INVITRO Fertilization

        In vitro fertilization (IVF) and other "high tech" procedures are now referred to as the assisted reproductive technologies (ART). These procedures all involve collecting the oocytes (eggs) and placing them in direct contact with sperm. Together they form an alphabet soup of techniques including: IVF, GIFT, ZIFT, ICSI, and FET.

        In its simplest term, IVF is simply the uniting of egg and sperm in vitro (in the lab). Subsequently the embryos are transferred into the uterus through the cervix and pregnancy is allowed to begin. IVF was the first of the ART techniques to be developed. The first birth was in 1978 in England. The procedure was pioneered by a Gynecologist and a Ph.D. (Drs. Steptoe and Edwards). Next came GIFT, which stands for gamete (egg and sperm) intrafallopian transfer. This procedure requires laparoscopy, which is a small incision surgery and requires a general anesthetic. With existing technology, pregnancy rates are similar with IVF and GIFT. Since IVF does not require surgery, it has supplanted GIFT.

        ZIFT involves IVF and then a laparoscopic surgical procedure to transfer the embryos into the fallopian tube. Since transferring embryos through the cervix with IVF gives the same pregnancy rate as ZIFT, and is nonsurgical, IVF has also supplanted GIFT.

        As the years have passed, IVF has become the dominant ART technology due to its simplicity, efficacy and lack of invasiveness. A typical IVF cycle begins with shutting down the ovaries. This is done with a medication known as a GnRH agonist. The most common drug such used is Lupron. Lupron is given for approximately two weeks after which the ovaries are shut down temporarily. The next phase involves stimulation of the ovaries with potent ovulation medications such as Pergonal. For a full description of these agents go to the page on ovulation medication. These injections are given for approximately 10 days. When the eggs are ready for harvesting, a final step is to give hCG to induce final maturation. The eggs are then harvested by a process called ultrasound guided vaginal retrieval. Under heavy sedation, and with ultrasound guidance, a thin needle is passed a short distance into the ovaries and the eggs are suctioned from the follicles. Typically 5-15 eggs are collected. Typically the eggs are fertilized by adding approximately 100,000 motile sperm to each egg. If the sperm will not fertilize the eggs naturally we can perform intracytoplasmic sperm injection (ICSI). This procedure involves puncturing the egg directly under a microscope and injecting one sperm in the egg.

       The day following retrieval, we can document fertilization under the microscope. We then observe the embryos for 3-6 days. The current trend is to observe longer. Typically 3-4 embryos are then placed in a catheter and transferred through the cervix into the uterus. This is a simple procedure much like a Pap smear. At the present time, embryos can be transferred either 3 or six days following retrieval. A 3-day embryo is usually at the 6-8-cell stage.

       Two weeks later a pregnancy test can be obtained. Two weeks after the pregnancy test, an ultrasound can be performed and the fetal hear beat can be seen. If more embryos were generated than can be replaced, freezing (cryopreservation) can save these additional embryos. Frozen embryos can be stored for future replacement at much lower cost than the original IVF cycle.

        As the years have passed, IVF has improved greatly. Today it is arguably the most effective technique to treat infertility when compared with others on a month by month basis. IVF has created a lot of controversy also. First, it is expensive. An IVF cycle can cost $6,000 to $7,000. It may not work on the first cycle. Multiple pregnancies can result. The truth is that it is a powerful technology and must be used carefully. Some patients may have very high odds of success: 45 - 60% chance per attempt. Others may due to their situation have only a 20% chance of success.

       The multiple pregnancy risk varies with age. Younger patients need fewer embryos to be replaced, and older patients need more. The worst thing that has happened with IVF is the various centers entering into a race to see who can get "the best statistics". This has encouraged centers to transfer high numbers of embryos to get the statistics while accepting too high a risk of multiple pregnancy.

Also in order to get the best statistics, some patients will be refused care in order to "protect the statistics".

f) cells, trigger a local or widespread inflammatory response, and retain the memory of the offending organism to repel it again if it should ever return. Like any finely-tuned machine, however, the system can break down and leave us open to the threat of infection, or, conversely, turn against our own healthy tissues, as occurs in such diseases as rheumatoid arthritis or lupus.

The immune system also plays an important role in human reproduction. Inflammatory cells and their secretory products are involved in the processes of ovulation and preparation of the endometrium for implantation of a fertilized egg. Dysfunction of the immune system can interfere with the normal reproductive processes and result in infertility. It has been estimated that an immune factor may be involved in up to 20% of couples with otherwise unexplained infertility. Although many of these associations with infertility remain unproven, there is solid scientific evidence to implicate the formation of antibodies against sperm as an important infertility factor.