In Vitro Fertilization (IVF) is an assisted reproductive technique that is used to treat infertility due to multiple etiologies including tubal disease, male factor endometriosis, and unexplained causes. California Fertility Partners provides IVF in its Los Angeles Fertility Center. IVF treatment involves stimulation of the ovaries to produce multiple eggs, removal of the eggs by an ultrasound directed needle aspiration, followed by insemination of the eggs in the laboratory. The fertilized eggs, or embryos, are grown in culture for 3-5 days before being transferred into the uterine cavity under ultrasound guidance.
A woman’s natural cycle is self-regulated to produce one egg per month. The eggs develop within fluid-filled sacs inside the ovaries called follicles. The hormones that are released by the pituitary to stimulate the follicles to grow each month is called follicle stimulating hormone, or FSH. By giving daily injections of medications containing FSH we can increase the blood level of these hormones, causing multiple eggs to develop to maturity.
There are several different types of medication used to prepare the ovaries for an IVF aspiration. Lupron and Ganirelix are used to prevent the surge of LH in mid-cycle and thereby prevent ovulation. Preparations containing FSH and LH include: Gonal F, Follistim, and Menopur. These medications are used to stimulate multiple follicle growth.
Careful monitoring of the ovaries during treatment is essential for the development of high quality eggs as well as patient safety. Serial ultrasounds and blood tests are used to evaluate the response and timing of egg recovery. The sizes of the follicles correlate with maturity of the eggs inside. When the eggs reach predicted maturity, an ultrasound guided aspiration procedure is scheduled to harvest the eggs.
The egg retrieval is a simple outpatient surgical procedure that is performed under intravenous anesthesia. A vaginal ultrasound probe is used to guide a needle through the vaginal wall and into the ovary. Once the needle is inside the follicle, suction is used to aspirate the fluid and egg into a test tube. The embryologist then examines the fluid for the presence of an egg. The entire procedure takes approximately twenty minutes to perform.
Our embryologist then mixes the eggs with sperm or assists fertilization by sperm injection (ICSI). The embryos are then cultured in a tightly controlled laboratory environment for 3-5 days. Extra embryos may be frozen and stored until a later time. The number of embryos transferred into the uterus is determined based on the woman’s age. This is because embryo transfers are done primarily at the day 5 blastocyst stage today. One or two blastocysts will be the number transferred.
Some women are fortunate enough to have sufficient eggs and embryos from one egg retrieval procedure to allow the extra embryos to be frozen and stored for future use. Any remaining good quality embryos that are not transferred in the fresh cycle may be frozen. The frozen embryos may be stored for an indefinite time period. When needed, the embryos are thawed and transferred into a hormonally prepared uterus. Today based on improved pregnancy outcome most embryos are frozen during the IVF cycle of stimulation and then transferred in a subsequent cycle so that ovarian stimulation for multiple egg production does not interfere with embryo implementation.
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