of time in the recovery area you may return home depending on your home location and mode of travel. Minimal activity is recommended for the next 24-48 hours, after which time near normal activity may be resumed.
Go to: Gonadotropins
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