In-Vitro Fertilization

Fertility Clinic Vancouver

Couples who become candidates for in vitro fertilization (IVF) often do so if all other treatments, such as IUI have failed. However, sometimes a precondition such as tubal disease, advanced age, or severe male factor infertility makes IVF treatment the only option available.

In vitro fertilization literally means "fertilization in glass" or outside the body in a Petri dish.

 

 

The IVF cycle happens in six distinct stages:

  1. Ovarian suppression
    First, the woman takes oral contraceptive pills and GnRH agonists or antagonists to prevent ovulation and to maximize the number of eggs available at the time of retrieval.
  2. Ovarian stimulation
    The ovaries are stimulated using follicle stimulating hormone (FSH), which encourages the recruitment and development of numerous follicles, each of which contains an egg. Most patients continue to receive GnRH agonists or antagonists during the stimulation phase to prevent a premature luteinizing hormone (LH) surge, which could cause ovulation prior to egg retrieval.
  3. Final follicular (egg) maturation
    The follicles are matured using an injection of hCG, a medication that mimics the LH hormone present during normal menstrual cycles. Timing of this medication is determined by follicle size and estrogen levels.
  4. Egg retrieval, fertilization, and embryo culture
    The eggs are retrieved 34-36 hours after the hCG injection using a needle that is passed through the ultrasound probe and into the ovary, where the eggs are aspirated from the follicles.The eggs are combined with the sperm in a Petri dish and fertilization allowed to occur.
  5. Embryo transfer
    Once the physician and embryologist judge that the embryos are ready for transfer, they are placed within the uterus using a small catheter. The patient must restrict her activity for the next 24 hours, after which she should minimize strenuous activities. Surplus embryos may be cryopreserved (frozen) for future embryo transfers.
  6. Progesterone supplementation and pregnancy test
    Progesterone supplementation starts the day following egg retrieval to support the developing pregnancy. Two weeks after egg retrieval, the patient takes a pregnancy test. If it is positive, the patient must continue progesterone supplementation until instructed otherwise. An ultrasound is performed two to three weeks later (six to seven weeks gestational age) to assess the health of the pregnancy.

In Vitro Fertilization (IVF) FAQ

Does IVF always result in multiple births?

No. In fact, IVF rarely results in high order multiple births because the number of embryos placed into the uterus is controlled. For example, if three embryos are transferred, it is unlikely that all three will implant and develop; however, it is possible.

The more embryos transferred, the greater the chance of multiple births.

What’s involved in IVF?

IVF is a complex procedure. That is why prior to undergoing IVF treatment, PCRM patients have an IVF orientation with their physician who will fully explain the IVF process, including pre-IVF investigations and processes. All IVF patients will receive instructions on the proper timing and administration of the fertility medications involved in the IVF treatment cycle.

What is the history and success of IVF?

The first successful IVF pregnancy in the world occurred in England in 1978 by Doctors Steptoe and Edwards. Now, almost thirty years later, IVF is accepted as a standard treatment and in many cases as a first-line treatment for infertility, resulting in the birth of more than one million babies worldwide.

How many patients require IVF?

Estimates vary, but only approximately 15 to 20% of patients will eventually require IVF.

How do the eggs get fertilized in the Petri dish?

The eggs are "inseminated" in one of two ways:

  • by conventional IVF, where the eggs are mixed with several thousand sperm;
  • by intracytoplasmic sperm injection (ICSI), where a single sperm is injected into the egg.

In both methods, fertilization is assessed the following day.

The eggs and embryos are kept in an incubator that strictly controls temperature and gases for four to seven days. The environment of the Embryology Laboratory at PCRM has been specially designed to limit pollutants. We also pay meticulous attention to stringent laboratory standards and embryo culture techniques to maximize embryo development.

Embryos can be left in culture until they reach the most advanced preimplantation stage, called the blastocyst. These should represent the healthiest of embryos and have the highest chance of implanting and developing. Not all patients are candidates for blastocyst transfer.

What are the advantages of IVF?

IVF allows the embryologist to directly view and document fertilization outside the body and observe development of the embryo under the microscope throughout the culture process. Unfortunately, our ability to pick embryos is still limited, so even the healthiest looking embryos may fail to develop after placement in the uterus.

There is a direct relationship between age and infertility in women, whereas men remain fertile for all of their adult lives. A woman’s decline in fertility is particularly rapid during her late thirties and early forties. Since many women are waiting until later in life to have children, the incidence of age-related infertility is increasing.

Are there tests available to determine if the embryo has a genetic disease before transferring it?

Yes. Preimplantation genetic diagnosis (PGD) is a breakthrough procedure that makes it possible to screen embryos for some genetic diseases prior to their placement in the uterus. PGD cannot guarantee a normal child but is a reliable tool used to minimize the most commonly-encountered genetic complications of pregnancy.

After the egg is fertilized and cultured, one to two cells are removed from the embryo and sent for a biopsy, which appears to be a safe process for the embryo.

The biopsy examination can identify:

  1. the sex of the embryo and sex-linked diseases like hemophilia;
  2. the number of chromosomes present (an abnormal number of chromosomes is associated with miscarriage and specific clinical syndromes like Down’s Syndrome); and
  3. certain known genetic diseases such as cystic fibrosis and polycystic kidney disease.

Transfer of embryos of a specific gender for non-medical reasons is prohibited by law in Canada.

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