In Vitro Fertilization (IVF) Overview
The IVF program at Baystate Health is a full service IVF center serving patients in western Massachusetts and Connecticut. Our IVF clinic has participated in the birth of over 2,000 babies since the program started in 1990.
IVF or “in vitro fertilization” literally refers to “in glass” and “outside of the body”, which is where fertilization occurs in IVF. Fertilization takes place in a Petri dish as opposed to a test tube.
IVF success rates have increased dramatically over the past several years and many couples, who once had no hope of having children, can now realize their dreams.
When is IVF Considered?
Most patients become pregnant without requiring IVF. However, there are conditions where IVF is considered to offer the best chance for success:
- Tubal blockage or after tubal ligation (tied tubes).
- Severe Endometriosis.
- Moderate to severe male factor infertility.
- Failed therapies such as stimulated IUI, especially if the cause of infertility is unknown.
- Female age related infertility caused by poor quality or too few eggs.
Cancer chemotherapy and/or radiotherapy can destroy eggs. Fortunately, with the emergence of egg freezing, healthy eggs can often be removed prior to cancer treatments and frozen, thus preserving fertility. Once chemotherapy is completed, the eggs can be thawed and used in an IVF cycle.
IVF Procedure Explained
IVF-Ovulation Induction and Controlling Ovulation
IVF cycles require several steps. First, the ovaries must be stimulated to produce multiple eggs, which are needed for the IVF procedure. FSH is a natural hormone, produced by the pituitary gland, that is responsible for follicular (each follicle contains one egg) recruitment and egg development. In an IVF cycle, additional FSH (Gonal-F, Follistim, Repronex, etc.) is administered by injection to stimulate the development of many eggs, a process known as ovulation induction.
IVF ovulation induction cycles should only be performed by a Reproductive Endocrinologist/Infertility Specialist thoroughly familiar with the use of fertility drugs.
IVF patients receive Lupron, Ganirelix, or Cetrotide while undergoing ovulation induction. These drugs prevent ovulation by blocking the production of LH. A “surge” of LH is needed to finally prepare the eggs and initiate ovulation.
Since ovulation cannot occur while receiving these drugs, the infertility specialist can administer FSH until the eggs mature. It is very important that ovulation not occur prior to egg retrieval or the IVF cycle would be cancelled. When the infertility specialist judges the eggs mature, an injection of hCG is given and the egg retrieval is scheduled.
IVF Cycle Monitoring
Women undergoing IVF ovulation induction with injectable fertility drugs must be carefully monitored using ultrasound, estradiol measurements, and physical examination. This monitoring helps insure the safety of ovulation induction, provides information used for FSH dosage adjustments throughout the IVF cycle, and insures egg development is progressing. The number of times a woman must come to our office for monitoring is usually dependent upon how she responds to ovulation induction, but is typically about 4-5 times over 10-12 days.
IVF- Egg Retrieval
In an IVF cycle, the eggs are retrieved from the follicles using transvaginal- guided ultrasound while the patient is under light general anesthesia. A small “needle” is passed through the back of the vagina into the follicle and the egg is withdrawn. The withdrawn follicular fluid is passed to the reproductive biologists in the lab who find the eggs and places them into culture fluids.
Sperm are added to the eggs in a Petri dish and fertilization is allowed to occur. IVF sometimes requires the use of intracytoplasmic sperm injection (ICSI) when male infertility or other conditions are present that might interfere with fertilization.
In some cases, no sperm is available on the day of IVF retrieval either because of semen collection issues or unexpected absence of sperm in the semen sample.In these cases, egg freezing is an option for couples. This is the only situation in which egg freezing is being offered at Baystate’s IVF clinic at this time, although research studies are underway at Baystate to expand this option. Men can freeze sperm in advance if they anticipate being away at the time of egg retrieval or if they are concerned about difficulty collecting sperm on the day of retrieval.
IVF-Incubation of the Pre-Embryos
Once fertilized, the pre-embryos are placed in an IVF incubator, which is strictly controlled for environmental variables such a temperature, gases in the air, etc. The pre-embryos remain in the incubator until mature, usually three to five days.
Embryos that have differentiated into two distinct cell types (usually incubated 5 or more days) are known as blastocysts. Blastocysts are heartier than day 3 embryos and have a higher implantation rate meaning fewer have to be transferred to the uterus thus lowering the multiple birth rates. Blastocysts are transferred where possible but not all couples will have enough embryos for culturing to the blastocyst stage. (See “Blastocyst Transfer”)
IVF- Pre Embryo Transfer
The IVF patient usually comes to our office 3 to 5 days after the retrieval, depending on the number and quality of cleaved embryos on day 3,and the embryos are transferred into the uterus in a procedure usually taking less than 15 minutes. The transfer of embryos to the uterus is performed with ultrasound guidance, allowing the physician to carefully place the embryo(s) in an optimal area of the uterus.
IVF-Support of the Uterine Lining with Hormones
Starting on the day of the egg retrieval, the IVF patient takes supplemental estrogen and progesterone to support endometrial development. A pregnancy test is performed 14 days after egg retrieval.
IVF Using Donor Eggs
Donor egg IVF is an option when a woman has poor quality, or too few, eggs. Egg donors are young fertile women and IVF success rates are typically high, matching the age group of the donor. For example, if the eggs of a 22 year old are used in an IVF cycle with a 38 year old, the success rates equal the 22 year old group.
Our infertility specialists provide a complete overview of the donor egg IVF procedure for patients. Please see our “donor egg program” and “IVF Success Rates” pages.
IVF Success Rates (See “IVF Success Rates” for more detail)
IVF success rates are reported to the Society for Assisted Reproductive Technology (SART) by reputable IVF centers. SART lists the success rates of all IVF centers in the region.
Our IVF data shows high success rates in four age categories while adhering to the guidelines for numbers of embryos transferred. Fewer embryos transferred translates to a lower incidence of multiple births.