IVF (In Vitro Fertilization)

Home » IVF (In Vitro Fertilization)

What is in vitro fertilization?

A very basic explanation of IVF, which is an Assisted Reproduction Technology (ART) procedure is:

• Extracting a woman’s eggs
• Collecting a man’s sperm sample (or purchasing donor sperm)
• An embryologist manually combining egg and sperm in a laboratory to create embryos
• Implanting an embryo into a woman’s uterus.

When many people think of fertility treatments, they think of IVF (In Vitro Fertilization).  It’s important to realize, however, that most patients get pregnant with less invasive fertility treatments.  Only 10-15 percent of patients require IVF treatment in order to have a successful pregnancy.  Here are some top questions you may have when first researching your treatment options.

In Vitro Fertilization is the process by which eggs (oocytes) are retrieved from the ovary, fertilized by the sperm in the laboratory, and cultured into early embryos. The embryos are then transferred into the uterus. Since multiple eggs are desired in order to enhance the likelihood of developing one to three healthy embryos, stimulation with injectable fertility drugs, (gonadotropins) are usually required. Frequent monitoring is necessary with sonograms and blood tests. When these diagnostic methods indicated that the time is appropriate, a trigger injection is taken to mature the eggs. The eggs are retrieved from the ovary just before they are ready to be ovulated. This is usually about 36 hours after the trigger injection.

For IVF, the eggs are usually retrieved by ultrasound guided needle aspiration through the vagina. Transvaginal egg aspiration is done using intravenous anesthesia, which is administered by an anesthesiologist. This out-patient procedure is performed at The Reproductive Medicine Group’s IVF and Surgery Center.

After aspiration, the embryologist determines the number of eggs obtained and classifies them as mature, immature, post mature or degenerative. Immediately following the egg aspiration, the spouse/partner will meet with the IVF Andrologist to provide a semen specimen. The sperm is then processed in our IVF lab in Tampa, Florida. The sperm and eggs are placed in a dish and fertilization takes place (in vitro) outside the patient’s body in the laboratory. The fertilization process takes approximately 10-20 hours. Embryos are then cultured for 5 days before being replaced back in the uterus by a simple technique much like intrauterine insemination or cryopreserved (frozen).  Prior to embryo cryopreservation, a few cells may be removed for genetic screening.

Embryo transfer occurs on day 5 at The Reproductive Medicine Group’s IVF and Surgery Center. Embryos are carefully placed into a special catheter and inserted into the uterine cavity. Generally, 1-2 embryos are transferred back into the uterus depending on the patient’s age, embryo quality and physician recommendation. The Reproductive Medicine Group strives to transfer the lowest number of embryos possible to reduce the risk of multiple pregnancy but maintain the best chances for conception.

A serum progesterone level is checked several days after a completed IVF cycle, and the first pregnancy test is approximately 10-14 days following the IVF transfer procedure.

As with many clinics throughout the U.S., patients planning to undergo IVF with The Reproductive Medicine Group will attend an evening IVF group class during which time the IVF procedures and protocols will be explained in detail. These classes are given by one of the RMG physicians and currently are held in the evening, the 3rd Tuesday of every month. A schedule of classes is posted in each RMG office.

Following the class, the couple will have an appointment to have the woman’s uterine cavity length measured, “mock transfer” and to sign consent forms. You should have a full bladder for the “mock transfer”. During that appointment, the physician will review information about IVF and answer your questions. The number of embryos to be transferred and plans to freeze embryos of high quality beyond the number to be transferred will be discussed at that appointment or the decision to perform genetic testing on the embryos or freeze all of the embryos for subsequent transfer will be discussed at that appointment. (It is critical that both you and your spouse read the IVF consent forms prior to that appointment!) The consent forms are extremely detailed and contain critically important information. Please do not leave that appointment without having all of your medical questions regarding IVF addressed.

You are expected to pay all fees not covered by your insurance at that appointment as well. As such if you have not received your bill, please contact the billing office prior to your appointment.

After your mock transfer/consent form signing consultation appointment, if your protocol includes down regulation with a birth control pill, you should be sure to pick up your pill pack. You are to call the ART nurse with the onset of your menses. You will be instructed when to begin your birth control pill and an appointment will be set up with the IVF nurses for you and your spouse to learn how to administer the IVF medications as well as to receive your personalized, detailed calendar which outlines expected appointments and timing of your medications.

You will begin your IVF stimulation medications according to your calendar after that appointment. Once you begin your stimulation medications, you will come into the office periodically for blood work and ultrasounds. These appointments are in the early morning usually between 7:30a.m. and 9:00a.m. The results will be ready in the mid afternoon and reviewed by the physician who will determine what your medication dose will be and when you will need to return for further monitoring. The IVF nurse will then contact you with instructions. For your convenience, monitoring is performed during the weekdays at all 4 of our locations. On weekends/holidays, monitoring is performed only at the North Tampa office. Oocyte (egg) stimulation medications (gonadotropins) are generally taken for 8-12 days (this does not include the days using the birth control pill).

When the blood work and ultrasounds (sonograms) suggest that several eggs should be mature, you will be instructed as to the time to take the trigger injection. Approximately 36 hours after the injection, the egg aspiration procedure will occur. Several days prior to the egg aspiration procedure, you will have a pre-op appointment with your doctor. You will have the opportunity to ask your doctor any additional questions you may have and will receive prescriptions for pain medication to use if needed, after the egg aspiration and for valium to be used on the morning of the embryo transfer.

You will report to the RMG IVF/Surgery Center at the instructed time on the morning of your egg aspiration. You are to have nothing to eat or drink beginning midnight prior to your aspiration procedure. This includes water, gum, candies and tobacco (all patients MUST discontinue tobacco at least 3 months prior to their IVF cycle). You may brush your teeth.

Upon arrival to the IVF Center, you will be admitted and an IV will be started. Your partner/spouse may be with you until you go to the operating room. You will be seen by the pre-op and OR nurses, the anesthesiology physician and the RMG physician who will perform the procedure. Once in the OR, you will receive medication through your IV to make you drowsy and then asleep. You will not feel any pain. The procedure takes 15 – 20 minutes. You will be returned to the post-op area. Once you are awake, your partner/spouse will be asked to produce the semen sample. If your spouse has difficulty producing a specimen, PLEASE inform your physician or the IVF nurses in ADVANCE (at least a week if not more prior to the aspiration procedure) so we can arrange to have his sperm collected and cryopreserved in advance when he will feel less pressure. As this incurs additional cost, we do not routinely recommend freezing sperm in advance. Men who have extremely low counts and some men undergoing retrieval of sperm from the testes will have their sperm cryopreserved prior to the IVF cycle.

The embryos will be incubated, undisturbed for an additional 4 days and reassessed on the 5^th day post retrieval.  Embryos that reach the blastocyst stage by day 5 may be transferred into the uterus or biopsied for genetic screening and then frozen (cryopreserved). Those that do not reach blastocyst stage by day 5 will be re-evaluated on day 6 and biopsied and then frozen if they reach the blastocyst stage.

On the morning of your embryo transfer, you will fill your bladder, take your valium pill as instructed and report to the RMG IVF/Surgery Center at the time assigned to you. You will be admitted, speak with the nurse and the physician will discuss the quality of embryo(s) to be transferred into the uterus. The number of embryos will be based on the grid previously discussed and determined at your consent form signing appointment. Your spouse/partner may accompany you throughout the procedure.

You will walk to the transfer room through the OR area (your spouse will be walked through the non-sterile hallway and meet you in the transfer room). Once in the transfer room, you will be asked to reverify your name and the number of embryos to be transferred. The procedure will be performed the same way the mock transfer was done by your doctor previously. An ultrasound will be performed while the physician places the transfer catheter and the embryos are inserted into the uterus. If your bladder is appropriately filled, you may be able to see the tip of the catheter on your smaller viewing screen. The lining closes around the embryos and, as such, you do not need to worry about the embryos falling out when you stand up or empty your bladder.

Many factors determine why some embryos implant while others do not. Embryo implantation success rates are directly related to the age and quality of the woman’s eggs. At The Reproductive Medicine Group it is our goal to give our patients the best chance for conception.

Assisted hatching through micromanipulation has been shown to increase the IVF embryo implantation rate of embryos that are being thawed for a frozen embryo transfer cycle. Even if sperm – egg interaction and embryonic development proceed normally, attachment of the pre-embryo to the uterus must still occur.

A layer covering the egg called the zona pellucida performs many crucial functions in the process of fertilization and development. However, in order for the embryo to implant into the uterine wall, it must hatch out from its zona pellucida with the help of substances produced by the embryo.

A number of findings suggest that human IVF pre-embryos sometimes lack the ability to thin and hatch through their zona pellucida. The pre-embryo is held by a micropipette while a specialized laser beam is utilized to create a small opening in the zona pellucida.

How can IVF “treat” male infertility?

Intracytoplasmic Sperm Injection (ICSI) enables men with poor sperm quality to father children. ICSI is used when the male has a very low sperm count, if sperm motility is poor, or if there is a low percentage of normal shaped sperm. It is used in some cases of unexplained failed fertilization in a prior IVF cycle.  It is also used for sperm obtained through TESE (testicular extracted sperm) and for all cycles involving PGT (pre-implantation genetic testing).

In the ICSI procedure, a microscopic hole is placed in the egg membrane with an instrument that resembles a needle. A single sperm from the male is inserted into the egg.

There is no difference between the offspring produced by ICSI and those conceived by other methods. There is now broad, successful, clinical experience with hundreds of ICSI patients and their children. Embryologists receive advanced training to enable them to perform this delicate procedure.

Even in men with no sperm seen at the time of semen analysis, there may be sperm within the testes. This sperm can be removed by aspiration from the testes or epididymis in procedures called TESE (testicular sperm extraction) or MESA (microscopic epididymal sperm aspiration). TESE and MESA procedures combined with ICSI allow many men, previously considered sterile, to produce children.

The Reproductive Medicine Group is a LEADER in the treatment of Infertility in the Tampa Bay region. ART therapies, most common of which is in vitro fertilization (IVF), assist couples in overcoming fertility issues through the joining of the sperm and eggs outside the body and then transferring the resulting embryo into the uterus. The ART program is comprised of dedicated physicians, nurses, embryologists and andrologists. Our ART Laboratory is located adjacent to our Surgery Center in North Tampa.

The RMG/ART Laboratory is fully accredited by the College of American Pathologists (CAP) in the areas of andrology and embryology. This accreditation indicates that the RMG/ART Laboratory belongs to an exclusive group of laboratories throughout the country that meet the highest standards of excellence as recognized by their peers. The accreditation process includes an evaluation of all aspects of quality in the laboratory: Methodology, reagents, medical equipment control, specimen handling, procedure manuals, reports and proficiency testing, personnel and the overall management principles that distinguish a quality laboratory. The CAP is an advocate for high quality and cost effective medical care.

The RMG/ART Laboratory also participates in the biannual proficiency testing by The American Association of Bioanalysts. This comprehensive external quality control program satisfies the proficiency testing requirements for Clinical Improvement Amendments, Commission on Office Laboratory Accreditation, Health Care Financing Administration, Joint Commission on Accreditation of Healthcare Organizations, CAP, and most state agencies.

The Reproductive Medicine Group ART Laboratories Inc. in Tampa, FL has been awarded accreditation by the Accreditation Committee of the College of American Pathologists (CAP), based on the results of a recent onsite inspection in December, 2010. The Reproductive Medicine Group was advised of this national recognition and congratulated for the excellence of the services being provided. RMG ART Laboratories Inc. is one of more than 7,000 CAP-accredited laboratories worldwide. The CAP Laboratory Accreditation Program, begun in the early 1960s, is recognized by the federal government as being equal to or more stringent than the government’s own inspection program. This stringent inspection program is designed to specifically ensure the highest standard of care for all of our patients.