Assisted Reproductive Technology (ART) refers to any fertility treatments that involve handling eggs and embryos outside of the body. In vitro fertilization, or IVF, is the primary type of ART.
In Vitro Fertilization (IVF) is one of the most common and effective forms of fertility treatments used to enhance the likelihood of pregnancy. During IVF, a woman’s eggs and man’s sperm are combined in a laboratory to create an embryo. The embryo or embryos are then transferred to a woman’s uterus. During a traditional cycle of IVF, we usually transfer 1 to 2 embryos to the uterus to maximize the chance of conception while minimizing the likelihood of multiple births. Additional embryos are cryopreserved and stored for future cycles.
What is the process for IVF?
Medication and Monitoring
First, fertility drugs are administered to help stimulate the ovaries to produce multiple eggs in one menstrual cycle (instead of just one egg in a typical cycle). Typically, fertility drugs are taken over the course of 8-11 days. During this time, the treatment will include 5-7 brief visits (scheduled in the morning before work) to monitor progress and assess the response to the medication via blood testing and transvaginal ultrasounds. This testing information is used by the doctor to adjust the medication as well as possibly the timing for the egg retrieval. When the eggs are sufficiently mature, the final medication, the HGC or “trigger” is injected at a specific time, approximately 36 hours before the retrieval to initiate the final stage of maturation. Because the timing is very important, every patient’s treatment plan is individualized to ensure that the medication is effectively working in conjunction with the body’s response. Therefore, the time schedule noted above may vary patient by patient and it is important to follow the doctor’s instructions re: medications.
The Egg Retrieval Procedure
The eggs are retrieved from the ovaries via a brief surgical procedure, which is performed under an intravenous sedation medication (not general anesthesia) to ensure that you will feel no pain or discomfort. Using ultrasound guidance, the procedure itself involves gently inserting a needle (attached to a catheter) through the vaginal wall into the ovaries and removing the eggs via light suction. After the procedure, patients are monitored for 30-60 minutes in the recovery area as they awake from the anesthesia. Patients are then released to their post-procedure escort and are advised to relax for the rest of the day.
Embryology Laboratory Procedures
After the eggs are retrieved, they are transferred to the embryology lab, where dependent upon the planned treatment plan:
- The eggs may be either directly frozen (or cryopreserved) via a flash-freezing method known as vitrification. The frozen eggs are then stored in cryopreservation tanks, until a future date when the patient is ready to thaw them and have them inseminated to create embryos.
- Or inseminated with sperm to create embryos; the insemination occurs either by placing the sperm in the culture medium with the eggs or by direct insemination (ICSI). Over a six day span, the embryos are then incubated and monitored for signs of successful fertilization and growth.
The Embryo Transfer
In the second phase of a fresh IVF cycle, the patient returns between three and five days after their egg retrieval procedure for an embryo transfer or in the case of a freeze only cycle in a subsequent cycle. Utilizing ultrasound guidance, embryos are transferred transvaginally with a thin catheter into the uterus through the cervix. Typically, the procedure is not painful and anesthesia is not used. Following the transfer procedure, patients rest for up to 30 minutes in the recovery room.
Embryo Transfers and e-SET
Assisted Reproductive Technology (ART) has revolutionized the treatment of infertility and given millions of couples who had difficulty conceiving the chance to build a family. However, it has also introduced a significant increase in the number of “multiple pregnancies” including twins and higher order multiple pregnancies (triplets, quadruplets and even more). There is overwhelming evidence that multiple pregnancies represent a major threat to the health of the mother and the growing babies. The rate of babies born prematurely is much higher for multiple pregnancies. Additionally, most complications of pregnancy, such as pre-eclampsia, pre-term labor and gestational diabetes are more common in multiple pregnancies as compared to singletons. Because of these increased risks to the mother and the infants, doctors try to prevent multiple pregnancies as much as possible. Improvements in assisted reproductive technology have improved implantation rates which have increased pregnancy outcome results and thereby allowed overall lowering of the number of transferred embryos while still maintaining good pregnancy outcomes. Although our goal is a singleton pregnancy, our approach is to develop an individualized transfer recommendation for each patient based on multiple factors including: patient’s age, embryo quality, previous IVF success or failure as well as the developmental level of the embryo (whether the embryo is at the cleavage stage – day 3 or is at the blastocyst stage – day 5). This guidance is shared in consultation with the patient to help in this decision. We follow the ASRM (The American Society for Reproductive Medicine and SART (The Society for Assisted Reproductive Technology) guidelines for the number of embryos to be transferred in an IVF cycle.
The pregnancy blood test is scheduled approximately 12 to 14 days after the transfer. This period of time known as the “the two-week wait” is a very stressful period. We understand that this period can feel like an eternity and we are ready with tips and counseling that can help our patients get through this difficult period.
Freeze Only Cycles
For many patients, especially those with a hyperstimulated response to the IVF medications, it is recommended that all created healthy embryos be cryopreserved prior to embryo transfer. For these patients the unstimulated endometrium is more suitable for implantation and the risk of hyperstimulation syndrome is significantly reduced. Patients undergoing PGS (Preimplantation Genetic Screening or PGD (Preimplantation Genetic Diagnosis) will also need to do a freeze only cycle since the preimplantation genetic testing results will not be available in time to do an embryo transfer during the IVF stimulation cycle.
Frozen Embryo Transfer (FET) Cycles
Patients with cryopreserved embryos need not go through an IVF stimulation during their FET cycle. Patients are monitored either during their natural cycle or during a hormone replacement cycle utilizing estrogen pills (Estrace) and progesterone. Both are equally effective.
As part of our IVF treatment, Long Island IVF also performs the following advanced laboratory services:
Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic sperm injection (ICSI) is a procedure in which a single sperm is injected into the egg, resulting in a significantly higher likelihood of fertilization especially when it is suspected that fertilization may be an issue. This process is used in conjunction with IVF.
Prior to the transfer of the embryo to the uterus, utilizing a laser, a small opening is microscopically created in the shell surrounding the embryo. When indicated (often age related), this procedure increases the likelihood that the embryo will implant into the wall of the uterus, resulting in a successful pregnancy.
Cryopreservation, or freezing of embryos (or eggs), allows excess embryos or unfertilized eggs to be stored for later use. At Long Island IVF, our success with frozen embryo transfers is equivalent to that of fresh embryo transfers.