IVF - In Vitro
How In Vitro Fertilization is Done
When a woman, or couple, and the
Fertility Specialist determine that in vitro fertilization is the
treatment of choice, there are several steps that must be taken to
promote the greatest chance of success.
The primary steps in in vitro fertilization include:
1. Counseling - you will discuss the IVF process, risks and
benefits, and outcome goals. Treatment consents will be signed,
which may include consents for IVF and embryo transfer,
micro-insemination, cryopreservation of resultant embryos and
2. Semen analysis - semen samples will be analyzed for: volume and
consistently, sperm count, motility, structure and survivability
3. Testing - including ultrasound and hormone levels to establish
baseline uterine and hormonal status, for the syncing of your IVF
4. Fertility drugs - hormones will be provided to the woman, to
stimulate egg production, including superovulation, where the
ovaries produce more than one egg during a cycle. A greater number
of eggs increases the chances for a successful IVF. Drugs will be
added at different times during the IVF cycle, to prepare the uterus
for implantation, promote egg and follicle development, and aid in
egg retrieval or harvesting.
5. Egg Retrieval - eat or drink nothing 8 hours prior to your
retrieval. Ultrasound is used to guide the needle as it enters the
ovary for harvest, through the vaginal wall.
6. Fertilization - concentrated sperm is introduced to your eggs, in
a petri dish or test tube
7. Transfer - with the use of a speculum, the procedure is similar
to a Pap smear. An ultrasound guides placement of the embryos inside
The steps related
to IVF are fairly consistent, regardless of the Fertility Clinic
that you use, due to the sequential nature of the human body in
terms of fertility. Following the guidelines and instructions of
your Fertility Specialist, will help to promote positive outcomes
Ethical and Moral Issues Related to In
The use of assistive reproductive technologies is more than just a
question of medical treatment and conception. There are also ethical
and moral dilemmas that can be a part of this process, which can
include, but are not limited to:
Fate of any
stored embryos should a couple divorce - is the embryo property
or a person. Who can claim the embryo or determine if it is to
be destroyed or kept in frozen stasis?
Rights of the
sperm or egg donor - some States laws include that donors have
no parental rights, however this is not as clearly delineated in
residual embryos - are we, in fact, murdering children? Some
religious beliefs feel that we are taking the life of a child,
rather than a potential being.
reduction in the event of multiple successful implants -
selective abortion of a fetus or more than one fetus, to promote
a more successful outcome for the remaining fetuses, is viewed
the same as the destruction of residual embryos. Some believe
that a child begins at conception rather than at birth.
morality regarding the use of assistive reproductive
technologies (ART)- the Catholic tenets specifically restrict
the use of ART such as IVF. The Donum Vitae states that
intrusion of someone other than a man and his spouse in the
making of a child is immoral, which rules out donor sperm and
eggs, and fertility treatments to promote conception.
physical aspects of the in vitro fertilization, there are also
the social and moral aspects that some feel must be considered
when making the determination to create a child using a test
Role of In Vitro Fertilization in
There are many causes of infertility, including hormonal problems,
structural or mechanical issues and medical conditions. There are
also many different treatments available, to address the specific
causes of infertility, such as hormone treatments or surgical
correction of structural anomalies.
In vitro fertilization - IVF - is one type of infertility treatment,
however it is not a first line treatment. Your Fertility Specialist
will try other less invasive and less expensive options before
choosing IVF, since many causes of infertility can be overcome with
other treatment options.
IVF is best used for those situations in which a woman is trying to
conceive and intrauterine insemination is not possible or effective,
or in which donation of eggs or sperm is necessary to complete the
process due to either male or female fertility problems within a
Risks and Complications of In Vitro
As with any medical treatment or
procedure, there are potential risks and complications. This is true
for in vitro fertilization, which has its own special risks that can
Side Effects - injectable medications may cause soreness,
injection site infection, swelling or localized allergic
reaction. Oral medication can contribute to weight gain, nausea,
bloating, mood swings, breast tenderness and headache.
Hyper-stimulation Syndrome - a reaction related to excessive
elevation of estrogen levels and the hormone given to ripen the
eggs for harvest, resulting in: fluid in the abdominal cavity,
blood clots in the large blood vessels, swelling of the ovaries,
which have a risk of rupturing or twisting.
Risks - since anesthesia, general IV sedation and a needle are
used for retrieval, anesthetic reaction, infection at the needle
insertion site, bleeding, damage to adjacent internal organs and
scarring are risks of the procedure.
Collection and Preparation Effects - this is a stressful time
for the man, who may have erectile difficulties or even changes
in sperm count in response to stress.
Side Effects - after embryo implantation, the woman may
experience vaginal dryness, PMS symptoms such as bloating and
tender breasts, depression or mood changes, which can be a
result of the hormones administered to prepare the ovaries and
uterus for the fertilization process.
Symptoms - infertility is stressful in itself. Add to this, the
stresses related to chemicals, physical evaluations and
treatments, and anxiety or depression may result, in addition to
sleep abnormalities, tensions within the relationship and
potential risks and complications involved with IVF will help
you better prepare for the process and the potential side
The process of In Vitro Fertilization
was initially brought to fame by the creation of the world's first
"test tube baby" - a breakthrough in assistive reproductive
technology, also called ART, that has helped many people achieve
pregnancy and childbirth, when other fertility treatment options
The IVF was first pioneered by Embryologist, Dr. Edwards, and
Gynecologist, Dr. Steptoe, in England in 1978, to help couples who
were unable to have children, by natural conception, due to
fertility problems that could not be overcome with traditional
The term "in vitro"
means, "outside the living body," and was initially referred to as
in vitro fertilization - pre-embryonic transfer, or IVF-ET, to refer
to the stage of cell development at the time of the implantation
into the woman's uterus.
Alternatives to In Vitro Fertilization
Since IVF is not the first line treatment for infertility, there are
other available options. Some of these options include:
therapy - sometimes it is a hormonal imbalance that is
preventing conception, and correction of this imbalance can
result in successful pregnancy
intervention - if structural problems, such as blocked fallopian
tubes or blockage of sperm ducts, are contributing to
infertility, repair of these reproductive parts can successfully
external causes - if acquired infection, radiation treatment for
cancer or other externally generated cause of infertility is
present, correction of these causes can aid in correcting
medical conditions - cysts on the ovaries or testes, diabetes,
pituitary tumor or other medical conditions can contribute to
infertility and, when corrected, the result is a successful
pregnancy and delivery
therapy - if emotional factors are contributing to infertility,
such as fear of failure, depression or anxiety resulting in
erectile dysfunction or painful intercourse, counselling or
other psychotherapy can help to relieve these symptoms, and
promote sexual function and fertility
reproductive technologies - intrauterine or intrafallopian
insemination involve placement of sperm directly into the uterus
or fallopian tubes during ovulation.
There are a
multitude of causes of infertility and a corresponding number of
treatment options, many of which are readily available,
inexpensive and effective.
In order for in vitro fertilization to
be successful, assistance must be provided in the form of fertility
drugs. These drugs are designed to stimulate and emulate hormones
which normally regulate reproductive activities, to control the
reproductive cycle and promote success with IVF. The primary drugs
used in IVF include
Releasing Hormone (GnRH) Agonists Antagonists Gonadotropinsh
CGSolu - Medrol Doxy cycline Progesterone
Progesterone is taken daily
beginning two days after egg retrieval to support the embryo in
the uterus until the placenta is able to make enough
progesterone. This takes about 2 months.
Doxycycline is given to the male
partner during the woman's stimulation cycle to reduce bacteria
that may be present in the sperm.
Medrol is a steroid hormone given
daily, for up to four days, to assist pre-embryo implantation in
the uterine wall, following embryo transfer.
Pregnyl, Profasi or Novarel is
taken to help maturate the eggs and prepare them for retrieval.
Gonal F, Bravelle, Follistim, Pergonal and Repronex are the most
commonly used gonadotropins and they stimulate the egg follicle
to ripen during inadequate follicular development.