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IVF is the name for in-vitro fertilization, a procedure that involves retrieving eggs and sperm from the bodies of the male and female partners and placing them together in a laboratory dish for fertilization. The fertilized eggs are then transferred two to six days later into the female partner's uterus. After the fertilized eggs are set into the uterus embryo development will hopefully occur as in a normal pregnancy. IVF is actually a four stage practice that begins with ovarian stimulation and monitoring. In order to maximize the patient's chances for successful fertilization, physicians typically use ovarian stimulation medications instead of following the natural cycle which only produces one egg. Ovarian stimulation causes several mature eggs to be produced for retrieval, fertilization, and transfer to increase the possibility that at least one will result in pregnancy. (See Figure 1) Ovarian stimulation involves the use of follicle stimulating hormone (FSH).
This hormone is necessary to stimulate multiple oocyte, or egg, development. FSH is a gonadotropin, the name for a type of hormone capable of stimulating the ovaries to produce eggs. The female partner is usually stimulated to produce eggs by the use of HMG/ HCG. Careful physician monitoring is necessary to adjust dosages to prevent hyper stimulation and monitor the injections site for possible infection. The physician carefully monitors the patient with vaginal or abdominal ultrasound and blood tests. The ultrasound scans provide an actual image of the ovaries and aid in monitoring follicle growth beginning approximately day eight of the cycle.
The physician is monitoring the growth, number, size of each follicle, and any signs of difficulty that require alterations in treatment. Monitoring also determines the timing of the next step; egg retrieval. In the second step, once the follicle has ruptured, the physician attempts to remove as many eggs as possible. Not all of the eggs retrieved will be used in the current IVF cycle. Unhealthy eggs and any eggs that fail to fertilize are not used.
The two methods used to retrieve eggs are laparoscopy and ultrasound- guided aspiration. In laparoscopy, a surgical procedure requiring general anesthesia, the physician uses a surgical instrument called the laparoscope inserted into the ovaries. The laparoscope contains an aspiration system that uses light suction to retrieve the egg from the follicle. The result of each attempt to retrieve the egg from the follicle is immediately examined under a powerful microscope. If the egg was not retrieved, fine adjustments are made for following attempts until all the mature follicles have been retrieved.
Ultrasound-guided aspiration is also performed under general anesthesia. The ultrasound image allows more accurate aspiration attempts because the physician can guide the needle into each follicle in order to withdraw the egg. After recovering the eggs, they are transferred to a sterile container to await fertilization in the laboratory. In the third step of In-Vitro Fertilization, a semen sample is collected from the male partner approximately two hours before the female partner's eggs are retrieved. These sperm are then processed, called sperm washing, using various laboratory techniques. Sperm processing helps selection of the strongest, healthiest, and most active sperm in the semen sample.
The mature, healthy eggs are then placed together in the laboratory with the selected sperm. They are incubated at a temperature identical to that of the female partner's body. After approximately 48 hours, the eggs that have successfully fertilized and are growing normally, are called embryos. The embryos are then ready for the next step which transfers them into the womb. (See Figure 2) Finally, embryo transfer occurs, which is done without anaesthesia.
The embryos are placed in a catheter, which is a tubular instrument used to transport the embryos from the laboratory container to the womb. The physician inserts the catheter through the female partner's vagina and cervix, in order to insert the embryos directly into the uterus. Normal implantation and maturation of the embryo is hoped to occur in order to conceive the child. Things must follow their natural course after this, and the process of in-vitro fertilization is finished.
IVF was originally developed in the early 1970 's to treat infertility caused by blocked or damaged fallopian tubes. In 1978, the first IVF baby, Louise Brown, was born in the U. S. Since then, the number of IVF procedures performed each year have increased and the success rate has improved significantly. Because IVF was the first Assisted Reproductive Technology procedure developed and widely publicized in the U.
S. , many people mistakenly think that IVF is the only treatment option for infertile couples. In fact, less than 3 % of all patients who seek medical treatment actually receive in-vitro fertilization as a treatment option. Most infertile couples who seek evaluation and treatment respond positively to the less involved treatment options; such as hormonal therapies and artificial insemination. Despite this, IVF remains the most commonly used of the ART procedures. Artificial insemination, AI, is often the best choice of treatment for couples that are infertile due to sperm disorders. AI involves injecting sperm through a narrow catheter into the wife's reproductive tract.
For most couples, artificial insemination is performed with the husband's sperm. When a man's ejaculate contains few or no live sperm, the couple may decide to undergo AI with sperm from a donor with the characteristics they desire. Depending on the husband's effective sperm count, the wife's cervical mucus quality at the fertile time of her cycle and estimated time to egg release from the ovarian follicle, the type of AI is selected. The type, intra cervical, intrauterine, intra follicular, or intra tubal, are named for the location of insemination Intrauterine insemination, IUI, is a type of artificial insemination procedure in which the sperm are placed in the uterine cavity through a trans cervical catheter.
With appropriate laboratory techniques, the sperm can be separated from the seminal fluid and placed in a very small volume of sterile medium which will keep the sperm alive and actively mobile. IUI may be indicated for the treatment of low sperm count and / or absence of fertile mucus. The rationale for the use of IUI for the treatment of oligospermia (low sperm count) is based upon the knowledge that only about 1 % of the total numbers of sperm deposited into the vagina at ejaculation will find their way into the upper female genital tract. IUI places the healthiest sperm into the female genital tract to increase the probability of fertilization. The use of IUI also does not stop the couple from having sexual intercourse nor from using other types of insemination. IUI is performed by passing a sterile catheter through the cervical canal into the uterine cavity and then injecting t...
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