What Is IVF?
With the advancement of modern science in the last few decades, assisted reproduction has become a successful and common course of treatment for infertile individuals and couples. In-Vitro Fertilization, IVF, is one such assisted reproductive technique that has been employed successfully as a solution to a range of infertility issues. The IVF process is both safe and effective, and it has been used as far back as the early 1980’s in helping infertile individuals and couples achieve their goal of becoming parents.
In vitro is Latin, meaning “in glass,” referring to the dish that is used to introduce the sperm to an egg. The term “IVF” includes a whole spectrum of assisted reproductive treatment possibilities that can be used separately or together to increase the chances of success. Whenever possible, IVF is used to fertilize an egg with a sperm, thereby forming an embryo. In specific circumstances, the sperm, the egg, or both can come from qualified, pre-screened donors facilitated by the NYFI. Additionally, the NYFI can freeze eggs, sperm, or embryos for procreative management or as a means of extending potential fertility in the future.
How Does IVF Work?
The common processes of embryo formation through the technique known as ‘intra-cytoplasmic sperm injection’ – ICSI. In this laboratory procedure, a specialized micro-thin pipette injects a single sperm into an egg to aid the process of fertilization.. This video was taken under a high-powered microscope capable of viewing cells, which normally are invisible to the naked eye.
Fertility treatment often includes use of hormone therapy to stimulate the ovaries to produce eggs. Then, IVF begins with retrieval of a woman’s (or her donor’s) eggs. Prior to the retrieval of the eggs, the male partner (or a donor) produces a semen sample, which is processed and washed, and the most motile (active) sperm are selected. Anywhere from three or four, or even up to twenty eggs are retrieved from the woman under general sedation. This procedure requires no surgical incision and is done purely on an outpatient basis in our office. The retrieved eggs are placed in a separate dish under a protective layer of oil and left alone for three to four hours to complete their maturation.
From here, two options are possible in the lab. The first is routine IVF, where the washed sperm is added in a measured quantity to each dish containing an egg. This method requires numerous amounts of motile sperm from the male. The second is ICSI, which is recommended when either the quality or the quantity of sperm is low. ICSI is also useful when the zona pellucida – the membrane surrounding the egg – is so thick that the sperm cannot penetrate on its own and requires forced injection. Done under a high-powered microscope, ICSI involves selecting one sperm and injecting it into an egg.
DAY 1: Check for Fertilization
About 14-18 hours later, the NYFI’s embryologist inspects the eggs under a microscope to ascertain whether they have been fertilized – whether the sperm has successfully penetrated the egg to create an embryo. The embryologist does so by looking for specific formed signs or genetic (pro-nuclear) changes: when a sperm enters an egg, it “wakes up” the condensed genetic material of the egg, activating or “opening” it and beginning the process of growth. The number of eggs fertilized is thereby noted. This is the earliest stage at which embryos can be frozen. Elective freezing enables the preservation of a woman’s potential fertility well past the time when her body could hypothetically stop producing viable eggs.
DAY 2: Monitor Growth
The fertilized eggs – embryos – are monitored in the lab as they begin the process of division. Within the next 24 hours a single embryo divides one or two times into a two-celled or four-celled embryo.
DAY 3: First Opportunity to Transfer
Over the following 24 hours, the embryo, which has divided further into either four or eight cells, can now be transferred to the uterus: this marks the first opportunity to transfer. Alternatively, the divided embryos can be frozen at this stage for the preservation of future fertility. Also, the divided embryos can grow for a further 48 hours to the blastocyst stage, where either a transfer or freeze cycle can be accomplished (blastocyst transfer is explained below).
DAY 3: Assisted Hatching
Another technique used at the NYFI to increase a woman’s chances of implantation is assisted hatching. To successfully implant in the womb, the outer layer or “shell” of the embryo, called the zona pellucida, must break, allowing the fertilized egg to “hatch out” and attach to the endometrial lining. However, as a woman ages, her eggs may develop thicker shells, making it more difficult for the egg to hatch naturally; or, the physician may have diagnosed a pattern with poor embryos from a previous IVF cycle. In these scenarios, the physician may choose to employ assisted hatching, which is the process by which a hole is opened in the shell of the fertilized egg, using mechanical or chemical means, to facilitate the natural process of hatching and improve the chances of implantation with embryo-transfer
DAY 3: Preimplantation Genetic Diagnosis
Day 3 is also the time when advanced techniques such as preimplantation genetic diagnosis are carried out. This technique employs molecular genetic methods to enable the identification of genetically normal embryos as well as to aid in the identification of the gender of the embryo. This stage is of obvious importance for individuals or couples who have selected a particular gender for the child.
DAY 5-6: Blastocyst Transfer
If it is decided that blastocyst transfer may be more successful for a particular patient, instead of the initial day 3 transfer, the lab will allow a fertilized embryo to multiply for 5-6 days in the dish, growing to the blastocyst stage.
The blastocyst is an advance-developed embryo, consisting of the inner cells (the developing embryo) in a fluid-filled cavity, all encased in the outer layer that will later become the placenta. In a natural pregnancy, this is the stage where the embryo—which would have been traveling down the fallopian tube—would implant in the womb. Transferring to the uterus at this stage is called a “blastocyst transfer.”
Embryos can also be frozen at this stage.
The different options available at each step of IVF will be thoroughly explained by Dr. Fateh and Dr. Sultan to give you the best understanding of the alternatives at your disposal, with a course of treatment tailored to the circumstances of your case