IVF & IUI

IVF & IUI

In vitro fertilization (IVF) is the best treatment for certain kinds of fertility problems. However, it can be demanding and doesn’t always result in pregnancy.

What is IVF?

When a couple conceives naturally, sperm from the man and the egg from the woman meet in the woman’s fallopian tubes. These are the tubes that join the ovaries to the uterus (womb). One sperm penetrates the egg and fertilises it.

In IVF, this process of fertilisation happens outside the woman’s body. A woman’s eggs are surgically removed and fertilised in a laboratory using sperm that has been given as a sperm sample.

Next, the fertilised egg, called an embryo, is surgically implanted into the woman’s womb.

Typically, one cycle of IVF takes between four and seven weeks.

What to expect of IVF treatment

IVF does not always result in pregnancy.

IVF can be a physically and emotionally demanding process. Some men and women have mental health or emotional problems such as anxiety or depression during or after IVF.

Anyone undergoing IVF should be offered counseling to help with the emotional impact of the process and its results.

What Causes of Infertility Can IVF Treat?

When it comes to infertility, IVF may be an option if you or your partner have been diagnosed with:

• Endometriosis

• Low sperm counts

• Problems with the uterus or fallopian tubes

• Problems with ovulation

• Antibody problems that harm sperm or eggs

• The inability of sperm to penetrate or survive in the cervical mucus

• An unexplained fertility problem

IVF is never the first step in the treatment of infertility. Instead, it’s reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination haven’t worked.

About the In Vitro Fertilization (IVF) Process

When medical conditions prevent the sperm from reaching the egg, our skilled physicians and laboratory staff are here to assist. Your eggs are retrieved, inseminated in our lab with semen from your partner or a donor, and then inserted back into your uterus as embryos. While every woman’s cycle is unique, the following is a general outline of the steps involved during a cycle of in vitro fertilization.

Step One: Ovulation Induction

Fertility drugs, taken through injections, are used to stimulate a woman’s ovaries to develop multiple mature eggs. This improves chances for fertilization and ultimately pregnancy. The most common medications are gonadotropins including Repronex, Follistim, Gonal F, and Menopur.

Step Two: Egg (Oocyte) Retrieval 

When the eggs are mature, they are retrieved by an ultrasound-guided procedure that is performed under light anesthesia on an outpatient basis.  During the procedure a needle is placed through the vaginal opening and into the ovaries. There are no abdominal incisions or suturing. The eggs are then evaluated in our onsite embryology lab. Once there, they are fertilized with sperm from your partner or a donor. Risks are minimal and recovery takes an hour or two, although post-operative cramping is common.

Success rates vary depending on a woman’s age, her response to the medication and the quality of her embryos. Risks include increased chances of multiple births and ovarian hyperstimulation. The chances of infection or significant blood loss are very low.

Step Three: Fertilization in the Lab

Once the eggs arrive in our embryology lab, our skilled staff analyzes them for maturity and then incubates them. At this time, partners are asked to collect a fresh sperm sample, which is then analyzed and treated to isolate the best sperm for insemination. The sperm is then mixed with the eggs or injected directly into the eggs using intracytoplasmic sperm injection(ICSI).

It takes approximately 18 hours to determine if fertilization has occurred and 24 to 72 hours to establish if the embryo is growing. During a successful IVF process, the oocytes and embryos will stay in the laboratory for approximately 2 to 5 days.

Step Four: Embryo Transfer

A few days after the oocytes are retrieved and fertilized in our laboratory, you will come to our office for the embryo transfer procedure. Embryo transfer is a simple technique and anesthesia is not required. On the day of transfer, you, your partner, and our specialist will discuss the number of embryos being transferred, as well as their quality and grade.

During the actual procedure, a long, thin catheter containing the embryos and a small amount of fluid is passed through your cervix into your uterus, where the embryos are placed.

Conventional embryo transfer is performed three days after the donor’s egg retrieval when healthy embryos (Day 3 embryos) reach the 6-8 cell stage. Blastocysts are embryos that have advanced to 30-60 cells and are transferred five days after retrieval.

If you have a large number of good quality embryos on day 3, we may recommend that you wait 2 days and have a blastocyst transfer on day 5. During the two additional days, some embryos will not progress and others should continue to develop. It is felt that the embryos that survive and progress during this time will be most likely to survive in the uterus. Thus, blastocyst culture is a tool that allows the embryologists and physicians to select the “best” embryos for transfer.

Additionally, blastocyst transfer allows the number of embryos transferred to be kept to a minimum, which reduces the chance for multiple births, while still giving you an excellent chance for conceiving. Transfer on day 3 is still recommended if there are a low number of “good” embryos on day 3.

Following the embryo transfer, you must limit certain activities and continue required medications. In five days, a blood test is done to monitor your hormone levels. A pregnancy test is taken 9 to 11 days after the embryo transfer, and will determine whether the procedure was successful.

Embryo Cryopreservation

Sometimes during the IVF process extra embryos develop during your cycle. If the embryos are of acceptable quality, they can be frozen and stored for future transfer. Since the IVF process can be difficult both physically and financially, cryopreservation helps facilitate treatment of infertility while also reducing the cost.

Patient Orientation Sessions

Any patient undergoing an In Vitro Fertilization (IVF) cycle must attend an onsite orientation session conducted by our nursing staff before beginning treatment. Partners are encouraged to attend this session as well. To provide additional review of the information, the orientation presentation is now available for you to review online. Please note, this availability does not eliminate the need to attend an onsite session.

IVF risks

There are health risks involved in IVF treatment. These include:

Multiple pregnancy

There is an increased chance of multiple pregnancy with IVF. Multiple pregnancy has health risks for both the mother and children as twins or triplets are more likely to be born prematurely and to be underweight at birth. Learn more about twins and multiples.

Ovarian hyper stimulation syndrome (OHSS)

Drugs used to stimulate the ovaries during IVF can lead to ovarian hyperstimulation syndrome (OHSS). In OHSS, the ovaries enlarge and become painful, causing abdominal discomfort. More severe cases can lead to shortness of breath, fluid retention in the abdominal cavity and formation of blood clots. In these cases, you may need a stay in hospital.

Infection

When eggs are removed from the woman, a fine needle is passed through the vagina and into the ovaries. There is a risk of introducing infection into the body, though antibiotics and surgical hygiene ensure that this rarely occurs.