In-Vitro Fertilization

In-vitro fertilization (IVF) is a method of fertility treatment in which the sperm and the egg (oocyte) are combined in a dish in the laboratory for fertilization to occur. Embryos develop in an incubator for several days. Your physician can transfer a resulting embryo to the uterus to develop naturally, while extra embryos are frozen and stored in the lab for future pregnancy attempts.

In a normal menstrual cycle, just one egg each month develops and matures. The egg matures within a fluid-filled structure on the ovary called a “follicle.” Once mature, the egg is released and travels down the Fallopian tube. Sperm travel from the vagina into the uterus and then up into the Fallopian tube, where fertilization occurs. The fertilized egg develops into an embryo. The growing embryo travels down the Fallopian tube into the uterus, where it implants approximately 5-6 days later.

IVF bypasses the Fallopian tubes, and accordingly, patients with damaged or absent Fallopian tubes can become pregnant. IVF is used to overcome endometriosis, male factor infertility, ovulatory dysfunction, advanced maternal age, and unexplained infertility.

Adore Fertility offers a variety of modifications to the standard IVF process to help patients with specific disorders and customize treatment plans. We provide intracytoplasmic sperm injection (ICSI) for couples with male factor infertility, preimplantation genetic testing for aneuploidy (PGT-A) for patients who want to screen their embryos for chromosomal abnormalities, preimplantation genetic testing for a monogenic disease (PGT-M) for couples with a single gene disorder, and assisted hatching of embryos for patients.

The IVF cycle includes five basic phases.

In IVF, Step 1 begins with controlled ovarian stimulation. Fertility medications stimulate the ovaries to develop multiple follicles, each of which contains an egg, rather than just one in a natural cycle. Most fertility medications that stimulate the ovaries include injectables called gonadotropins. Some fertility medications contain only FSH, whereas others include both FSH and LH. Typically, the follicles reach optimal size after ten days of taking the injectable medication(s). When most follicles have reached a mature size, another medication, human chorionic gonadotropin (hCG) or Lupron, will be given by injection to trigger the final maturation of eggs. The egg retrieval procedure is scheduled 36 hours after the trigger shot and before the eggs are ovulated.

Step 2 is the ultrasound-guided transvaginal oocyte retrieval (TVOR) and takes around 15 minutes. You will be anesthetized while eggs are harvested from your ovaries.

Step 3 is the insemination of your eggs and occurs on the same day as your TVOR. Your partner will collect a semen sample, which will be analyzed and washed in preparation for insemination. Frozen donor sperm or partner’s sperm can be thawed and prepared for insemination, also. Several hours after the eggs are retrieved and placed in a culture medium, the sperm are added (standard insemination)or injected with sperm via ICSI (intracytoplasmic sperm injection). Next, the eggs are cultured in a lab incubator overnight in precise temperatures to mimic the conditions in the human body.

Step 4 is embryo development. This begins on day 1, the day after your egg retrieval and insemination of the eggs. On the morning of day 1, an embryologist will check for fertilization. The embryologist will see two pronuclei (2pn) in a fertilized egg, which is now called a zygote. You will receive a call on the morning of day 1 to tell you how many mature eggs are fertilized. On day 2 of culture, the 2pn embryos will divide or cleave into 2-4 cell embryos. On day 3 of culture, many of the embryos will divide into the 6-8 cell stage. By day 5 of culture, some of the embryos will develop to the blastocyst stage. A blastocyst embryo is comprised of hundreds of cells that have differentiated into an inner cell mass, which develops into the baby, and a trophectoderm, which develops into the placenta. A blastocyst can be transferred to the uterus on day 5 to attempt pregnancy, while the extra good-quality blastocysts are frozen for future attempts at pregnancy. Slower growing embryos may develop to blastocysts on day 6 or even day 7 of culture. Day 6 and day 7 blastocysts cannot be transferred to the uterus during your fresh cycle, but they can be frozen for future frozen embryo transfer (FET) procedures.

Blastocysts can also be biopsied at Adore Fertility for preimplantation genetic testing (PGT) to determine if they are chromosomally normal. The biopsied cells are transported to a genetics lab for testing, while the blastocyst/s are frozen and stored at Adore Fertility. It takes approximately 2 weeks for the genetics lab to release the PGT report to your doctor. In a future FET cycle, a chromosomally normal embryo can be thawed and transferred to your uterus.

Step 5 is the embryo transfer procedure. An embryo transfer can occur at the following times:

• On day 3 of your fresh cycle.
• On day 5 of your fresh cycle when the best-quality embryos have developed into blastocysts.
• On day 5 of a frozen embryo transfer cycle (FET). In a FET cycle, typically one blastocyst is thawed for transfer into the uterus to attempt pregnancy.

You will remain on hormones throughout the first trimester to support your uterine lining, called the endometrium.

Many fertility centers are moving to “Freeze All” cycles and FET cycles only. Some studies have suggested slightly higher pregnancy rates in the FET cycle. The reason why FET cycles may result in higher pregnancy rates is that during the FET cycle, the uterus is not exposed to the ovarian stimulation medications and supraphysiologic estrogen levels common in a fresh cycle. Thus, by freezing all good-quality embryos and allowing your body to recover, you can return for a FET cycle that allows a more natural environment for the transferred embryo to implant.

With a FET cycle, you do not undergo multiple injections of gonadotropins as you did during your fresh cycle. Instead, estrogens are prescribed to prepare your uterus. After 5-6 days of progesterone (injectable and/or vaginal), you then come in for your frozen embryo transfer procedure. Before your scheduled procedure, your embryo is thawed by an embryologist in the laboratory. Next, the embryologist loads your embryo into the tip of a soft, flexible catheter that is attached to a syringe. The loaded catheter is handed to your doctor, who slowly passes the tip of the catheter into your uterus through the cervix under ultrasound guidance. Then the embryo is carefully released into your uterus as your doctor gently presses the plunger. The embryo transfer procedure takes approximately 10 minutes, and no anesthesia is usually necessary.