In vitro fertilization involves both the
female and the male partners. Eggs
are retrieved from the ovaries and are placed with the male partner’s
sperm in a petri dish in a laboratory, where fertilization occurs to
produce embryos. After the
embryos have matured for several days in the laboratory, they are placed
into the uterus for implantation and a pregnancy should result.
At the proper time in her cycle, the
female partner is given hormone medication that should produce multiple
eggs in each ovary. Egg production is monitored by a series of
vaginal ultrasounds and blood tests. When the eggs are ready, the
patient is sedated in the office, and the eggs are retrieved using an
ultrasound guided needle through the vagina. The needle is
advanced into the ovarian follicle and the eggs are aspirated into a
test tube for transport to the lab. After the retrieval procedure, the
patient spends a short time recovering and can then go home.
Limited activity is recommended for a time.
Just prior to egg retrieval, the male
partner’s sperm is obtained and processed. A suspension of the
best population of sperm is added to the eggs for fertilization.
If the quality of the sperm is very poor, ICSI (intracytoplasmic sperm
injection) can be performed. When ICSI is used, a single sperm is
captured in a needle-like pipet and is then injected directly into the
egg to facilitate fertilization.
The eggs and sperm are monitored
regularly to assess fertilization and the production of embryos.
Embryos are allowed to mature for several days until they reach the
blastocyst stage.
When the embryos are ready, 2 or 3 are
transferred into the uterus using a small catheter threaded through the
cervix. No sedation is required; the transfer takes approximately
10 minutes. After a short rest period, the patient can go home.
Again, limited activity is recommended for a time. Any remaining embryos
can be cryopreserved, or frozen, for possible use with another cycle.
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Intracytoplasmic
Sperm Injection:
ICSI (Intracytoplasmic Sperm
Injection)
is performed in the laboratory when the quality or concentration of the
sperm is very low and the possibility of fertilization of the eggs is
unlikely. When the eggs are retrieved, one sperm is captured in a
needle-like pipet. Using a microscope for viewing, the sperm is
then directly injected into the egg. ICSI can be used to treat
several sperm issues including low motility, low concentration,
antisperm antibodies, prior failure to fertilize in IVF ans use of frozen
sperm collected prior to cancer treatment. Although ICSI is very
successful, the process may damage some eggs.
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Embryo
Cryopreservation:
Often, an IVF cycle will result in more
embryos than can be used for that cycle. Extra embryos can be
cryopreserved, or frozen, in liquid nitrogen at an extremely low
temperature. They can then be saved for possible use in another
otherwise natural cycle, sparing the patient from undergoing ovulation
induction, egg retrieval, etc. Approximately 50% of frozen embryos
will survive the thawing process.
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Sperm
Cryopreservation:
Like embryos, sperm can also be
cryopreserved, or frozen, in liquid nitrogen at an extremely low
temperature where they can remain viable indefinitely. This can be
useful for patients with poor sperm quality who are undergoing IVF.
Several semen samples can be processed and added together to provide a
specimen with a larger population of higher quality sperm.
Patients undergoing cancer therapy or vasectomy may also choose sperm
cryopreservation prior to their treatments.
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PGD:
PGD (Preimplantation Genetic Diagnosis)
is a clinical diagnostic procedure used with IVF for testing human
embryos for the presence of genetic abnormalities (inherited diseases),
before transfer to the uterus and pregnancy. Only embryos that are shown
to be free of the genetic disorders are transferred to the uterus. PGD
is a major advance in treating infertility in couples who may have a
genetic disorder.
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Donor
Egg:
In some cases, disease or ovarian failure
(including menopause) may diminish the ability to produce a fertilizable
egg. Egg donation offers a realistic opportunity for pregnancy.
Egg donation involves retrieving eggs from one woman (the donor),
fertilizing them in the laboratory, and transferring the resulting
embryos into the uterus of the recipient, who will carry the baby to
term.
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Ovulation
Induction:
Occasionally, a woman’s body does not
produce mature eggs on its own during a monthly cycle. It may
be necessary to use medication to help stimulate the maturation of one
or more eggs. This is referred to as ovulation induction.
Ovulation induction may be achieved by taking pills for several days
during a cycle or may require alternate medication in the form of
injections.
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Intrauterine
Insemination
Intrauterine Insemination is an office
procedure where washed sperm are delivered directly into the uterus
using a small catheter that is passed through the cervix. The
procedure is relatively quick with very minimal discomfort. The
cervical mucus, which can sometimes be hostile to the sperm, is
completely bypassed. All of the sperm in the ejaculation are
placed in the uterus as compared to the 1% (approximately) that make it
during natural intercourse.
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Success in achieving a pregnancy depends
on the quality of both the female egg and the male sperm. In some cases,
treatment for male factor infertility is unsuccessful. Donor sperm from
an approved sperm bank may be used in conjunction with intrauterine
insemination (IUI). The sperm bank provides profiles on various proven
sperm donors and a donor can be selected based upon his genetic and
physical factors.
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