IVF, in vitro fertilization, is an assisted reproductive technology procedure where fertilization occurs “outside of the body” in a Petri dish. IVF is an accepted, and proven, fertility treatment that has enabled tens of thousands of couples to have babies.
Our IVF laboratory at the Center for Women’s Medicine moved to its new location in the Allon health Center in late 2005. Our Houston, TX, IVF clinic success rates are among the highest in the nation partly due to our state of the art equipment and use of the latest techniques. Furthermore we take pride in having one of the lowest multiple pregnancy rates.
IVF is now recognized as a “first line” procedure for many conditions like endometriosis, tubal disease and male factor infertility. Male factor infertility occurs when the partner produces too few sperm cells, or sperm of poor morphology and motility. Using ICSI, (Intracytoplasmic Sperm Injection) one sperm cell is inserted directly into the egg. Our laboratory director is Dr. Dozortsev, who is one of the pioneers in the development of ICSI. He performed his first successful ICSI case in 1993 in Ghent, Belgium. Dr. Dozortsev's unique expertise encompasses more the 16 years in the field of human embryology and genetics. He has written more than 40 publications and his experience in PGD (preimplantation genetic diagnosis) has won him the recognition of “Best PGD Practice Guidelines” from ESHRE (the European society of human reproduction and embryology).
When IVF is combined with PGD, a biopsy is obtained from the embryo at the 6-8 cell stage and analyzed to screen for many genetic diseases, or cells with other genetic defects. All genetic disease are not identifiable using PGD but the list of those that can is rapidly growing. Once a normal embryo(s) is selected it is transferred to the uterus. If there are abnormal embryos, they will not be transferred.
IVF requires that several eggs be available for retrieval, fertilization, and embryo culturing. The female receives daily injections of follicle stimulating hormone (FSH), which stimulates the development of multiple follicles, each containing an egg. IVF patients will typically have 3-5 ultrasounds and estrogen measurements during a 10-14 day period to determine the “stimulation quality” and adjust FSH dosages.
Once the eggs are grown to a certain size and produce an expected amount of estrogen, an injection of hCG (human chorionic gonadotropin) is given to mimic natural ovulation. IVF egg retrieval is than conducted 36 hours later at our clinic as an outpatient procedure. This procedure is performed using IV sedation and ultrasound guidance. The eggs will then be withdrawn from the follicles through the vaginal wall.
Once the eggs are retrieved, they are passed to the embryologist who separates them from the follicular fluid and places them in the appropriate media to promote their growth. After a few hours, they are exposed to sperm and fertilization is allowed to occur. If ICSI (injection of the sperm into the egg) is indicated, it will be performed at this stage.
The fertilized eggs, now called embryos, are allowed to develop for 2-5 days inside of the incubator. Incubators control environmental conditions such as temperature, gas levels, air particles, etc. Generally, the more embryos a patient has, the longer they would be allowed to develop in vitro. This extended culture does not improve embryo quality, but allows us to better identify the most viable embryos.
Blastocyst Stage Embryos
Sometimes we use blastocysts in an IVF cycle. A blastocyst is an embryo that has differentiated into two distinct cell masses. Blastocysts are typically "heartier" and produce higher fertilization rates. Because of this increased viability, fewer need to be transferred to the uterus thus reducing the incidence of multiple births.
If the IVF patient does not have at least 8 fertilized oocytes, we do not usually recommend extended culture to the blastocyst stage. This is because enough embryos may not survive for the transfer. Once the embryos are grown to certain number of cells, they are placed back to the uterine cavity using a catheter and ultrasound for guidance.
Houston IVF Program Acceptance Criteria
In general, IVF patients should meet the following criteria, which are different for IVF/Donor egg.
Female should be 44 years of age or younger
Patient must have a normal uterus and at least one (1) normal ovary, or an acceptable ovum (egg) donor
Female must be in generally good health
IVF Indications
Tubal disease- Women with blocked or tied tubes. IVF bypasses the tubes since the eggs are physically retrieved and fertilized outside in a Petri dish
“Male factor”- abnormal semen analysis or presence of antisperm antibodies
Unexplained infertility- Women who failed to achieve pregnancy after superovulation with injectable medications in whom no cause for infertility can be identified
During the IVF cycle, follicle size is monitored using ultrasound. Estradiol blood tests (E2) are performed regularly to monitor the IVF patient’s response to FSH and dosage adjustments are made as necessary.
The IVF Egg Retrieval
The IVF egg retrieval, also called transvaginal oocyte aspiration, is done 35-37 hours after the hCG (Pregnyl, Novarel, Ovidrel) injection. The retrieval is performed under sedation and may be followed by intermittent “crampy pains”. The procedure requires approximately 15 to 30 minutes and patients are monitored for approximately two hours. IVF patients are asked to arrive 45 minutes prior to their appointment.
The physician guides the aspiration needle through the vaginal wall into the ovarian follicles using ultrasound guidance. After the eggs are removed, they are taken to the IVF laboratory in a culture tube with special media to examine the follicular fluid for eggs.
IVF Post Egg Retrieval Instructions
There may be slight spotting the day of the IVF egg retrieval. Call our office if you are experiencing excessive bleeding, or temperature greater than 100.4.
Additional Information
Do not use tampons
No Intercourse until the blood pregnancy test
Avoid caffeine
No smoking
No alcohol
Do not make travel plans until you have consulted with your physician
Please be sure to get any additional information from your physician the day of your retrieval
Incubation
Once the eggs have been fertilized, the resultant embryos are transferred to an incubator. The incubator strictly controls the embryo’s environment including temperature, air quality, acidity, and many other parameters.
IVF and Assisted Hatching (AH)
In order for the embryo to implant and develop into a fetus, it must first “hatch out” from its surrounding membrane, the zona pellucida. AH is a microsurgical procedure that uses a laser, or a microsurgical tool to make a small opening in the outer membrane of the embryo. The” opening” theoretically makes it easier for the embryo to hatch and attach to the endometrium. Assisted hatching is particularly useful for patients in whom the outer zona pellucida is very thick or in patients with previous IVF failures.
IVF Embryo Transfer
Once the physician and embryologist decide on the optimal day for the transfer, embryo transfer will be scheduled. The number of embryos transferred depends upon many factors including patient age, cause(s) of infertility, past IVF cycle history, and others.
Embryo transfer takes approximately 15 to 20 minutes. During this procedure, a speculum is placed in the vagina, the cervix is washed with culture media and a catheter containing the embryos is placed inside the uterus. Catheter and embryo placement is done under ultrasound guidance.
IVF patients will remain in recovery for one hour and are then discharged with instructions to limit activities for 24 hours. There should be no heavy lifting or strenuous exercise until the pregnancy test results are available.
Extra embryos can be frozen (cryopreservation) for use in future “none stimulated” IVF cycles. The embryologist microscopically examines the catheter to make sure that the embryos have been transferred into the uterus.
EmbryoGlue®
Recently an EmbryoGlue® was introduced into clinical IVF. It contains hyaluronan and nutrients that are required to support the embryo from transfer to implantation and the biomechanical interactions during implantation. Some studies show that it may enhance the pregnancy rates while there are other studies suggesting that it has no benefit. We use EmbryoGlue® in those patients who have an unexplained implantation failure as well as other selected cases.
Post IVF Embryo Transfer Instructions
Rest and limit activities the day of the embryo transfer
Avoid strenuous activity for two weeks after embryo transfer
Abstain from sexual activity for 14 days after the transfer
There may be spotting or vaginal discharge after embryo transfer. Call our office if there is excessive bleeding or cramping.
No tampons
No douching
No bathing, only showers
No alcohol
No cigarette smoking
No caffeine
Avoid medications other than instructed by your physician.
For headaches, do not take antihistamines, Motrin or aspirin. You may take a baby aspirin or regular/extra Strength
Do not make travel plans until you have consulted with Dr. Allon
Please be sure to get any additional information from Dr. Allon, or his nurse, the day of your embryo transfer.
General Recommendation for Patients Considering IVF
Maintain good general health
Eat three well balanced meals daily
Drink 6-8 glasses of water daily
Limit alcohol intake to no more than 1-2 drinks per day
Do not smoke
Do not drink herbal teas
Limit caffeine intake
Ask Dr. Allon about any medications, supplements or vitamins that you or your male partner are taking
Men should avoid soaking in hot water, i.e. bathtubs or a Jacuzzi as elevated scrotal temperature may adversely affect sperm.
