What is In Vitro Fertilization (IVF)?
In vitro fertilization (IVF) literally means “fertilization under glass” in Latin. This is because in 1978, the earliest IVF cycles used glass tubes or dishes where eggs were cultured then fertilized by sperm. Today, sterile plastic culture dishes are used instead, but the name remains unchanged. Embryo transfer is the process of placing the fertilized eggs into a woman’s uterus.
There are basically six steps in the IVF and embryo transfer process which include the following:
1. Monitor and stimulate the development of follicles (egg sacs) in the ovaries.
2. Collect the eggs.
3. Obtain the sperm.
4. Combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and embryo growth.
5. Transfer embryos into the uterus.
6. Awaiting the pregnancy results
Step 1: Fertility medications are given to encourage the development of multiple follicles during one of the woman's cycles. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. Progress is monitored every few days using ultrasound to examine the ovaries and blood test samples to check hormone levels.
Step 2: The eggs are retrieved through a minor surgical procedure. Under sedation, a transvaginal ultrasound probe is used to guide a hollow needle in to the ovary (from the vagina). The fluids and egg inside each follicle are gently aspirated and sent to the IVF lab. The entire procedure usually lasts less than 15 minutes. Some women may experience cramping, a feeling of fullness or pressure may last for several days following the procedure.
Step 3: Sperm, usually obtained by ejaculation is prepared for combining with the eggs. If necessary, minor surgical procedures can be used to obtain sperm directly.
Step 4: The sperm and eggs are placed in incubators located in the laboratory and watched for signs of fertilization. If needed a single sperm is injected directly into the egg; this procedure is known as intracytoplasmic sperm injection (ICSI). For the next 2-5 days, the embryos are carefully tended and observed.
Step 5: The embryos are usually transferred to the uterus under ultrasound guidance. A speculum which is inserted into the vagina to expose the cervix and a small thin tube (smaller than a spaghetti noodle) is advanced in to the uterus, where the embryos are gently deposited.
Step 6: About 9-12 days after embryo transfer a blood test and potentially an ultrasound will be used to determine if implantation and pregnancy has occurred.
What is PGD or PGS?
Preimplantation Genetic Diagnosis (PGD) or Preimplantation Genetic Screening is the process of doing genetic testing on embryos prior to transferring them into the uterus. Several methods can be used. For example, one cell can be removed at the 6 to 8 cell stage and then testing for extra or missing chromosomes can be done using fluorescence in situ hybridization (FISH) or Polymerase Chain Reaction (PCR) can be done to screen for specific genetic disorders, like cystic fibrosis or Tay-Sach’s disease. Newer methods of PGD involve testing embryos at the blastocyst (50 to 100 cell) stage and offer the advantage of being able to screen all 23 chromosomes where day 3 PGD using FISH is usually limited to 5 chromosomes. Genetically normal embryos have a better chance of implanting and the resulting pregnancies have a lower chance of ending in miscarriage. However, these additional procedures can add thousands of dollars to the cost of IVF. Some patients with a history of repetitive miscarriage or with family histories of genetic disorders are particularly appropriate candidates for PGD or PGS.
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