In Vitro Fertilization, IVF
Our IVF clinics are located in Skokie and Shaumburg, Illinois. In vitro fertilization (IVF) is a mainstay of assisted reproductive technology and has allowed many couples to conceive and deliver healthy children. IVF literally means "fertilization outside of the body". Sperm from the male are combined with the female's eggs in a Petri dish (round glass dish) where fertilization occurs.
Sperm for IVF can be collected from the spouse, or in cases of severe male infertility, from a donor or using intracytoplasmic injection (ICSI /IVF). ICSI is often used to obtain sperm from men with very poor sperm counts or in some cases, no sperm in the ejaculate. The eggs can also be from the spouse or in cases of poor egg quality or ovarian failure from a donor.
First, there must be numerous eggs (oocytes) for the infertility specialist and embryologist to retrieve and fertilize as manipulation sometimes causes damage to the delicate oocytes. The development of these eggs is under the influence of follicle stimulating hormone (FSH). Injectable fertility medications (i.e., Gonal-F, Follistim, or Bravelle) are administered by during specified days of the cycle as dictated by individual treatment protocols. The injection is usually administered by the patient or her spouse.
The first days of the menstrual cycle are when follicle recruitment occurs. FSH is often administered beginning day three of the IVF cycle although this varies dependent upon the patient’s individual protocol. FSH stimulates the ovaries directly to release more than one egg and fosters their continued development. In stimulated cycles, it is common for a woman to produce 15-20 eggs.
Developing healthy oocytes produce the hormone estrogen, which stimulates thickening of the endometrium in preparation to receive the pre-embryo. Later in the IVF cycle, progesterone also supports development of the endometrium. Estrogen levels are monitored via blood tests throughout the IVF stimulation cycle to insure that ovarian hyperstimulation (enlarged ovaries, changes in body fluid distribution, potentially very serious) does not occur.
Non-specialists should generally not administer FSH. Reproductive endocrinologists undergo extensive advanced training and have clinical experience in the use of ovarian stimulation agents. They are best suited to monitor and adjust doses. Ultrasounds and estradiol levels are necessary when receiving these medications and, depending on the patient's response, they may be required a minimum of 3 times during the cycle to a maximum of once daily.
During IVF, Lupron is often administered until the eggs are ready to be retrieved immediately before the ovulatory phase. Whether or not it is given depends on the patient’s individual protocol and "response history". Lupron suppresses the body's production of LH and FSH. Since FSH is given by injection, production by the body is not critical.
Eggs are retrieved via a catheter (needle) inserted through the vagina into the follicles on the ovaries under general anesthesia. The physician aspirates (withdraws) the eggs, which are then placed in a special media for examination by the embryologist.
The fertilized eggs are placed in an incubator where temperature and other environmental factors are strictly controlled. They remain there from three to six days and are examined daily.
The embryos are often cultured longer to the eight cell or blastocyst stage. Blastocysts are more viable than earlier stage embryos and fewer embryos must be replaced in the uterus thus reducing the chance for multiple births. Blastocysts have a higher implantation rate and fewer are usually placed back into the uterus.
After incubation, the embryos are transferred back to the uterus via a catheter. This procedure is painless and usually takes ten to twenty minutes to perform. The patient remains in the bed for twenty-four hours after the procedure. Progesterone is administered via injection after the transfer to provide support for the developing embryo. A series of b-HCG tests and ultrasounds are performed after transfer to document pregnancy.