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TREATMENT - IN VITRO FERTILIZATION (IVF)

In vitro fertilization (IVF) is the joining of a woman's egg and a man's sperm in a laboratory dish. In vitro means “outside the body”. Fertilization means the sperm has attached to and entered the egg.

Description

Normally, an egg and sperm are fertilized inside a woman's body. If the fertilized egg attaches to the lining of the womb and continues to grow, a baby is born about 9 months later. This process is called natural or unassisted conception.

IVF is a form of assisted reproductive technology (ART). This means special medical techniques are used to help a woman become pregnant. IVF has been successfully used since 1978. It is most often tried when other, less expensive fertility techniques have failed.

There are five basic steps to IVF:

Step 1: Stimulation, also called super ovulation

Medicines, commonly called fertility drugs, are given to the woman to boost her egg production. Normally, a woman produces one egg per month. Fertility drugs tell the ovaries to produce several eggs. During this step, the woman will have regular transvaginal ultrasounds to examine the ovaries and blood tests to check hormone levels.

Step 2: Egg retrieval

A minor surgery, called follicular aspiration, is done to remove the eggs from the woman's body. The surgery is normally done as an outpatient procedure in the doctor's office. The woman will be given medicines so she does not feel pain during the procedure. Using ultrasound images as a guide, the health care provider inserts a thin needle through the vagina and into the ovary and sacs (follicles) containing the eggs. The needle is connected to a suction device, which pulls the eggs and fluid out of each follicle, one at a time. The procedure is repeated for the other ovary. The woman may have some cramping after the surgery, but it usually goes away within a day. In rare cases, a pelvic laparoscopy may be needed to remove the eggs.

If a woman does not or cannot produce any eggs, donated eggs may be used.

Step 3: Insemination and Fertilization

The man's sperm is placed together with the best quality eggs and stored in an environmentally controlled chamber. The mixing of the sperm and egg is called insemination. The sperm usually enters (fertilizes) an egg a few hours after insemination. If the doctor thinks the chance of fertilization is low, the laboratory staff may directly inject the sperm into the egg. This is called intracytoplasmic sperm injection (ICSI). Many fertility programs routinely do ICSI on some of the eggs even if everything is normal.

Exams and Tests

When you should seek treatment for infertility depends on your age. It is recommended that women under 30 should generally try to get pregnant on their own for 1 year before seeking testing.

Infertility testing involves a complete medical history and physical examination of both partners.

Blood and imaging tests will be done. In women, this may include:

Blood tests to check hormone levels, including progesterone and follicle stimulating hormone
Checking body temperature first thing in the morning to check if the ovaries are releasing eggs
FSH and clomid challenge test
Hysterosalpingography (HSG)
Pelvic ultrasound
Laparoscopy
Luteinizing hormone urine test (ovulation prediction)
Thyroid function tests

Tests in men may include:

Sperm testing
Testicular biopsy (rarely done)

Treatment

Treatment depends on the cause of infertility. It may involve:

Education and counseling
Fertility treatments such as intrauterine insemination (IUI) and in vitro fertilization (IVF)
Medicines to treat infections and clotting disorders
Medicines that help the woman grow and release eggs from the ovaries

It is important to recognize and discuss the emotional impact that infertility has on you and your partner, and to seek medical advice from your health care provider.

You can increase your chances of becoming pregnant each month by having sex at least every 3 days before and during ovulation. It is especially important to do so 72 hours before ovulation begins.

Ovulation occurs about 2 weeks before the next menstrual cycle (period) starts. If a woman gets her period every 28 days, the couple should have sex at least every 3 days between the 10th and 18th day after the period starts.

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