Assisted Reproductive Technology
ART refers to the process of surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s uterus.
In vitro Fertilization (IVF)
The most common type of ART is In vitro Fertilization (IVF). There are 4 Stages of IVF:
1: Follicular Stimulation This is the process of developing eggs, which are formed in follicles on your ovaries and takes about ten days. Having a greater number of mature eggs available for retrieval increases the chances for achieving pregnancy. Since a woman’s body normally releases only one mature egg every month, gonadotropins such as Follistim and Menopur, are used to stimulate the ovaries to develop more follicles.
2: Egg Retrieval/Aspiration Once ovarian stimulation is complete and follicles have matured, as many eggs as possible will be retrieved, although all eggs may not be used in the current IVF cycle. The vaginal egg retrieval is performed under IV sedation. A needle guide is placed alongside the ultrasound probe which is then inserted into the vagina. A long, skinny needle is then inserted through the needle guide, penetrating the vaginal wall and directed into the ovary(ies) to withdraw the fluid from the mature follicle with gentle suction. The fluid is immediately examined under a microscope to see if an egg has been retrieved. The process is repeated for each visible follicle in both ovaries. All retrieved eggs are removed from the follicular fluid and placed in an incubator to await fertilization. On day of aspiration, a fresh semen sample is collected from the male partner and processed to select the strongest, most active sperm.
3: Fertilization Intracytoplasmic Sperm Injection (ICSI) Each egg is placed under a microscope and held in place by a gentle vacuum with a small glass tube called a micropipette. A single sperm is then drawn up and quickly passed through the zone pellucida (the gel-like egg shell) and the inner cell membrane, directly into the center of the egg, anticipating fertilization. When the egg is fertilized with the sperm, embryos are now created. The embryologist will monitor and incubate the embryos until transfer time. Assisted Hatching In order for implantation to occur, the embryo must hatch out of its outer layer and implant in the lining of the uterus. Just prior to the transfer, the embryologist makes a small opening in the outer layer of the embryo with a tiny needle to facilitate this process.
4: Embryo Transfer The embryo transfer itself is not a complicated procedure and is performed in our office. The embryos are placed in a catheter which is inserted through the cervix into the uterine cavity, by visualization from an abdominal ultrasound. The number of embryos transferred depends, but is not limited to, a woman’s age, cause of infertility, pregnancy history, and other factors. If there are additional embryos that are of exceptional quality, they may meet the guidelines for freezing (cryopreservation) for later use. Approximately two weeks after the day of egg retrieval, a pregnancy test is performed.
Frozen Embryo Transfer (FET)
Sometimes there may be extra embryos created in the process of IVF which are not transferred to the uterus. They can be frozen for future cycles. When you are ready to use these embryos, the thawing and transferring of these embryos is known as a Frozen Embryo Transfer (FET).
Uterine preparation begins with the use of the birth control pill and then overlaps with the start of daily Lupron injections to suppress ovulation and keep your ovaries quiet. You will have an assigned date to stop the pill which will bring on a period, but you will continue the Lupron. This period is referred to as a Lupron bleed. The use of Estrace then begins for approximately 3 weeks. This helps to thicken your uterine lining for the transfer. When the endometrial lining is sufficient in thickness, progesterone in oil injections will begin to help to continue to enrich the lining to accept the embryos for implantation.