In vitro fertilization and embryo transfer (IVF) is the fertilization of an egg outside the body and transfer of the embryo into the uterus. This process is accomplished by stimulation of the woman’s ovaries with medication, monitoring the growth of ovarian follicles with blood work and transvaginal ultrasonography, followed by a transvaginal oocyte retrieval. The egg is fertilized and allowed to grow (cultured) for 3 to 5 days. The embryo is then transferred into the woman’s uterus. Patients who may benefit from IVF include those with male factor infertility, endometriosis, ovulatory dysfunction that has not been successfully treated with medications, damaged fallopian tubes and unexplained infertility.
Patients interested in IVF will first schedule a consultation with one of our doctors to discuss the treatment options. The doctor will also inform you of any tests or procedures that should be performed prior to the start of your IVF cycle to maximize the likelihood of treatment success. These tests include a semen analysis on the male, blood tests to evaluate ovarian reserve, a transvaginal ultrasound and evaluation of the uterine cavity and a trial transfer. Once ready for treatment, all patients will have a dedicated appointment with their nurse to review their IVF treatment calendar and do injection teaching. Your nurse will remain in close contact with you during your stimulation period, egg retrieval and in preparation for embryo transfer. You will know if the treatment worked within two weeks of the embryo transfer.
Recommendations are made based upon your particular infertility diagnosis, and we may recommend one or more procedures for your IVF cycle in an effort to increase the likelihood of achieving pregnancy.
Once fertilized, the embryo will be grown or cultured in the lab for a number of days. An embryo transfer is typically performed on Day 3 (Cleavage stage) or Day 5 (Blastocyst stage). Extended culture, or growing the embryos to Day 5, allows us to better assess the health of the embryo and identify those with greater implantation potential. Your physician will make a recommendation regarding the length of embryo culture based on your specific history and embryology results.
In a normal conception cycle, the human embryo hatches out of the zona pellucida (the clear cover that surrounds the embryo) about seven days after fertilization occurs. The embryo then implants on the uterine surface and continues to grow. Some embryos may have difficulty hatching, such as embryos from women of advanced reproductive age or embryos from couples who have failed to conceive in prior IVF cycles. Assisted hatching is a procedure in which a small hole is made in the zona pellucida to help the embryo hatch and implant. This procedure is performed under a special microscope a few hours before the embryo transfer.
Intracytoplasmic Sperm Injection (ICSI)
ICSI involves the injection of a single sperm directly into an egg. This procedure improves the fertilization rates when sperm cannot penetrate an egg. ICSI is most often recommended for treatment of severe male factor infertility due to very low sperm counts, poor sperm motility and/or increased numbers of abnormal sperm. ICSI may also be recommended if fertilization did not occur in a prior IVF cycle.
Preimplantation Genetic Screening (PGS)
PGS is a technique that can be used during IVF to identify which embryo(s) have the highest implantation potential based on their relative amount of DNA. A euploid embryo, or an embryo with the normal amount of DNA, has a 60-80% implantation potential. Aneuploid embryos, or embryos with an abnormal amount of DNA, usually result in a negative pregnancy test, occasionally in a miscarriage and least commonly in a live birth of a child with genetic problems. Five to six cells are removed from the outside of the embryo (the trophectoderm) at the blastocyst stage. The cells are then sent to a special genetics laboratory for testing while the embryos are cryopreserved at Alabama Fertility.
Preimplantation Genetic Diagnosis (PGD)
PGD is a technique that can be used during IVF to test embryos for specific genetic disorders prior to their transfer to the uterus. This technique makes it possible for couples with certain serious inherited disorders to decrease the risk of having a child who is affected by the same problem. Five or six cells are removed from the outside of the embryo (the trophectoderm) at the blastocyst stage. The cells are then sent to a special genetics laboratory for testing for the specific disorder. Only the embryos that will be unaffected are transferred to the uterus. Patients interested in this technique must also undergo genetic evaluation and counseling.