In Vitro Fertilization (IVF): Step by Step
Finally, we get to in vitro fertilization (IVF), which is the third and final level of assisted reproductive technology. In vitro is a Latin term that literally means “in glass,” because the first IVF embryos were conceived in glass dishes. Now, petri dishes are made of plastic – but the original name lives on.
In vitro fertilization takes the bull by the horns, where conception is concerned, by physically introducing the egg and sperm, and then allowing the fertilized eggs to grow into embryos in the lab. If the process is successful, we manually insert an embryo (or, sometimes, embryos) into the uterus hoping that one will successfully implant in the uterus.
IVF Part I: Ovarian Stimulation (just like COH)
The first part of the process looks very much like the process we use with fertility injections (COH). The only difference is that for IVF, we use higher doses of FSH because our goal is to retrieve 10 to 20 eggs. The potential side-effects are the same, including temporary cysts or the rare chance of developing severe OHSS.
Remember we said that we use ultrasound technology to monitor patients using fertility injections? If you’re going the IVF route, our ultrasound checks will show us exactly when the eggs are ready to be retrieved. The egg retrieval process only takes about 15-minutes from start to finish.
IVF Part II: The Egg Retrieval Procedure
When the eggs are ready to be retrieved, you will come to our clinic where we have our operating room (OR) that is connected to the embryology laboratory. You will meet with an embryologist before the egg retrieval and he will introduce your eggs to the sperm. We administer IV sedation to help you stay calm and to mitigate any potential discomfort that could arise during the procedure- this is called conscious sedation so you will be breathing on your own, but very relaxed.
The ultrasound, connected to a very special needle, will be inserted through your vagina and into each ovary. We use a monitor to help us guide the needle right into the middle all of the follicles. The mature eggs are sucked up (we say, “aspirated”) by the needle, one by one, and deposited into a small glass tube.
This is where the embryologists begin their work. Eggs are too tiny to be seen with the naked eye, so our embryologists use a microscope to verify the egg was, indeed, safely deposited into the tube. When all the eggs have been retrieved, they’re ready the next step.
Unless you are using donor sperm, we like to make it a “double retrieval day.” While the female half the equation is busy having mature eggs removed from her ovaries, the male half of the equation is busy producing a sperm sample for the embryologist that will be washed and then centrifuged so we can isolate the best sperm.
IVF Part III: The Fertilization Process
There are two ways to fertilize the eggs:
- The conventional method, by which we mix one egg and around 20,000 sperm in petri dishes and leave them alone in a cozy incubator, lights off, overnight. In the morning, we hope to see petri dishes laden with fertilized eggs, now embryos.
- Intracytoplasmic sperm injection (ICSI) is used in many circumstances, usually in cases where sperm are low or have a problem with motility or morphology. Using this method, individual sperm are injected directly into each egg, essentially eliminating any male factor.
Once the eggs are fertilized, we watch the embryos grow for five days, during which time the embryos multiply from a single-cell to 100-cells. Not coincidentally, day five is also the day your uterus is the most ripe to receive an embryo. Thus, embryo transfers at our clinic occur on Day 5, to synchronize a five-day old embryo with the ideal implantation opportunity. In most cases, we transfer one or two embryos per IVF cycle. In rare circumstances, we may transfer three.
After 8-10 days, you will come back in for a pregnancy test to confirm that the embryo has implanted and that you are officially pregnant.
So now you’ve learned The Fertility Basics when it comes to maximizing your chances of getting pregnant at home, fertility testing and fertility treatments. Now, it’s time to embark further into the nitty-gritty of each of these subjects.
Next Up: Endometriosis