In
Vitro Fertilization, or IVF, was first
performed in 1978 and has become the standard for treating the many fertility
disorders in men and women. With IVF, women are given fertility
medications to stimulate the development of multiple eggs. The eggs are
retrieved in the office, and cultured in vitro (in the laboratory) with sperm to
create embryos. Usually, 2 to 3 embryos are placed back into the uterine
cavity (womb) 3 to 5 days later where they may attach and develop in hopes of
achieving a pregnancy.
The typical in vitro fertilization
cycle consists of several phases including the suppression phase, the
stimulation phase, the egg retrieval, the embryo transfer, and the follow up
phase. Each step of the treatment is performed by Dr. Nabal Bracero.
The Suppression Phase
The Suppression Phase begins the month before your scheduled egg
retrieval. We will spend this month "suppressing" your ovaries to prepare them
for the stimulating medication that will begin the following month. We suppress
the ovaries using oral contraceptives and a medication called Lupron.
The Stimulation Phase / Fertility Drugs
A woman typically makes one mature oocyte, or egg during each monthly
menstrual cycle. To optimize pregnancy rates during IVF it is important to have
more than one mature oocyte (egg) available for fertilization. We can stimulate
the production of multiple eggs using injectable
fertility medications which contain human follicle stimulating hormone
(FSH), a natural hormone which induces the development of multiple eggs. These
medications are taken once or twice a day and are administrated for 10-12 days.
The Stimulation Phase / Monitoring
Use of these powerful fertility drugs requires careful monitoring
with ultrasounds and blood tests to limit any
potential side effects. Ultrasound
allows us to obtain an accurate picture of how many eggs are developing. Blood
tests of estradiol also allow us to monitor the development of the eggs. Once
your follicles have reached their optimum size, a midcycle hormonal surge is
essential to prepare the oocyte for fertilization, just like your own natural LH
surge. This is accomplished with the use of an intramuscular injection of hCG.
Retrieval of the eggs occurs approximately 36 hours later.
The Egg Retrieval
Egg
(oocyte) retrieval is done in a dedicated procedure room within our fertility
center. A small needle is
advanced under ultrasound guidance through the upper portion of the vagina into
the follicles of the ovary. There is no incision. The fluid
is aspirated and immediately taken to the laboratory,
where the oocyte is identified. The procedure is done under deep intravenous
sedation to prevent any pain or discomfort during the procedure.
Insemination of the Eggs
Shortly after retrieval, the prepared sperm is placed into a highly
specialized culture
solution with the oocyte. If
Intracytoplasmic Sperm Injection (ICSI) is being performed, then the injection of the
sperm takes place at this time. They are placed in a
controlled environment and observed periodically over the next 18-20 hours to
determine if fertilization has occurred. The oocytes
that have fertilized are now considered embryos. These embryos are
transferred to a different culture media and are monitored closely
over the next 2 to 6 days. The exact nature of what
is done
will be highly dependent on the needs of the individual
couple. The healthy
embryos are then transferred to the patient's
uterus or cryopreserved (frozen) for future use.
Embryo Transfer
The embryos will be returned to the uterus 3 days (standard IVF) or 5
days
(blastocyst transfer) later. A small highly specialized plastic catheter
will be passed through the cervix into the endometrial cavity.
No sedation is
needed for this procedure. After 30 minutes of rest, you may resume most normal
activities.
Post Embryo Transfer
For the next 10-12 days, progesterone supplementation will be given
to help the developing embryos implant. The pregnancy test is done 14 days after
the egg retrieval.
