Infertility Treatments > ART > IVF

In Vitro Fertilization (IVF)

Jarrett Fertility Group

Dr. Jarrett established the ART program at Midwest Reproductive Medicine in 1985,and in 2005 left to form Jarrett Fertility Group. We offer comprehensive treatment modalities for impaired fertility including IVF, micromanipulation such as ICSI (Intra-Cytoplasmic Sperm Injection), assisted embryo hatching, and embryo cryopreservation. Dr. Jarrett is a charter member of the Society for Assisted Reproductive Technology and a charter participant in the National IVF Registry, and a Board Certified Reproductive Endocrinologist. Dr. Richard Rawlins, PhD. also joined JFG in 2005. Dr. Rawlins is from Chicago and is an internationally renowned expert in IVF.

Day 3 vs Day 5 Embryo Transfer

We currently perfom almost exclusively Day 3 transfers. The rationale for this is as follows:

The primary motivation for doing Day 5 transfers was that it would enhance our ability to select the very best embryos for transfer and thereby reduce the multiple pregnancy rate. In the course of doing blastocyst transfers (day 5) we learned a lot about what embryos on day 2 or day 3 had the greatest chance of progressing to a good blastocyst on day 5. We learned what criteria, including appearance and progression rate, were most reliable and became very proficient at predicting which embryos would become good blastocysts. Therefore, much of the advantage of day 5 transfer was eliminated. There are also drawbacks to blastocyst transfer, one of those being the significant number of embryos that are lost and do not progress to day 5. The second disadvantage, and this at this point must be considered a theoretical one, is the risk of gene imprinting disorders such as Beckwith-Weideman Syndrome. There is some evidence from animal studies that these disorders occur in relation the culture media used for IVF, For these reasons, we at this point in time, feel that we can achieve results on Day 3 that are every bit as good as those on Day 5, and we minimize the length of time embryos are maintained in culture. As good as our current culture approaches are, the uterus is still better.

Single Embryo Transfer

One of the biggest concerns about IVF is the risk of multiple pregnancy. We are very conservative in the number of embryos transferred (rarely more than two). This however, still carries with it the risk of twins. While the majority of couples do well during pregnancy with twins, there are increased risks associated with a twin pregnancy. For this reason, and occasionally for other indications, establishment of a singleton pregnancy is a matter of significant priority. We do therefore offer single embryo transfer (SET). With adherence to our established guidelines and protocols, and with embryo cryopreservation as an integral part of this procedure, success rates with SET are virtually the same as with transfer of more than one embryo.

Introduction

IVF is a method of assisted reproduction in which the man's sperm and the woman's egg are combined in the laboratory. Following fertilization and early embryo development in the laboratory, an appropriate number of embryos are transferred to the woman's uterus.

Natural conception begins with the release of a single ovum (egg) from the woman's ovaries. The fallopian tube picks up the egg, and it is within the fallopian tube that the sperm will fertilize the egg. Following fertilization, the zygote, or early embryo, stays in the tube for about three days while it divides into more and more cells. The embryo is then transported to the uterus where it will "float" for another three days or so until it implants into the wall of the uterus.

IVF was originally designed for couples with absent or damaged fallopian tubes - the events normally occurring in the fallopian tubes, including fertilization and early embryo development, occur in the laboratory instead. Success with IVF has progressed to the point where it is now an alternative, if not the treatment of choice, for many couples with impaired fertility. IVF has revolutionized the approach to couples with impaired fertility.

The basic steps of IVF

1. Ovarian stimulation and egg development
   
   During the first half of a normal cycle, follicles (the fluid -filled sacs that contain the eggs) develop and a single egg is released. There is no question that the chances of success with IVF increase if there is more than one oocyte available for use in the ART laboratory. A combination of medications and hormones is, therefore, routinely utilized during the early part of an IVF cycle. The goal is the synchronous development of multiple follicles and eggs. The most commonly used combination is Lupron and FSH. (although other ovulation induction protocols are available. Your physician will determine the protocol most appropriate for you.) The Lupron suppresses the normal mechanism by which the ovaries are stimulated while the FSH provides direct stimulation to the ovaries.
   
   The response to the Lupron and FSH is monitored through a combination of blood tests and pelvic ultrasounds. Once this monitoring suggests that the eggs have reached maturity, hCG is given. The egg retrieval is scheduled 36 hours after hCG administration.
   
   
2. Egg Retrieval
   
   The eggs are removed from the ovaries with a needle that is inserted through the vagina. This procedure is performed using ultrasound guidance which allows precise placement of the needle into each follicle. Intravenous sedation makes this a painless procedure - general anesthesia is not required. The contents of each follicle are collected into a test tube and immediately transferred into the ART laboratory where the eggs are identified, isolated, evaluated, and placed into an incubator in less than two minutes.
3. The ART Laboratory
   
   The eggs, sperm, and embryos are handled under sterile conditions at all times. Once an egg is identified, it is placed into a special culture medium for two to six hours before it is inseminated. After the egg retrieval, the husband will be asked to obtain a sperm sample. The sperm are then isolated from the remainder of the ejaculate and added to the eggs to allow fertilization to occur. After 18 to 24 hours, the first signs of fertilization occur. The ART laboratory personnel will notify you at this time as to how many of the eggs successfully fertilized. The embryos are incubated in the laboratory for an additional 48 hours to 96 hours (72 to 120 hours total). By this time, they will have developed to between four cells and the blastocyst stage.
4. The embryo transfer
   
   Embryo transfer is essentially a painless procedure performed in a small room adjacent to the ART laboratory. An appropriate number of embryos (see below) are loaded into a small catheter. This catheter is then introduced through the cervix and into the uterus, and the embryos are gently deposited in the uterus. After you return home, we suggest very minimal activity for the first twenty-four to forty-eight hours. After that, you may resume normal activity.
5. After the transfer
   
   Progesterone, the hormone responsible for preparing the lining of the uterus to accept a pregnancy is often given for at least a couple of weeks following the transfer. Small additional doses of hCG may also be given - this stimulates the ovaries to produce additional progesterone.
   
   The first pregnancy test can be done as soon as twelve days after the embryo transfer. This test is almost always repeated after two days. If the tests are positive, we will continue to provide your care, including ultrasounds, for the next several weeks and then refer you back to your obstetrician. If the tests are negative, we will arrange a post-cycle consultation at which time the events of the cycle will be analyzed and plans made for the future. If unsuccessful, an attempt may be repeated in two to three months.

• the attempt may be cancelled prior to egg retrieval if an adequate ovarian response is not achieved,
• not all follicles contain an egg,
• not all eggs will fertilize,
• not all embryos will develop normally.
• even though everything goes well, the procedure still may be unsuccessful

© 2005 Jarrett Fertility Group