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How IVF Works
In Vitro Fertilization, or IVF, is a highly sophisticated technique used to assist infertile couples in achieving pregnancy. Even though this procedure has excellent success rate, every couple attempting this type of therapy should understand the steps involved in this process and be realistic about their chance of success. Careful evaluation of the infertility problem, full pre-screening, and an individualized approach to treatment will maximize each couple's chances for success. Our team of fertility doctors will develop an individualized treatment plan that will optimize your chances of achieving a pregnancy and delivering a baby.
In order for conception to occur, one sperm must fertilize the mature egg, while that egg is traveling through the fallopian tube. This happens during ovulation, during the time when the woman has her monthly cycle. The fertilized egg must then attach to the wall of the uterus, thereby creating an embryo. The In Vitro Fertilization technique typically involves four major steps: 1) ovulation inductions, 2) egg retrieval, 3) fertilization and embryo culture, 4) embryo transfer.
STEP 1 – Ovulation Induction
A woman is first treated with fertility drugs to stimulate the multiple egg production. The IVF drugs are administered in order to prevent ovulation until the desired time and to stimulate the development of the eggs. The medication is typically given subcutaneously (under the skin).
STEP 2 – Egg Retrieval
Once these eggs have matured, the next step in the process is to harvest them. To remove the fluid that contains the egg, the doctor will insert a needle into the ovarian follicle. This is a relatively minor procedure and is performed by visualizing the follicles with a vaginal ultrasound probe. A needle is directed alongside the probe, through the vaginal wall, and into the ovary. To avoid any discomfort, the doctor will administer a strong but short acting intravenous sedation. The eggs are then placed in a specially-prepared laboratory dish.
STEP 3 – Fertilization and Ebryo Culture
The embryologist then identifies the eggs and places them in a specially-prepared laboratory dish. After a process called sperm washing, sperm are mixed with the retrieved eggs. The very same day, the eggs are fertilized with sperm either by conventional insemination or by Intracytoplasmic Sperm Injection (ICSI). The latter technique involves a use of another needle to inject the sperm into the nucleus of an egg. During "conventional" insemination approximately 50,000 sperm are placed with each egg in a culture dish and left together overnight to undergo the fertilization process.
The eggs will be checked the following day to document fertilization and again the next day to evaluate for early cell division. They are now called embryos and are placed in a special culture media to promote growth. A sign that fertilization has occurred is when the eggs begin to cleave, or divide, into multiple cells.
Until recently, embryos were cultured for three days and then transferred to the uterus and/or cryogenically frozen for later use. Medical professionals now have the ability to grow the embryos for five or six days until they reach the blastocyst stage. For some couples these blastocysts may have a greater chance of implantation, allowing doctors to transfer fewer embryos and lower the risk of multiple births while increasing the chance of pregnancy.
On day two or three after fertilization, the embryos will be evaluated. If there are sufficient numbers of dividing embryos they will be placed in special blastocyst media and grown for two or three additional days.
STEP 4 – Embryo Transfer
Embryos are transferred on day 3, 5, or 6 after egg retrieval. They are placed through the cervix into the uterine cavity using a small, soft catheter. This procedure usually requires no anesthesia. Additional medication may be prescribed by your doctor to improve the likelihood of the embryos implanting in the uterus. Furthermore, in order to increase the chance for a successful pregnancy, more than one embryo is usually transferred. This can sometime result in multiple births.
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