IVF
In Vitro Fertilization, or IVF, is one of the most well-known infertility treatments, IVF refers to a process in which multiple eggs are retrieved from the ovaries and fertilized in an IVF laboratory. A select number of the embryos created are then transferred back into the uterus. Dr. Kelly is among the most experienced physicians in the country currently performing IVF. She is a renowned leader in IVF and is widely known for her IVF success rates. Throughout her 30+ year career, she has personally performed thousands of successful IVF cycles
IVF can be summarized as a series of 4 steps: ovulation induction, egg retrieval, fertilization, and embryo transfer. Several additional techniques can be used in the laboratory to enhance pregnancy rates including blastocyst transfer, intracytoplasmic sperm injection (ICSI), PGT, assisted hatching, and cryopreservation. One IVF cycle takes about 4 to 6 weeks to complete.
IVF Phase 1: Ovulation Induction
In the first phase of IVF, we induce ovulation. This is accomplished using medications that stimulate the ovaries to produce multiple mature eggs in one cycle. This differs from a natural or spontaneous cycle, where typically only one egg develops to maturity, is ready for fertilization and is subsequently released into the fallopian tube.
Using medication to develop more than one egg at a time allows us to overcome one of the surprising facts about human fertility, which is that chances are surprisingly low that any given mature egg will be genetically normal and able to lead to a healthy, full-term pregnancy. Fifty percent of the eggs produced by a woman in her twenties who is not experiencing infertility will be genetically abnormal. This percentage increases as a woman gets older. By age 40, 85 - 90 % of released eggs are genetically abnormal.
When we induce ovulation in the first phase of IVF, we increase the chances that one or more of the eggs released will be genetically normal, which gives us a much greater chance per cycle of achieving a healthy pregnancy. Combining a genetically normal egg with sperm increases the chances of success in the later stages of the IVF process - of creating a healthy embryo, of the embryo implanting into the uterus, of the pregnancy developing to full-term and ultimately of having a healthy baby.
We use bloodwork and ultrasound to carefully observe the maturing eggs until just before they are ready to be released. This phase takes approximately 9 to 12 days.
IVF Phase 2: Egg Retrieval
Once the eggs have matured fully, they are ready for retrieval. Eggs are retrieved in a short, straightforward outpatient procedure performed by Dr. Kelly. The entire procedure takes place at an IVF-specific surgical center and typically lasts about 15 minutes. We do egg retrievals using intravenous sedation, which puts you to sleep but is not considered general anesthesia because you continue to breathe on your own. In between falling asleep and waking up, a thin needle is passed through the vaginal wall to reach the ovaries and gently aspirate the follicular fluid and eggs. Most people feel well enough to go to work the day after the egg retrieval procedure is completed.
IVF Phase 3: Fertilization
We immediately expose the mature eggs that are retrieved to sperm in the IVF laboratory to allow them to fertilize. The resulting embryos are carefully monitored by Dr. Kelly and the embryologist as they develop in an incubator over the next 3 to 5 days. They are watching the embryos to monitor cell division, their rate of development, and their degree of fragmentation.
You will be in close communication with Dr. Kelly and her team during this time to discuss the results of fertilization and embryo development. Based on these results you and Dr. Kelly will decide how many embryos to transfer back into the uterus and the optimal number of days after the retrieval to do so (usually 5 days).
IVF Phase 4: Embryo Transfer
The embryo transfer is the final and simplest, albeit critical, step of the IVF process. Like the egg retrieval, the embryo transfer is done at the IVF-specific surgical center. During a short procedure, the embryo or embryos are deposited into the uterus using a thin catheter that passes through the naturally occurring cervical canal under abdominal ultrasound guidance. Typically we do not need to use anesthesia.
Additional Laboratory Techniques
Depending on your infertility diagnosis, new developments in reproductive medicine may greatly improve your chances for success when utilizing IVF. These developments include the following laboratory technologies:
Blastocyst Transfer
As mentioned above, embryos that result from fertilization are allowed to develop for 3 to 5 days in the laboratory after the egg retrieval and before the embryo transfer. Advances in laboratory technology now allow more embryos to reach day 5 of development, at which point they are called blastocysts.
Once embryos reach the blastocyst stage, Dr. Kelly and the embryology team can determine with greater certainty which embryos are healthiest and have the greatest chance of successfully implanting in the wall of the uterus. As a result, we can simultaneously maximize pregnancy rates while reducing the number of embryos that need to be transferred. This decrease the chances of you having a multiple pregnancy (carrying more than one child) without compromising your chance of becoming pregnant.
Blastocyst transfer is typically used for those who have a good response to ovulation induction and who produce numerous healthy eggs.
Intracytoplasmic Sperm Injection (ICSI)
ICSI technique refers to the process of a single sperm being injected directly into the center of an egg using a micro-needle. This is done by the embryologist under magnification provided by a microscope.
ICSI greatly improves pregnancy rates for patients with moderate to severe male factor infertility and those who, for other reasons, have failed to achieve fertilization in the laboratory.
Even men with no sperm in the ejaculate can conceive with the help of ICSI. In this case, a urologist can obtain sperm through either aspiration or testicular biopsy.
PGT
Preimplantation Genetic Diagnosis (PGT) is a major advancement in IVF. In PGT, 4-5 cells are removed from embryos which reach blastocyst stage. The embryos are then cryopreserved and the cells are sent to a specialized genetic center which examines the DNA content for chromosomal balance. A normal chromosome has 46 chromosomes. A report is released to us within 10-14 days indicating which embryos have a normal chromosomal content and therefore the greatest likelihood of creating a healthy pregnancy. Studies have shown that the pregnancy rates are the same for all women regardless of age if we transfer a normally balanced embryo.
PGT is also used to look for specific mutations which are carried by parent(s). This is a highly successful technique which we have used in numerous situations. Examples of genetic alterations include cystic fibrosis, sickle cell anemia, Tay -Sachs and SMA.
Assisted Hatching
In order for an embryo to attach or implant to the wall of the uterus, it first has to hatch out of its outer shell. Assisted hatching is a technique recommended when the outer shell of the embryo, called the zona pellucida, appears thick. Shortly before an embryo is transferred to the uterus, a small opening is made in this outer layer surrounding the egg to help stimulate the hatching and implantation process.
Cryopreservation
High-quality embryos that are not used in an IVF cycle can be frozen, or cryopreserved, for future use. We take care to apply the most advanced freezing techniques at the ideal stage of embryo development. This allows us to achieve the highest chance of success in future cycles using frozen embryos. Recent research indicates that pregnancy rates are higher in frozen embryo transfers (FET) in many instances compared to transfers which occur in the same cycle as stimulation and retrieval.
