In Vitro Fertilization

Overview:

In Vitro Fertilization (IVF) is a series of procedures (Ultrasounds, Blood Work, etc.) used to assist with fertility or prevent genetic problems. During the IVF procedure, eggs are retrieved from ovaries and fertilized by the sperm in our lab. The fertilized egg (or eggs) are then transferred into the uterus. A full IVF cycle takes about three weeks to complete. The procedure can be done multiple different ways. Often times a woman uses her own eggs and her partners sperm, However egg donors and Sperm donors are also an option. In some cases a gestational carrier, a woman who has an embryo implanted in her uterus, might be used. The chances of having a healthy baby using IVF depends on many factors:

• Age of the patient

• Reason for Infertility

Often times more than one egg will be implanted into the uterus to increase the chances of conception. However, this also can result in a pregnancy with more than one fetus (multiple pregnancy).

Why it is Done:

IVF is a treatment for infertility or genetic problems. This procedure is often discussed after the couple has tried other methods of artificial insemination such as fertility drugs and Intrauterine Insemination (IUI). Although, for women over 40, IVF is the primary treatment offered to increase the chances of pregnancy. IVF can also be done if you have certain health conditions, for example IVF may be an option if a patient has:

• Fallopian Tube Damage or Blockage - This makes it difficult for an egg to be fertilized or an embryo to travel to the uterus.

• Ovulation Disorders - If ovulation is infrequent or absent, less eggs are available for fertilization

• Endometriosis - This occurs when the uterine tissue implants and grows outside the uterus effecting the function of the uterus, ovaries, and Fallopian tubes

• Uterine Fibroids - Fibroids are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. These tumors can reject the implantation of the fertilized egg.

• Previous tubal sterilization or removal - If you’ve had tubal ligation, a type of sterilization in which your Fallopian tubed are cut or blocked to permanently prevent pregnancy, and want to conceive, IVF can be an alternative to tubal ligation reversal.

• Impaired Sperm production or function - Below-average sperm concentration, poor mobility of sperm, or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg.

• Unexplained Infertility

• A genetic Disorder - If you or your partner is at risk of passing on a genetic disorder to your child, pre-implantation genetic screening might be for you. After the eggs are collected and fertilized, they are screened for genetic problems, although it is important to note that not all genetic problems can be found. Embryos that do not contain identified genetic problems can be implanted into the uterus.

• Fertility Preservation for cancer or other health conditions - common cancer treatments such as radiation and chemotherapy can hard your fertility. IVF for fertility preservation may be an option if you are starting these treatments. Women can have eggs collected and frozen in an unfertilized state for later use. Or the eggs can be fertilized and frozen as embyros for future use.

Egg Retrieval:

The egg retrieval will be done in our office 34 to 36 hours after the final injection and before ovulation. During the egg retrieval, you will be sedated and given pain medication. Transvaginal ultrasound aspirations is the usual retrieval method. An ultrasound probe is inserted into the vagina to identify follicles. Then a thin needle is carefully inserted through the vagina and into the follicles to retrieve the eggs. The eggs are then collected and removed.

After the egg retrieval, you may experience cramping and feelings of fullness or pressure, this is normal, if any other concerns appear after the procedure please give us a call at (716) 243-8377.

Mature eggs are then placed in a nutritive liquid and incubated. Eggs are examined and any that appear healthy and mature will be fertilized by the sperm to create embryos. However, not all eggs may be successfully fertilized.

Sperm Retrieval:

If you are using your partners sperm, he will provide a semen sample the morning of the retrieval. See “Semen Analysis” as the instructions are the same as far as the collection guidelines and pick-up / drop-off requirements. Donor sperm also can be used, in this case the sperm will already be in our lab and ready for use by the time of the procedure. The sperm is then separated from the semen fluid in the lab and prepared to fertilize the eggs.

Embryo Transfer:

After the eggs are fertilized in the lab, the embryo transfer is done. This procedure is done in out main office and usually takes place 2-5 days after the egg retrieval. The procedure itself is usually painless, although you might experience mild cramping. Our doctor will carefully insert a long, thin, flexible tube called a catheter into the vagina, through the cervix and into your uterus. A syringe containing one or more embryos is attached to the end of the catheter, using the syringe the doctor will place the embryo(s) into your uterus.

If this procedure is successful, an embryo will implant in the lining of your uterus about 6 to 10 days after the egg retrieval.

After the Transfer:

After the transfer we recommend you have a family member or friend drive you home, this is only because of the possible drowsiness you experience after the anesthesia. You may resume normal daily activities after this procedure as long as you avoid vigorous activities in hopes to avoid discomfort.

Typical side effects include:

• Passing a small amount of clear or bloody fluid after the procedure. This is due to the swabbing of the cervix before the embryo transfer

• Breast tenderness due to high estrogen levels

• Constipation

• Mild bloating

• Mild cramping

If severe pain develops after the transfer, contact our office. We will evaluate you in order to catch or prevent infection, twisting of an ovary, and severe ovarian hyper-stimulation syndrome.

Results:

About 2 weeks after the retrieval, we will set you up for Blood Work to detect whether you are pregnant or not. If you are pregnant we will do a couple follow-up ultrasounds to ensure correct placement of the growing fetus in the uterus and make sure everything is OK before sending you to your OBGYN. If you are not pregnant, you will stop taking progesterone and likely get your period in a week. If you are interested in attempting another cycle of IVF, we will set up a consultation with you and Dr. Dipaola to discuss next steps in order to improve your chances of conception.